Medicaid expansion killed in House — now what?

After fierce debate, the Pennsylvania House of Representatives voted today to approve an amendment stripping Medicaid expansion language from the state welfare code.

The measure kills any chance of seeing a large expansion to the Medicaid program by the Legislature. The Medicaid expansion is a portion of the Patient Protection and Affordable Care Act, also known as Obamacare, which would allow those whose incomes are within 133 percent of the federal poverty rate to get on the government insurance roles. It was also a portion of the law which was deemed optional for states by the Supreme Court.

After a year of pushing and advocating and legislating on the issue, a vote was held in the Senate this weekend, which added language to the state welfare code that would expand Medicaid. That was overwhelmingly approved by the state Senate. The language then went to the House Rules Committee this morning, who stripped the language from the code. That language then went to the full House, who held a vote on whether or not to approve the language—and it was approved, 108-94, largely along party lines.

Medicaid expansion would have given an estimated 500,000-700,000 Pennsylvanians healthcare. Numerous studies done around the state also showed that the expansion would save us money, which advocates have recommended sending into education funding.

That vote was met on Twitter afterwards with party-line comments. State Sen. Vincent Hughes (D-Philadelphia), a strong supporter of Medicaid expansion, noted, “Sad day for health care in PA: PA House rejects Med Expansion 108-94. We will continue 2 fight 4 the health care 4 low income working PA’s.” The House Democratic Twitter feed said: “#PAhouse #GOP votes to destroy 40,000 #jobs, close rural hospitals statewide, deny care to 30,000 veterans. Appalling.”

Representative Stephen Bloom (R-Cumberland), had a different take: “11th-hour push to force disasterous Obamacare Medicaid expansion on citizens of PA fizzles. Whew.” And Rep. Ryan Aument (R-Lancaster) called the vote, in a tweet, a “major win for Pennsylvania taxpayers.”

This is a huge blow for the law, sure, but it’s probably still isn’t dead. Gov. Tom Corbett is allegedly still negotiating a deal with the federal government to do the expansion his way.

And he’s probably going to have to come up with something. As we’ve been writing for the better part of a year, Obamacare gets rid of Disproportionate Share Payments, which the federal government gives to hospitals when they treat people without health insurance. The idea of getting rid of that cash was that expanding Medicaid (and other incentives in the law) would have given virtually everyone insurance. States who’ve denied the Medicaid expansion have largely ignored the fact that hospitals are going to suffer pretty badly without this cash—or they’re going to turn away patients, which, in some parts of the U.S., hospitals already do.

Follow Randy on Twitter: @RandyLoBasso

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