WASHINGTON — So far, 26 states and the District of Columbia have agreed to expand Medicaid coverage, providing coverage to 5.2 million more people.
But 5.7 million more people could be receiving the coverage in states that are forgoing the expansion and missing out on a combined $88 billion in federal funding through 2016.
Pennsylvania is among them, and the White House says its residents are suffering physically and economically because of it. The administration today begins a new push to get more states to expand their programs. It makes its case with a new report showing how states that expanded their programs are benefiting from a surge of federal money that goes along with the expansion.
Gov. Tom Corbett, meanwhile, has proposed an alternative to expanding Medicaid called Healthy PA.
His plan would allow about 500,000 individuals who would have to be financially eligible for expanded Medicaid to instead purchase private insurance using subsidies. His administration has also asked the federal government to make a number of changes to the state’s existing Medicaid program, many of which are controversial, such as allowing some low-income individuals to be charged premiums for coverage and consolidating most existing benefit plans.
While the plan is still awaiting federal approval, his administration is moving forward as if it will be implemented Jan. 1. The Corbett administration is also counting on the plan to bring $125 million in savings to the state’s budget for the fiscal year that began Tuesday.
State officials would say only that negotiations with the federal government about the plan are ongoing.
A spokesman for the Centers for Medicare and Medicaid Services said agency leaders are in close contact with the Corbett administration and that no decision has been made, he said.
White House spokesman Josh Earnest said the administration wants to be flexible with Pennsylvania, as it has been with other states.
For example, the federal government has approved Arkansas Gov. Mike Beebe’s plan to use federal funds to buy private insurance for 250,000 low-income residents. And it approved Michigan Gov. Rick Snyder’s plan to expand coverage while requiring new recipients to pay premiums and co-pays.
Under the Affordable Care Act, states that agreed have expanded eligibility to include nonelderly people earning up to 138 percent of the federal poverty level. In effect, that meant that an individual earning up to $16,105 per year or a family of four earning up to $32,913 would be eligible.
The federal government would pick up the entire cost of additional enrollees through 2016. After that it would pay at least 90 percent, with states making up the difference.
In Pennsylvania, the federal government would pay $8.2 billion over three years.
Medicaid is funded jointly by the federal and state governments to provide coverage to low-income people.
The expansion is a central piece of the Affordable Care Act, the president’s signature domestic policy and was intended to be compulsory. However, the U.S. Supreme Court rendered compliance optional.
Nationwide, the additional coverage would enable about 15.4 million physician office visits per year and would save an estimated 255,000 people from catastrophic out-of-pocket medical costs in a typical year, according to the report.
The coverage would greatly improve access to treatments and to preventative care such as mammograms, cholesterol screenings and pap smears, according to the report.
In Pennsylvania, an expansion would give an estimated 72,000 more people access to clinic care. There would be about 824,000 additional physician visits per year; 25,000 fewer people experiencing depression; and 41,000 more people reporting they are in good, very good or excellent health, according to the report being released today. It also would help 13,700 Pennsylvanians avoid catastrophic out-of-pocket medical costs in a typical year and would help 43,400 avoid having to borrow money or skip payments on other bills in order to pay medical expenses.
Washington bureau chief Tracie Mauriello: firstname.lastname@example.org, 1-703-996-9292 or on Twitter @pgPoliTweets. Kate Giammarise: email@example.com, 1-717-787-4254 or on Twitter @KateGiammarise.