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, Health Equity, Health Reform, Medicaid, Pennsylvania

Healthy Pennsylvania? Not exactly.

Tuesday afternoon the nation stood by waiting for Pennsylvania Governor, Tom Corbett, to announce that Pennsylvania would opt in to the Medicaid expansion provision of the Affordable Care Act.  The news viewers received instead was something very different.  Corbett made it clear that he was not “expanding Medicaid”, but providing a “common sense” plan to reform the state’s Medicaid program. The plan’s title, Healthy Pennsylvania, is quite the misnomer when one looks at the details.

The Healthy Pennsylvania objectives are threefold: reform Medicaid, increase access, and stabilize financing.  Reforming Medicaid is at the heart of the plan and includes many controversial proposals such as condensing the 14 existing Medicaid benefit plans into two alternative benefit packages; applying a $10 co-payment for “inappropriate” emergency room use; requiring applicants and beneficiaries to comply with work search requirements; and attaching a monthly premium for individuals who have incomes as little as 50% of the federal poverty level.

For the reasons below and others, I do not support Governor Corbett’s Healthy Pennsylvania plan.  It is unlikely that the federal government will approve it as well due to the many provisions presented in the plan that are contrary to the laws and regulations governing the Medicaid program. Instead of taking meaningful action to help improve access to care and health of Pennsylvanians, this proposal will act as a needless delay prohibiting hundreds of thousands of Pennsylvanians from getting comprehensive, affordable health coverage as set forth by the Affordable Care Act.

Consolidation

While it is true that the Medicaid program in Pennsylvania is complex, it serves a variety of different populations. For example, there is a plan for women who make slightly higher incomes to receive coverage for certain OBGYN services known as the Women’s Select Plan.  Another existing benefit in Pennsylvania is the Medical Assistance for Workers with Disabilities (MAWD).  This plan provides health coverage for workers with disabilities whose income would otherwise make them ineligible for the traditional Medicaid program in Pennsylvania.  The Governor’s proposal to consolidate the existing Medicaid programs leaves advocates questioning the fate of programs like these that serve specific groups.  Even more troubling is  that in addition to consolidation, the Governor would like the services covered by the plans to reflect that of employer-sponsored coverage.  The traditional Medicaid plan in Pennsylvania offers  coverage for a wide-range of coverage including comprehensive services for mental health and substance use challenges.  If this proposal were implemented it would significantly reduce the scope of services individuals would receive to keep them well.

Expansion

Within the Healthy Pennsylvania plan the Governor does agree to expand Medicaid eligibility for individuals up to 133% of the federal poverty level. He proposes to do this by enrolling those individuals into private health insurance plans on the Marketplace.  While this expansion of eligibility would increase access to some type of health coverage for individuals, it would do so in a way that is more costly and less efficient than enrolling individuals into traditional Medicaid.  The fact is that it is less costly to insure individuals through Medicaid than it does through the private health insurance market.

Cost Containment

In an effort, under the guise of cost savings and promoting personal responsibility, Corbett proposes to mandate several requirements under the Healthy Pennsylvania plan. Among the most controversial is the work search requirement. While the Governor stated that this requirement would only apply to “able bodied” individuals capable of working, his plan does not clearly define how this requirement would be applied and enforced.  Currently, no other states in the nation apply a work requirement to its Medicaid benefit.

Another controversial provision is the premium that individuals will need to pay for coverage. Individuals with incomes as low as 50% of the federal poverty level ($5,745/year) will be asked to pay a premium. The maximum premium an individual will pay will be $25 per month.  While $25 per month does not seem like much money to individuals who have steady incomes, for low-income individuals, it will act as a significant barrier to coverage and care.

