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.