Why the GOP is splitting in Pa. House over Medicaid

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HARRISBURG -- Three Republican House members crossed party lines to join with Democrats on Wednesday for a committee vote in favor of Medicaid expansion, which could set up a fight with other Republicans in the state House later this month.

Rep. Gene DiGirolamo, R-Bucks, the chairman of the state House Human Services committee and an advocate for Medicaid expansion in the state -- as permitted and funded under the Affordable Care Act -- said he believed such an expansion was "the right thing to do."

The vote followed more than an hour of procedural maneuvering by the committee's Republicans, who tried to halt the vote by making motions to refer the bill to another committee. Even when it became clear the bill would likely pass, opponents persisted, motioning for the committee to adjourn, and speaking about the perceived ills of the Affordable Care Act and federal government in general.

"I think many people in this room agree that Obamacare is probably one of the worst things that has ever happened to this country," said Brad Roae, R-Crawford. "Obamacare is ruining our health care system."

Gov. Tom Corbett does not favor a Medicaid expansion, and has submitted a "Healthy PA" plan to the federal government that would allow about 500,000 individuals who would have to be financially eligible for expanded Medicaid to instead purchase private insurance using subsidies. Those subsidies would come from the money that the ACA has already earmarked for Medicaid expansion.

He has also proposed extensive changes to the existing Medicaid program; the proposals are before federal officials for review.

In a statement following the vote, the governor's office said that "Pennsylvania cannot afford Medicaid expansion. ... Healthy PA is a responsible, Pennsylvania solution."

Mr. Corbett, when he was attorney general, joined 25 other states in a lawsuit seeking to overturn a key piece of the Affordable Care Act. Mr. Corbett's opponent in the November gubernatorial election, Democrat Tom Wolf, supports expanding Medicaid.

Medicaid expansion is a key part of President Barack Obama's health care overhaul, and was intended to help insure 17 million Americans who were previously unable to obtain or afford health insurance; the federal government committed to pay nearly $1 trillion to help states pay for the expansion. But two years later, a U.S. Supreme Court decision rendered the Medicaid expansion optional for states.

In Pennsylvania, Medicaid is available to only certain vulnerable and disabled populations. If expanded, the program would become income-based, and anyone making below 138 percent of the federal poverty line could get Medicaid coverage.

Some states have opted not to participate in the expansion; others, such as Pennsylvania, are hoping to use the cash to revamp the original Medicaid model significantly in a manner more palatable to the state's Republican legislature and governor.

Mr. DiGirolamo said an amendment to the bill that passed out of committee would allow Medicaid enrollment to begin immediately, but also allow Mr. Corbett's administration to continue negotiating with the federal government on his alternate plan.

Wednesday's committee vote may end up being merely symbolic, however. House Republican leadership has generally been opposed to a Medicaid expansion and an attempt to vote on the issue last summer was halted in a committee.

"The governor is negotiating with the federal government and there are no plans whatsoever to bring that bill up for a vote," said Steve Miskin, a spokesman for House Majority leader Mike Turzai, R-Marshall, speaking after Wednesday's vote.

Last year, the Republican-controlled state Senate approved a Medicaid expansion plan by a vote of 40 to 10.

Senate Majority Leader Dominic Pileggi said last week however, he doesn't think the Senate would take up the issue again as long as the Corbett administration is still in talks with the federal government.

State legislators must pass a budget by June 30 and with a shortfall of at least $1.2 billion, Mr. DiGirolamo said he believes the issue could find enough support to pass, as an expansion would bring millions in federal dollars.

"I think we have a legitimate chance of getting this voted on before we go home," he said.

All three Republicans who voted in favor of the expansion are from the southeastern corner of the state. Mr. DiGirolamo was joined in his support of the measure by all the Democrats at the meeting and by Reps. Joe Hackett, R-Delaware and Tom Murt, R-Montgomery.

The measure passed 12-11.

"I truly don't think this is a party issue," said Mr. Hackett, who cited increased access to drug treatment for people with addiction issues and access to health care for low-income veterans under an expanded Medicaid program.

Kate Giammarise: 717-787-4254 or kgiammarise@post-gazette.com or on Twitter @KateGiammarise. First Published June 4, 2014 2:14 PM

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