Affordable Care Act, Health Policy, Medicaid, Philadelphia

Healthy or Unhealthy PA? Advocates Weigh in on Gov. Corbett’s Plan to Reform Medicaid in Pennsylvania

Governor Corbett’s Healthy PA proposal to reform the Medicaid system in Pennsylvania through a Medicaid 1115 Demonstration Waiver has been met with harsh criticism by many and for good reason.  Healthy PA (known fondly by some as Unhealthy PA) would disrupt the current cost-efficient Medicaid program in Pennsylvania by enrolling newly eligible individuals and many currently existing Medicaid beneficiaries into private health insurance plans.

So, why is this a problem? A couple of reasons:

  1. Historically, private health insurance plans do a poor job of providing coverage for specific types of illnesses. For example, the lack of private coverage for mental health and substance use disorders called for the enactment of federal legislation known as the Mental Health Parity and Addiction Equity Act.
  2. Private health insurance companies spend much more money on administrative costs and profits than Medicaid. This means that administering the Medicaid program through the private  insurance industry will mean less bang for the tax payers’ buck.

Additionally, Governor Corbett’s plan includes many controversial provisions that are likely to face close scrutiny by the federal government:

  1. A monthly premium for individuals making as little as 50% of the federal poverty level (less than $6,000/year).
  2. Work search requirements (no other state in the United States has such a provision). As a side note this would apply to certain individuals who meet “medically frail” criteria, but that are otherwise “able bodied.”
  3. A $10 co-payment for “non-emergent” emergency use.
  4. Harsh punitive measures that would disqualify households from Medicaid if the fail to pay their monthly premiums.
  5. Benefit limits that would substantially reduce scope of coverage that is currently offered through Medicaid.

Perhaps, most importantly, the plan is not set to go into effect until January 1, 2015 (assuming it would get approval by the federal government by this time) meaning hundreds of thousands of Pennsylvanians will fall into a “coverage gap” qualifying for neither Medicaid or a tax subsidy through the health insurance marketplace.  These individuals will have no source of meaningful health coverage for the entire year.  Not to mention, delaying expansion until 2015 will cost the Commonwealth 2.5 billion dollars of potential funding.

Advocates representing many different groups and organizations have voiced their opinion on the plan.  Not all of the testimonies provided and comments submitted were adamantly opposed to the plan, but many were. The following is a list of organizations’ comments and/or testimony on the plan:

  1. Community Legal Services of Philadelphia
  2. Project HOME
  3. Public Citizens for Children and Youth
  4. Disability Rights Network of Pennsylvania
  5. Hospital and Healthsystem Association of PA (HAP) 
  6. Delaware Valley Healthcare Council of HAP
  7. Safety Net Association Pennsylvania
  8. Community Behavioral Health of Philadelphia (CBH)
  9. Pennsylvania Association of County Drug and Alcohol Administrators
  10. Pennsylvania Association of County Administrators for Mental Health and Developmental Services
  11.  The Alliance of Community Service Providers (Testimony January 3rd)
  12. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (DBHIDS)
  13. Philadelphia Department of Behavioral Health & Intellectual disABILITY Services (Appendix A- Questions to PA DPW on the plan)
  14. The Philadelphia Coalition
  15. Pennsylvania Budget & Policy Center
  16. Todd Keefer, York County resident
  17. Center for Advocacy for the Rights and Interests of  the Elderly (CARIE)
  18. Pennsylvania Partnerships for Children (PPC) 
  19. Rehabilitation and Community Providers Association (RCPA)
  20. The ARC 
  21. Pennsylvania Homecare Association
  22. Public Interest Law Center of Philadelphia (testimony of staff attorney, Benjamin Geffen, on January 3rd)
  23. A coalition of organizations representing individuals with disabilities
  24. Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC)
  25. Juvenile Law Center (JLC)
  26. Pennsylvania Association of Medical Assistance Manged Care Organizations
  27. Women’s Law Project
  28. Greater Philadelphia Chamber of Commerce
  29. Joanne Grossi, Health and Human Services (HHS) Region III (House Democratic Policy Committee Meeting: January 8, 2014)
  30. Joan Alker, Center for Children and Families, Georgetown University (House Democratic Policy Committee)
  31. Jim Willshier, Pennsylvania Association of Community Health Centers (House Democratic Policy Committee)
  32. Sol B. Vazquez-Otero, Disability Rights Network of Pennsylvania (House Democratic Policy Committee)
  33. Jacob Bowling, Mental Health Association of Southeastern PA (House Democratic Policy Committee)

    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commowealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
    Attorney Richard Weishaupt of Community Legal Services of Philadelphia speaks to Cover the Commonwealth advocates prior to the Healthy PA testimony in Philadelphia on January 3, 2014.
Affordable Care Act, Education, Health Reform, Medicaid, Pennsylvania, Philadelphia, Uncategorized

