Medicaid expansion tangles bill

| Wednesday, July 3, 2013, 12:01 a.m.

HARRISBURG — The Senate on Wednesday could again vote on expanding Medicaid in Pennsylvania, a provision of the federal Affordable Care Act that Republican Gov. Tom Corbett has refused to embrace.

The Republican-controlled Senate on Sunday voted for language that approves the expansion with conditions aimed at tailoring the plan to Pennsylvania. The state House on Monday stripped the Medicaid expansion language from a Department of Public Welfare bill — and then recessed for summer after sending the welfare bill to the Senate.

The Senate returns to session for at least one day to consider the welfare bill and several other unfinished bills.

The Republican Caucus is reviewing options on Medicaid expansion, said spokesman Erik Arneson.

The Senate could agree with House changes and send the bill to Corbett or disagree and send the bill to a conference committee of House-Senate negotiators.

A third choice is to amend the bill and send it back to the House.

“We're not (in Harrisburg) till September,” said House Majority Leader Mike Turzai, R-Bradford Woods.

Stephen Miskin, a spokesman for Turzai, said having no welfare code, which lays out changes in welfare law, would affect state assessments or fees levied on hospitals. A portion of the $150 million assessment is returned to health care facilities to help cover disparities in what Medicaid pays.

The state budget, in that case, would not be balanced, and that could impact payments to state-related universities such as Penn State and the University of Pittsburgh, Miskin said. Those universities are listed as “non-preferred” appropriations, meaning funding allocated after priority spending.

The law creating the assessment won approval in 2010 but needed reauthorization by Sunday, said Paula Bussard, of the Hospital & Healthsystem Association of Pennsylvania.

“It needs to be acted on before the Legislature adjourns for the summer,” said Bussard.

A failure to pass a welfare code bill could put millions of Pennsylvanians at risk, said Bev Mackereth, secretary of the Department of Public Welfare.

“It would mean the loss of hundreds of millions of dollars to fund Pennsylvania's health care system, including funding for hospitals and nursing homes,” she said.

Lawmakers on both sides of Medicaid expansion remain passionate about the issue.

Rep. Daryl Metcalfe, R-Cranberry, believes Medicaid expansion would “break the backs of taxpayers in Pennsylvania.”

Senate Minority Leader Jay Costa, D-Forest Hills, said studies show joining the expanded program would result in 35,000 jobs and $3 billion more per year from the federal government. There's a “moral obligation” to provide health care to more than a half-million people, he says.

Up to 800,000 low-income Pennsylvanians would get health coverage if the state agrees to the extension left optional for states as a result of a Supreme Court ruling last year on the health care law.

Political analysts are somewhat puzzled why 17 Republican senators voted for Medicaid expansion, while the House Republican Caucus shot it down.

Senators have larger, more diverse districts than House members, said Steve Peterson, a political science professor at Penn State's Harrisburg campus.

One reason for House GOP opposition is fear of creating more federally dependent programs for which money one day disappears, said Rep. Mike Reese, R-Mt. Pleasant. He views it as similar to stimulus money, which ended and “left state taxpayers picking up the tab,” Reese said.

“Members of the Senate (voting for it) are taking the long view that it will provide money for the state to spend down the road,” said Tom Baldino, a political science professor at Wilkes University. “In the House, it's more of an ideological view.”

Some state legislatures and governors, even those with a conservative tilt, “ended up saying yes” after recounting the numbers, Peterson said.

Brad Bumsted is Trib Total Media's state Capitol reporter. Reach him at 717-787-1405 or

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