By Melissa Daniels | PA Independent
HARRISBURG – One year ago, on June 28, 2012, the U.S. Supreme Court left with the states a decision on whether to expand their respective Medicaid programs.
That same day, Gov. Tom Corbett stood alone at a podium and delivered a four-minute address, expressing disappointment but a will to abide by federal law. Outside the Capitol, Patient Protection and Affordable Care Act supporters stood on the Capitol steps and cheered.
Now, Pennsylvania is one of six states without a decision on expanding Medicaid. That could change in the next three days.
Corbett has remained visibly cautious on Medicaid expansion. His administration has engaged in months of mostly uneventful negotiations with the federal government, citing a will to develop a program that works for Pennsylvania while remaining wary of the costs.
But the state Senate is on the cusp of changing that trajectory.
“There’s clearly bipartisan, bicameral support to do something along the lines of Medicaid expansion,” said Senate Minority Leader Jay Costa, D-Allegheny. “It’s a pretty significant step as it relates to our history regarding our ability to provide health care to Pennsylvanians.”
The apex of a charged debate may come Friday, on the one-year anniversary of the Supreme Court decision on Obamacare.
Passing a state budget requires a welfare code bill, which spells out rules for spending. The Senate plans to insert language into this bill that would expand Medicaid. The vote may happen Friday, or sometime before the budget deadline Sunday night.
Costa said he was disappointed it has taken this long.
“I think a series of roadblocks have been put up over the course of the past several months,” he said, “which I think were unnecessary and ill-advised.”
Rep. Dan Frankel, D-Allegheny, a strong Medicaid proponent, said Corbett has dragged his feet, which has helped polarize the debate.
“We have not been proactive,” Frankel said. “I think that this whole thing about the governor asking these questions of Washington is really a ruse to basically avoid having to make this decision that we really should be making.”
Frankel points to Republican governors in states such as Ohio and New Jersey, which have opted for expansion. Thirty states, including Washington, D.C., support Medicaid expansion, according to the Kaiser Family Foundation. Fifteen states oppose it, and six, Pennsylvania included, are weighing options.
Both Frankel and Costa said a Medicaid expansion bill, in some form, can pass with bipartisan General Assembly, despite vocal opposition from many Republicans.
Earlier this week, House Health Chairman Matt Baker, R-Tioga, was joined by dozens of House Republican colleagues to reiterate opposition to Medicaid expansion. Baker said cost is the biggest concern. Though most of the Medicaid expansion will be federally funded in the outlying years, Baker said he fears the debt-laden federal government won’t keep its pledge.
Beyond that, the state is looking at an $800 million funding gap — without the expansion — next year, Baker said.
“If that in fact is going to happen in Pennsylvania, how are we going to pay for it?” he said. “What funds are we going to have to transfer from other vital services to fund that mandate by the federal government?”
Baker said he supports Corbett’s cautionary approach. He said the state would do well to address Medicaid cost concerns before expanding the program.
“The responsible thing to do is to continue to talk with the administration and the federal government and look for creative ways to reform our Medicaid system so at least we’re revenue neutral,” Baker said.
Rep. Mauree Gingrich, R-Lebanon, said the state needs to see through the “sales talk” on the Medicaid expansion. Without reforms to the current system, taxpayers and current enrollees will lose, Gingrich said.
Adding hundreds of thousands to an overloaded system means there won’t be enough doctors and care providers to go around, especially if the federal government limits its funding ratios.
“It’s our responsibility to determine and maintain a common-sense way to ensure reliable, efficient, sustainable health care for our neediest citizens,” she said. “They deserve a program that provides adequate access to providers and quality health care.”
When the Supreme Court said states could decide if they wanted to participate in the expansion, it meant taking a look at how the program was already operating, said Christine Cronkright, deputy press secretary for the administration.
“If we are to add more individuals into this and don’t do anything to reform the program, it would not be sustainable for Pennsylvania,” she said. “It would cause a lot of additional impacts through the whole General Fund budget.”
The goal is to find a way to expand health care coverage without busting the General Fund budget. From letters to in-person visits, the Corbett administration has tried to develop a plan with the federal Department of Health and Human Services.
But these discussions haven’t always gone the way the administration has hoped.
“At this point, we’re not hearing a lot back from them in allowing us that flexibility in order to do that,” she said.
Even if the Legislature acts on the Medicaid expansion, HHS still has to sign off on the plan, she said.
“That’s part of the reason we’ve been trying to have the discussion up front. Can we work to do this in a way that really allows us to do more with our program and to reach more people, but in a way that it can also be more sustainable to our budget?”
House Human Services Chair Gene DiGirolamo, R-Bucks, has defied the view of many in his caucus by supporting Medicaid expansion. And he’s supportive of the Senate’s proposition to work the expansion into the welfare code bill.
He said 15 to 20 House Republicans would likely join their Democrat counterparts should an expansion bill reach the floor, giving it enough votes to pass.
“I think there’s enough members of my caucus that want to get this done on the Republican side that I really think we have a shot at our leadership bringing it up for a vote,” he said.
Expansion is meant to help the working poor — people with jobs but no health insurance or disposable income to buy private insurance, he said. Once those who oppose the expansion understand that, they may get used to the idea.
“It’s toxic from the standpoint that you hear the word ‘Obamacare,’ but this is law,” DiGirolamo said. “We’ve got to make a decision on this expansion, which is the best decision for Pennsylvania.”
Contact Melissa Daniels at firstname.lastname@example.org