One of the more alarming provisions set forth in the plan without any clarification or description is a $10 co-payment for “inappropriate” emergency room usage.  The plan fails to define or describe situations when using the emergency room would be inappropriate as opposed to appropriate.  The plan also fails to explain how this co-payment would be collected or who would be responsible for determining when the co-payment should be imposed on an individual.  Individuals and families who might be experiencing serious medical conditions could delay seeking emergency treatment due to this co-payment.  The Emergency Medical Treatment and Labor Act (EMTALA) was enacted to ensure all individuals had access to necessary health services in times of crises regardless of ability to pay.  Enacting a policy such as this can confuse individuals about their right to receive care in these settings.  If implemented this provision will unjustifiably penalize the poor.

The Governor’s plan can be accessed here: http://www.dpw.state.pa.us/healthypa/index.htm.

Comments on the plan can be submitted via email to: RA-PWHealthyPA@pa.gov or by mail to:

Department of Public Welfare,
Office of the Secretary,
Health & Welfare Building,
625 Forster Street,
Harrisburg, PA 17120

Uncategorized

Thoughts on Governor Corbett’s coming announcement re: Medicaid expansion in Pennsylvania

Public health advocates in Pennsylvania have been working tirelessly to influence Governor Corbett to “opt in” to Medicaid expansion since the U.S. Supreme Court made its surprising decision on June 28, 2012 regarding the Affordable Care Act (ACA).  The Governor’s office has leaked to the press that tomorrow we will get the news we have been waiting for during a big announcement the Governor is set to deliver.  One would think that advocates should welcome this news; however instead of celebrating, many of us are gearing up for our next challenge: explaining to the public and the legislature why we will not support Governor Corbett’s Medicaid expansion proposal.

For months Governor Corbett adamantly opposed expanding Medicaid eligibility citing misleading financial analyses, over reliance on the Medicaid program, and unsubstantiated fears that the federal government will “break its promise” regarding the 100% federal matching rate for the program for years 2014, 2015, and 2016.  More recently, as the Governor’s political popularity continues to dwindle, he has moved from adamantly opposing expansion to considering options within expansion.  Based on recent statements by the Governor, the Pennsylvania Department of Welfare Secretary, Beverly Mackereth, and the Insurance Commissioner, Michael Consedine, it is very likely that the Governor’s proposal will be similar to those of Arkansas and Iowa.  Governor Corbett favors privatization and it is likely he will propose expanding Medicaid eligibility for individuals, but instead of enrolling them into the traditional Medicaid program, the newly eligible individuals will be enrolled into the private health insurance plans on the Marketplace. In addition to this, the Governor will likely request a waiver from moving children in households with incomes up to 138% of the federal poverty level from CHIP into the Medicaid program; a provision of the ACA to which the Governor has expressed great opposition.  Other items the Governor might propose as part of the Medicaid expansion in Pennsylvania could include work requirements and increased co-payments for services. With the maintenance of effort requirement of the ACA expiring at the end of the year, advocates also fear Governor Corbett’s expansion plan will unfortunately come with a reduction in the current Medicaid benefit, negatively impacting our most vulnerable residents.

Governor Corbett is making the issue of Medicaid expansion in Pennsylvania needlessly complex in order to satisfy both a Republican base and to improve his popularity overall.  In doing so, the Governor will continue to delay the opportunity for approximately 600,000 residents to get comprehensive health coverage.  Some of the messages we need to get across are clear: (1) The current Medicaid program in Pennsylvania is efficient and works to provide comprehensive coverage to those who need it most; and (2) Pennsylvania residents will pay for Medicaid expansion through income tax regardless of whether we expand or not.  The government should expand in a way that provides the best services to individuals, not the highest profits for corporations.

 

Uncategorized

Corbett’s Health Insurance Exchange Decision

Corbett’s Health Insurance Exchange Decision

Pennsylvania Governor, Tom Corbett, announced on December 12th that the Commonwealth will not be establishing its own Health Insurance Exchange. To most of us, this came as no surprise. Here’s the link to the Governor’s statement along with his letter to Secretary Sebelius. Within his letter, the Governor states his financial concerns of expanding Medicaid eligibility within the state. He cites to a $4 billion cost to the state over an eight year period. At this time the Governor has not decided whether Pennsylvania will expand Medicaid eligibility or not.