Affordable Care Act (ACA) Education & Outreach

This weekend I had the opportunity to discuss the Affordable Care Act (ACA) with Pennsylvania Senator Vincent Hughes and Philadelphia Department of Behavioral Health & Intellectual disABILITY Services Commissioner Arthur Evans on Philadelphia radio show Philly Speaks on 100.3 FM. The show gave us a chance to demystify “Obamacare” and what it really means for individuals. A few of the key messages that were expressed include:

  • Getting insurance coverage is essential for many individual and societal reasons.
  • The new Health Insurance Marketplace provides an opportunity for individuals to purchase health insurance on a more “level playing field” than in the past.
  • Through the Marketplace individuals could receive financial assistance to purchase coverage.
  • The Marketplace will screen individuals for public and private health insurance options and financial assistance to purchase insurance.
  • Individuals with behavioral health needs (mental health and substance use challenges) will have an increased opportunity to access services due to the Affordable Care Act’s provisions.
  • Expanding Medicaid in Pennsylvania is a “no brainer” and will be a huge missed opportunity if the state administration does not act soon.
  • Healthcare.gov, localhelp.healthcare.gov, and 1-800-318-2596 are valuable resources for individuals to learn more about their options and places to get in-person assistance.

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Food Insecurity, Food Policy, Homelessness, Pennsylvania, Philadelphia

Philadelphia Outdoor Serving of Food Task Force Update

Outdoor Serving of Food Task Force members

In a recent post I called for more attention to be brought to Philadelphia Mayor, Michael Nutter’s Outdoor Serving of Food Task Force Report. This weekend I got what I wished for.

Philadelphia Inquirer reporter, Jennifer Lin reported on the fact that Mayor Nutter and outdoor food serving groups came to an agreement about the ban on outdoor serving of food. The two former adversaries agreed to put the litigation aside in order to focus on a long-term solution to end food insecurity and chronic homelessness in Philadelphia.

In a similar article, CBS reporter, Cherri Gregg also reported on the compromise. The Task Force’s recommendation to establish a neutral space that different food serving groups could utilize in order to increase capacity to serve was highlighted by Mayor Nutter’s press secretary, Mark McDonald.

Philadelphia

Mayor’s Task Force on Outdoor Serving of Food

Mayor’s Task Force on Outdoor Serving of Food

This year, Philadelphia Mayor, Michael Nutter’s controversial ban on outdoor serving of food garnered nationwide attention; however, efforts to propose comprehensive solutions to address Philadelphia’s critical food insecurity issues were largely left unnoticed.

The outdoor serving of food ban was implemented through two regulations:  one promulgated through the City’s Board of Health and the other through the Department of Parks and Recreation.  In short, the Board of Health regulation required outdoor servers of food to obtain food safety and handling training and the Department of Parks and Recreation regulation prohibited the serving of food to three or more members of the public within a City park without acquiring a special event permit prior to the distribution.  While the regulations applied to all parks within the City, it disproportionately impacted individuals who served food along the Ben Franklin Parkway, since that is where many homeless individuals gathered for meals.

Plaintiff food servers brought suit against the Mayor and the City claiming that the regulations violated their constitutional right of Freedom of Religion.  The plaintiffs claimed that serving food to individuals in need was a religious calling and often part of a religious ceremony or practice.  Judge Yohn, who presided over the case, ruled in favor of the plaintiffs and granted an injunction for the Parks and Recreation regulation; however, he allowed enforcement of the Board of Health regulation.  In his ruling the Judge cited to a need for a long term solution in Philadelphia for food insecurity.

While the regulations and the suit that followed received much attention from the national and local press, another effort by Mayor Nutter to address food insecurity went largely left unmentioned.  Following the implementation of the regulations and prior to Judge Yohn’s decision, Mayor Nutter convened a Task Force on  Outdoor Serving of Food comprised of indoor and outdoor food servers, individuals who have previously sought free food services, and representation from City government.  The task force was led by Dr. Arthur Evans, Commissioner of Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).

As an assistant to the project, I personally witnessed the Task Force work diligently over a three-month period to analyze the complex situation, including the reasons why individuals sought outdoor food services and the motivation of groups to serve food outdoors.  The Task Force collected data from both those in need and those that provided services and identified key core issues and proposed comprehensive recommendations to the issues.   The Mayor accepted the Task Force’s report with a commitment to implement some of the recommendations. Specifically, the Mayor stated that he would identify leadership within his office to lead efforts aimed at reducing food insecurity in the City.

Certainly, policies that risk impeding on individuals’ rights should continue to be vetted publicly and through the judicial system.  However, the spotlight should not be diverted away from issues and efforts that lack a certain level of “controversy” but may present feasible solutions to those issues that are being disputed.