Photo by Matt Rourke/AP
Gov. Tom Corbett speaks with medical personal at St. Christopher's Hospital for Children Wednesday in Philadelphia. Corbett visited the hospital to promote his “Healthy Pennsylvania” initiative.
Pennsylvania Gov. Tom Corbett may have been keeping an eye on his fellow Republican governor in Ohio last week as Gov. John Kasich bypassed Ohio’s Republican legislature to expand the state’s Medicaid program.
As part of the Affordable Care Act, states have the option to extend health care coverage to low-income adults, with the federal government picking up almost all of the tab. So far 30 states have planned to do that, 16 have opposed doing so, and five states are weighing their options, according to the Kaiser Family Foundation’s tracking tool. (Find a more granular tracking tool here.)
Pennsylvania is among the five states weighing its options — as are Kansas, Maine, Tennessee and Utah.
Subsidizing private insurance with Medicaid money
Gov. Corbett is now canvassing the state touting his new “Healthy Pennsylvania” plan, which calls for accepting the generous federal dollars to expand Medicaid, though with certain caveats.
At the St. Christopher’s Hospital for Children hospital in North Philadelphia recently, Corbett said: “We need a medical insurance program that’s designed for Pennsylvania. One size does not fit all.”
Gov. Corbett’s plan would direct newly eligible people — mostly adults without children — into the health insurance marketplace where they could buy private coverage.
Currently, Pennsylvania — like Kansas — puts Medicaid patients into private managed care plans.
Using new federal expansion funds to help subsidize private plans instead was first proposed in Arkansas by former Kansas Medicaid Director Andy Allison back in March. It has since attracted interest in other states and has been pushed by the federal government as an option for state governments otherwise opposed to the health reform law, including Kansas.
In Pennsylvania, Gov. Corbett said of the approach “It’s not putting 500,000 more people into an entitlement program. 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,” he said.
In Kansas, Gov. Sam Brownback has said he’s listening to both proponents and opponents of Medicaid expansion.
Encouraging states to ‘Be creative’
Last month, the federal government approved Arkansas’ plan to direct new Medicaid recipients to shop for coverage on the insurance marketplace.
Corbett’s plan differs from Arkansas’s though, so federal approval is not guaranteed. He’d also change some current Medicaid benefits and include a job training component.
“The governor is looking for a way to draw down the federal money,” says Nicole Huberfeld, a professor of health law at the University of Kentucky. She’s not surprised by Corbett’s latest move – she said the federal money is too much of an opportunity for even Republican governors to pass up.
“The legislature may or may not be on board, but the governor recognizes a lot of federal money to be had that will likely save the state a lot of money in the long run,” Huberfeld said.
Photo by Mike Sherry
Minnesota State Rep. Alice Hausman, right, greeted U.S. Health and Human Services Secretary Kathleen Sebelius before the secretary addressed a Council of State Governments conference in Kansas City, Mo., Sept. 19.
U.S. Health and Human Services Secretary Kathleen Sebelius — speaking last month at a national conference in Kansas City — said her agency “stands ready as a partner” for plan proposals that meets state’s individual needs.
“I do believe in the phrase that the laboratories of democracy are state government. The opportunity to innovate, the opportunity to share good notions,” Sebelius said. “We have done a lot of work in my time as secretary with various states to see Medicaid differently, depending on where they are in the country. We are open to a very flexible example. We want to see what states have in mind.”
No backlash?
When the Supreme Court ruled last year that Obamacare’s Medicaid expansion must be optional, many Republicans didn’t have an appetite to do it, no matter who paid the bill, said Matt Baker, a Republican lawmaker in Pennyslvania who chairs the state’s house health committee.
Democrats “by-and-large support a full blown Medicaid expansion. The Republicans do not. And we’re very, very concerned about the cost,” Baker said.
But Baker doesn’t view Corbett’s plan as an expansion because of the shared responsibility element and proposed changes to current Medicaid.
New Jersey Gov. Chris Christie says he supports expanding Medicaid under Obamacare, joining other Republican governors who have been staunch opponents of the health reform law.
Corbett’s plan doesn’t appear to be facing much political backlash. After all, conversations about Medicaid had been began seeping into the political discourse months earlier, when neighboring New Jersey’s Republican Gov. Chris Christie opted for Medicaid expansion.
Pennsylvania Senate Majority Leader, Republican Dominic Pileggi, said “It would be foolish to leave people uninsured” which would leave hospitals and doctors providing free care to “uninsured individuals while money we send to Washington goes to other states to deal with their issues.”
Democratic leaders worry Corbett’s moving too slowly and say they, too, want more details.
But at least some advocates for a full expansion are cautiously optimistic, including Michael Race of Pennsylvania’s Partnership for Children. While he “would have preferred to see Medicaid expansion put on the table,” and says he was hopeful early on a plan would surface.
The whole plan isn’t a done deal, but Huberfeld, with the University of Kentucky, says one thing is clear: Federal officials at the Department of Health and Human Services have signaled from the outset that they’re willing to work with states to give them maximum flexibility to expand Medicaid under their own terms.
This story is part of a collaboration that includes WHYY, NPR and Kaiser Health News.
KHI News Service coverage of Medicaid expansion
→ Medicaid Access Coalition launches online “ticker” showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
→ House speaker says Medicaid expansion is “up to the governor” (1/10/14)
→ KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
→ Profiles of the coverage gap: Kathleen Christian (1/6/14)
→ Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
→ Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
→ Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
→ White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
→ Republican governor talks up plan to expand Medicaid — his way (10/28/13)
→ Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
→ Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
→ Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
→ Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
→ Medicaid expansion coalition finds strength in numbers (9/17/13)
→ Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
→ Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
→ Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
→ CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
→ Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
→ The Arkansas Medicaid Model: What you need to know about the ‘private option’ (5/2/13)
→ Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
→ Brownback says he’s listening to Medicaid expansion proponents, opponents (4/5/13)
→ Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
→ Governor urged to expand Medicaid eligibility (3/27/13)
→ Arkansas Medicaid expansion attracts other states’ interest (3/26/13)
→ Senate president prefers options remain open on Medicaid expansion (3/25/13)
→ States urged to expand Medicaid with private insurance (3/22/13)
→ Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
→ Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
→ More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
→ Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
→ Medicaid expansion supporters to step up lobbying efforts (3/7/13)
→ Budget committee hears resolution opposing Medicaid expansion (2/22/13)
→ Legislators focusing on Medicaid expansion cost estimates (2/19/13)
→ Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
→ Brownback officials release their cost projections for Medicaid expansion (2/8/13)
→ Medicaid expansion bill introduced (1/22/13)
→ Kansas hospitals worried about loss of dollars for charity care (1/14/13)
→ Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
→ Group urges Brownback to expand Medicaid eligibility (11/9/12)
→ Debate begins on possible Kansas Medicaid expansion (10/25/12)
→ Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
→ Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
→ Kansas AG claims partial victory in health reform case (6/29/12)
→ High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)
Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange
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