The trick Corbett (and his successor) will use to change Obamacare

corbettGovernor Tom Corbett agreed to meet Republicans and the people of Pennsylvania halfway when he introduced his Healthy PA plan. Healthy PA would expand Medicaid to those making 133 percent of the poverty rate (a requirement as originally written into the Patient Protection and Affordable Care Act, also known as Obamacare, in 2009), but there’d be a few changes.

For instance, Corbett would rather use federal expansion funds to subsidize low-income adults’ individual, private plans, instead of putting them on the government rolls, which is how the bill was originally written.

“It’s not putting 500,000 more people into an entitlement program,” Corbett noted when introducing the plan. “It’s putting them in a program where they are invested in the program, they are invested in their health care, in a way where a person in Medicaid may not have that same personal investment.”

His plan also calls for a so-called small monthly payment for the plan—perhaps $30 or so. It would also require recipients to search for work (even though many who receive Medicaid are employed). The number and actual details of what will and won’t be in the final Pennsylvania plan won’t be known until, perhaps, the end of the week. But maybe later.

But here’s the thing: The Democrats running for the nomination to take on Corbett in Nov. 2014 are all in favor of expanding Medicaid as per Obamacare’s original standards, which were deemed optional by the Supreme Court decision upholding the law.

And right now, although we’re still about a year out, a Democrat seems poised to win. What happens in that scenario is about as confusing as the health care system itself. But here goes.

What will it take to make Corbett’s Healthy PA program law?

Tom Corbett is looking to get the 1115 waiver. This device, used since Medicaid became a law in 1965, “allows states to alter their Medicaid programs for purposes of a demonstration project,” according to Shannon Mace, a public health lawyer in Philadelphia.

Has anyone done this before?

Yes. Arkansas used the 1115 waiver to expand Medicaid in that state and the Centers for Medicare and Medicaid Services (CMS) approved it in September. In that state, like ours (potentially), the 200,000 people who qualify for the Medicaid expansion are being sent to the health insurance marketplace, where they can buy an individual plan, and then the Medicaid agency is picking up the bill.

The 1115 waivers have been used by various states for individual Medicaid purposes since it was passed in the 1965. It’s “provided important opportunities for states to test new coverage approaches in Medicaid, but have also raised some issues,” according to the Kaiser Family Foundation. Massachusetts actually used it to help create their universal healthcare program, too.

And is that it? Does it last forever?

No. Waivers handed out for this purpose last five years or less. Arkansas’ goes for three years. After that, either the federal government or state government can decide whether to withdraw or renew the plan. CMS can additionally terminate the waiver if the state fails to comply with the rules or if the project is not meeting its goals.

I bet a bunch of states are doing this and getting approval.

Nope. Most states are either going with an all-or-nothing approach.

Really, so some places are plain old not expanding Medicaid at all?


So, what’s happening to hospitals in poor areas of poor states?

They’re closing. And the anti-Obamacare Republicans who refuse to compromise in those areas are blaming—

No wait, don’t tell me…Obama?

You guessed it!

Sounds like something they would do. But which states besides Arkansas have sought and received a 1115 waiver, then?

Only Arkansas has been approved.

Huh. Well, let’s say the federal government is cool and gives Corbett the waiver. Then what?

Hold on a second. If only it were that easy. The waiver may come, but it won’t come any time soon. Even if Healthy PA were approved today, or tomorrow, it’d still be months before a Medicaid expansion program could go into place. Even though those states which complied with the original Obamacare writing have seen residents sign up all season.

“In order to get an 1115 waiver approved there must be a formal notice and comment period at the state and federal levels,” notes Mace. “Pennsylvania must host at least two public hearings and have a 30-day comment period.”

And legally speaking, Corbett’s Healthy PA plan has no authority. It’s really just some ideas on paper that may or may not hold water. But the federal government is currently in talks with the administration about whether or not all or some aspects of that particular plan may go through. I say “some aspects” here because the idea for a work-search requirement has already been killed by the feds in other states. Because come on.

If a Democrat beats Corbett in 2014, will s/he have to comply with Healthy PA instead of the Obamacare-written Medicaid expansion?

That depends. A new governor will probably be able to undo Corbett’s plan once in office. Mostly because the federal government needs to approve any Medicaid plan and it’s a given that the federal government will approve of the plan signed into law by President Obama.

But, according to Mace, if the situation were to come up where we have a Democratic governor and a Republican expansion plan put in place with the 1115 waiver, the Democrat can likely go through the same waiver process the Republican had already done.

Or, they could try to pass a bill expanding Medicaid according to the original plan via the state Legislature. This almost happened in the spring, when the state Senate passed Senate Bill 12, written by state Sen. Vincent Hughes. But that bill was later killed by the House, then, when it went back to the Senate, killed again.

But aren’t most states supposed to have a Medicaid expansion program in place by January, or something?

Part of the negotiations going on right now between the Corbett Administration and the Obama Administration would allow a plan to go into place later on, and we wouldn’t be penalized for it.

So, we’d still get 100 percent of funding from the federal government for the first three years?

Yes, probably. We’ll have to see what comes about in the negotiations. But let’s just say that if the feds approve of Corbett’s idea, or some variation of it, it’ll be a nice end of November for the Pennsylvania governor.

Between this and the transportation bill, you mean?


The transportation bill you wrote about in dire terms in last week’s PW, which actually passed the House after the paper went to press?

You had to bring that up, didn’t you.

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2 Responses to “ The trick Corbett (and his successor) will use to change Obamacare ”

  1. Mal says:

    Corbett’s ‘plan’ turns Obamacare into just another welfare program, instead of providing affordable access to health care for everyone. Health care is recognized as a human right all over the world, but apparently not in Pennsylvania.

  2. Charles says:

    What’s happening to hospitals in states that’s expanded Medicaid? That’s right they’re cutting staff. Facing reduced revenue and extra costs from dealing with Medicaid’s low payouts, high denials and slow payouts, Washington hospital Center in DC laid off staff. Meanwhile around the nation for decades, even Obama’s precious example hospital Mayo Clinic have reduced the number of Medicaid patients they see.

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