Medicaid Expansion Proposals

06.21.13 | Abby Lutcher

Senate President Pro Tempore Joe Scarnati, R-Jefferson, said a Medicaid expansion will help the state's hospitals stay afloat. He drew a distinction between the Medicaid expansion and the rest of President Barack Obama's health care law, often referred to as Obamacare, big portions of which go into effect next year. "Health care is changing next year no matter what, and I know that some view the Medicaid expansion as an embrace of Obamacare, but clearly it's a rational decision that needs to be made," Scarnati said. An expansion would cover hundreds of thousands of uninsured working adults, with the federal government paying the entire cost for the first three years and no less than 90 percent of the cost after that. Billions of federal health care dollars flowing into Pennsylvania also will boost the economy and lead to new health care jobs, supporters say. But it is an uncomfortable issue for Republicans. Many conservatives view it as an unaffordable new entitlement for the poor, but a broad coalition is in favor of a Medicaid expansion, including hospital executives, Democratic lawmakers, labor unions, the AARP, religious leaders and advocates for the poor. A leading Pennsylvania Democrat in the effort to expand Medicaid, Philadelphia Sen. Vincent Hughes, called talks in recent days with Republican senators "a little bit of a breakthrough." "They've kind of come along to a position where (Senate Democrats) already were, and we're trying to work through some of their concerns," Hughes said. However, with a raft of legislation passing with the state budget before the new fiscal year begins July 1, Democratic-penned amendments to expand Medicaid will be unavoidable in the House and the Senate. That may have forced the hand of Republicans. Counting 23 Democratic senators, enough Republican senators already have expressed support to pass an expansion bill. In the House, Republican leaders have remained quiet about the matter, preferring to let Republican Gov. Tom Corbett take the lead. Corbett, who as attorney general sued unsuccessfully in federal court to overturn the health care law, has continued to raise questions about the cost to Pennsylvania and said that he would not accept a Medicaid expansion unless his administration is allowed substantial flexibility to run it. Corbett aides did not immediately respond Thursday evening to the question of whether Corbett is supportive of the Senate effort to draft a Medicaid expansion bill. The conditions that will be in the Senate bill are still under discussion. Scarnati said one condition in the forthcoming Senate legislation could require that children covered by the Children's Health Insurance Program cannot be forced by the federal government to switch into Medicaid. Under the health care law, states must expand the eligibility limits of Medicaid for people ages 6 to 19 beginning next year, though CHIP in Pennsylvania already provides coverage to those children through privately run insurance plans that the Corbett administration prefers. Other conditions that have been discussed by senators include a work search requirement and cost sharing with enrollees, although federal officials have discouraged the Corbett administration from a work search requirement and maintained that cost sharing be minimal. On one key concession being pursued by Corbett, the federal Department of Health and Human Services indicated that it may discuss the privatization of Medicaid plans, Corbett spokeswoman Jennifer Branstetter said.