Gov. Tom Corbett (R-PA) proposed an alternative to Obamacare’s Medicaid expansion on Monday during a press conference at PinnacleHealth Hospital in Harrisburg, Pennsylvania. The decision is a change of course after the governor initially rejected the expansion outright in February.
Corbett’s plan is similar to ones that have been proposed by governors in states such as Arkansas and Iowa — where conservative lawmakers have been reluctant to expand the public Medicaid entitlement — and will require a special waiver from the federal government in addition to legislative approval in Pennsylvania. His proposal also comes with a string of demands that would reform the state’s existing Medicaid program, subjecting both current beneficiaries and newly-eligible Pennsylvanians under the expansion to monthly premiums and work-search requirements.
A summary of the plan is available on the Commonwealth of Pennsylvania’s official website. In short, Corbett wants to use federal money that would normally have been used to enroll Americans living up to 133 percent of the Federal Poverty Level (FPL) in Medicaid under the health law and instead provide them with private coverage through Obamacare’s statewide insurance marketplaces. If the plan is approved, it could provide health benefits to over 520,000 previously uninsured low-income Pennsylvanians.
Furthermore, Corbett’s plan would force all existing Medicaid beneficiaries — as well as the newly-expanded pool — to pay a monthly premium of as much as $25 for individuals and $35 for households while eliminating co-payments for primary care doctor’s office visits. The premiums would start at individuals making 50 percent FPL, or just $5,745 per year, and increase on a sliding scale up to the Medicaid expansion’s upper threshold of 133 percent FPL. Healthy and uninsured low-income Pennsylvanians would also have to prove that they are searching for work or in a job-training program in order to qualify for Medicaid benefits.
During Monday’s press conference, Corbett said that he would refuse any sort of Medicaid expansion unless his cost-sharing and work-search demands were met.
There is some question as to whether or not Corbett’s proposed premiums for very low-income people would be approved by the Obama administration, since federal law prohibits imposing premiums on Medicaid beneficiaries who make less than 150 percent FPL.
Some public health advocates are also skeptical about the possible negative consequences of Corbett’s proposed reforms. “I definitely think that a cost-share of this amount, which might seem low for folks who have a steady income, would definitely be a barrier for low-income individuals,” said Shannon Mace Heller, a Philadelphia-based public health attorney, in an interview with ThinkProgress. “Any cost-share would definitely be a deterrent on seeking medical care.”
“I also think that [the job-seeking requirement] is going to be a barrier for individuals to get coverage,” added Heller. “I’m not aware of any other state that has a work-search requirements just for the Medicaid benefit.”
Corbett is the 10th Republican governor to embrace some form of the Medicaid expansion. To date, 25 states (including Pennsylvania) and the District of Columbia are moving forward with attempts to implement Medicaid expansion, while 22 others have declined and another three remain in limbo.