Why Petitioners Insist Gov. Corbett Should Accept Medicaid Expansion in Pennsylvania
It’s a new year with bright possibilities and chances to make something good of yourself — you know, all that stuff you believed until the reality of life set in, around age 9. One thing, at least, we can be certain of: In 2013, Gov. Tom Corbett will make a decision regarding Pennsylvania’s participation in the Patient Protection and Affordable Care Act. Will he or will he not accept the Medicaid expansion?
While much of the health-care reform law (frequently dubbed “Obamacare”) is scheduled to go into effect nationwide in 2014, a Supreme Court ruling last summer left the Medicaid question up to the discretion of individual states. The expansion would open up eligibility for the government health-care program to those who make as “much” as 133 percent of the federal poverty line. For an individual, that translates to an income of $15,302 per year, and, for a family of four, $31,155 — obviously, not enough to live on in any kind of comfort, let alone without being able to see a doctor. According to estimates, about half a million Pennsylvanians currently ineligible for Medicaid would thus become eligible if the expansion is accepted.
For Gov. Corbett, it’s a tough call. On the one hand, not accepting the infusion of cash, which the federal government would pay over the next nine years, could kill a number of state hospitals and leave impoverished families out to dry. On the other, Corbett has spoken against health-care reform since it passed Congress and was signed by President Obama.
The Pennsylvania Health Access Network, a coalition of organizations dedicated to expanded health-care access, is trying to help him make that decision. They’ve created a petition that asks the governor to take the deal from the federal government — calling it a “win for Pennsylvania” for both social and fiscal reasons.
Corbett has given little hint as to whether or not he will take the deal. He has already opted not to create a state exchange system to work with the federal government, choosing instead to let Pennsylvania citizens get health insurance through the federal exchange, which, although praised by conservatives throughout the commonwealth, is actually good for those who’d like to see the law work.
According to the Medicaid expansion’s rules, the federal government will fully pay for the first three years of the expansion as the state gains its bearings, after which the state would start kicking in 10 percent of the cost. Many conservatives say they’re worried that health-care costs will rise in that time, and paying just 10 percent may be too heavy a burden for states to carry. (The federal government currently pays only 54 percent of Medicaid expenses, but that’s under the current eligibility rules whereby only those at the poverty level — about $10,000 a year income — qualify.)
Last month, 48 state House Republicans sent a letter to the governor asking him to opt out. Pennsylvania Senator Pat Toomey has previously spoken out against the Medicaid expansion as well. “The Supreme Court has ruled significant parts of the Medicaid expansion of the President’s health care law unconstitutional as well as ruling that the individual mandate violated the Commerce Clause and will therefore be implemented as a punitive tax on the middle class,” states a letter Toomey and others signed last year.
And now state Rep. Stan Saylor (R-York) has sent out a memo in Harrisburg calling for “Obama Medicaid Expansion Prohibition,” attempting to stop the expansion legislatively. “As a skeptic of the expansion who previously introduced legislation to prevent the Medicaid expansion in Pennsylvania on the basis of it potentially bankrupting us,” writes Saylor, “I am reintroducing this legislation and reaffirming with the latest evidence that the Medicaid expansion as stipulated under Obamacare is the wrong course of action and a disaster in the making.”
It’s likely a symbolic gesture; the ball is in the governor’s court. In any case, what Saylor’s memo does not address is the long-term effect that rejecting the expansion would have on the state’s hospitals.
See, one thing the Patient Protection and Affordable Care Act does is phase out something called Disproportionate Share Payments, which are essentially extra money Medicaid sends to hospitals to make up for uncompensated care. You know how conservatives discussing health-care reform often complain that anyone can just walk into an emergency room, regardless of insurance status, and get care? Yeah, that. The PPACA guts those DSH payments on the logical basis that, when everyone has health insurance — including the poor who’ll now qualify for Medicaid — there’s no need for that extra money. But that means if the state rejects the Medicaid expansion, hospitals will still find themselves in the position of caring for uninsured patients who are brought through the emergency room, and just won’t get compensated for doing so.
Pennsylvania received more than $500 million in DSH payments in FY 2011 out of the $11 billion spent nationwide. One estimate by the Washington Post found that hospitals could spend 27 percent more covering unpaid bills in states that reject the Medicaid portion of the PPACA.
In other words, not accepting the Medicaid expansion would likely put those people in between current Medicaid poverty requirements and just being poor in a weird purgatory. One in which hospitals would still find themselves giving out care to those who desperately need it, but eating that same cost due to a stubbornness for small government.