Corbett administration seeking assurances state won't be left holding Medicaid bag
By Brad Bumsted
Published: Saturday, June 15, 2013, 9:00 p.m.
HARRISBURG — Pennsylvania's top welfare official will meet with Medicaid's federal overseers on Monday in hopes of getting Republican Gov. Tom Corbett the flexibility he's seeking to determine whether to expand the state's program.
The meeting “is a continuation of ongoing discussions,” said Jennifer Branstetter, Corbett's policy director. “Our team goes into every meeting hopeful that they will have a meaningful discussion around building a program that works for Pennsylvania.”
Beverly Mackereth, the acting secretary of the state Department of Public Welfare, will meet with officials from the federal Department of Health and Human Services, the agency Corbett has been negotiating with to decide whether to expand the health insurance program for low-income people.
Expansion is an option for states under the federal Affordable Health Care Act, often called Obamacare. About half of states tentatively agreed to expand. There's a “misunderstanding” that Corbett, who was one of the attorneys general to unsuccessfully challenge the federal health care law, has rejected expansion, Branstetter said. Corbett was elected governor in November 2010.
Medicaid covers one in six Pennsylvanians. Under the federal health care law, 25 percent of the state's population would be covered if the state opts in. Pennsylvania spends $21.9 billion in federal and state money annually on Medicaid, which serves 2.2 million people. Under the expansion, 500,000 to 700,000 people — some working people whose employers don't provide health care coverage — could be added.
Corbett has said he is holding out until he is persuaded the expansion will be financially sustainable over the long haul for Pennsylvania.
The Washington meeting occurs as Corbett and state legislative leaders attempt to negotiate a budget for 2013-14 by the constitutional deadline of June 30. A budget the House approved last week did not make adjustments for Medicaid expansion because Corbett is negotiating with HHS, said House Appropriations Chairman Bill Adolph, R-Delaware County.
Democrats in the House and Senate, serving in the minority party of both chambers, are calling for Corbett to agree to the expansion.
Unless Corbett agrees to participate, the expansion probably won't happen, political analysts say. While it is “technically possible” for Democrats to garner enough Republican votes for passage, Corbett could veto any bill, said Chris Borick, a political science professor at Muhlenberg College in Allentown.
“The key is the governor coming out and saying, ‘I want it,' ” said Tom Baldino, a political science professor at Wilkes University in Wilkes-Barre. “He has been dragging this out waiting for an answer from Washington.”
Supporters say expansion would provide a state budget savings next year, establish jobs in the heath care sector and provide billions of federal dollars to provide more people with health insurance coverage.
Corbett's administration is concerned that there's no guarantee the federal government in years to come will continue to pay states that expand, and that could leave Pennsylvania taxpayers holding the bag. Moreover, Branstetter said, there is no initial “savings” because of the state's start-up costs.
Rep. Joe Markosek, ranking Democrat on the House Appropriations Committee from Monroeville, disagrees. Without expansion, he says, Pennsylvania is “leaving (federal) money on the table.”
Whether state or federal dollars are spent, it's all taxpayer money, said Matthew Brouillette, president of the Commonwealth Foundation, a conservative policy group.
“The so-called free money coming from Washington is not free at all,” Brouillette said. “It's coming directly out of taxpayers' pockets.”
Average Pennsylvanians don't distinguish between federal and state money since they pay taxes toward both, Brouillette said. “There is no free lunch,” he said.
Sharon Ward, executive director of the Pennsylvania Budget and Policy Center, a liberal-leaning group, rejects Brouillette's argument. “It's kind of irrelevant,” she said, noting there are vast differences between the duties of federal and state governments.
“We pay anyway — in premiums and tax dollars,” Ward said, referring to people without insurance who often are treated in emergency rooms. That's absorbed by hospitals that receive state subsidies called “uncompensated care” to offset the cost, she said.
As the debate over expansion continues, the backdrop is the sharp partisan division among Pennsylvanians.
A Quinnipiac University poll this month of 1,032 registered voters found voters support Medicaid expansion by a 49-44 percent margin. The poll's margin of error was 3.1 percent.
Republicans oppose expansion 73 percent to 18 percent with 9 percent undecided. Democrats support expansion 78 percent to 17 percent with 6 percent uncertain.
“It's now wrapped up with the principle and concept of Obamacare,” Borick said. “Anything with that stamp on it will be highly charged in a partisan way.”
Brad Bumsted is state Capitol reporter for the Tribune-Review. He can be reached at 717-787-1405 and firstname.lastname@example.org.
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