Healthy PA enrollment begins but program could be scrapped next year
December 1, 2014 12:03 AM
Gov.-elect Tom Wolf called outgoing Republican Gov. Tom Corbett last month, after his election triumph, and asked the sitting governor to scrap his overhaul.
By Bill Toland / Pittsburgh Post-Gazette
Starting today, uninsured Pennsylvanians whose annual income is less than 138 percent of the household federal poverty limit may apply for health coverage through the state’s new “Healthy PA” program, which offers subsidized, Medicaid-like insurance plans through private health carriers.
For those determined to be eligible, as many as 600,000 low-income Pennsylvanians, coverage could begin as soon as Jan. 1.
How long will that coverage last, given that Democratic Gov.-elect Tom Wolf says he favors a straightforward Medicaid expansion and hopes to undo Healthy PA as soon as is practical?
“Whoever has enrolled, their coverage will not be interrupted,” said Estelle Richman, Pennsylvania’s former Department of Public Welfare (now the Department of Human Services) secretary, who last month was appointed to Mr. Wolf’s transition team as its Medicaid adviser.
“It should be as invisible as possible,” she said. “Do no harm.”
Unharmed does not mean unchanged, and Mr. Wolf’s team plans dismantle the underpinnings of Healthy PA nearly as soon as he takes office, Ms. Richman said Friday.
“There will be some fairly quick shifts,” she said. “My hope is that we are pretty far down that road” by the end of the first quarter of 2015.
The launch of Healthy PA, like the process that conceived it, is tangled in gubernatorial politics: Mr. Wolf called outgoing Republican Gov. Tom Corbett last month, after his election triumph, and asked the sitting governor to scrap his Healthy PA Medicaid overhaul. Throughout his gubernatorial campaign, Mr. Wolf said he favored an expansion of the state’s existing Medicaid program rather than Mr. Corbett’s plan to use billions in federal subsidies to pay for private insurance policies for low income Pennsylvanians.
Mr. Wolf made the call because, according to his campaign’s conversations with the U.S. Centers for Medicare and Medicaid Services, the transition to a straightforward Medicaid expansion would be complicated by the launch of Healthy PA. By the time Mr. Wolf is inaugurated Jan. 20, thousands of Pennsylvanians might already have private health coverage.
Mr. Corbett refused to back down, and the Healthy PA overhaul remains on schedule.
Mr. Wolf’s new chief of staff, Katie McGinty, has criticized the Corbett administration’s decision, saying the governor’s team is knowingly driving toward a “dead end and a brick wall.”
Jeffrey Sheridan, a spokesman for Mr. Wolf, said the transition between Healthy PA and its successor could be unnecessarily “time-consuming and costly.” State Sen. Vincent Hughes, D-Philadelphia, said the media campaign advertising the Healthy PA expansion is “being spent on a program that very likely will never see the light of day” or at least will be unraveled in short order.
With today’s launch, Pennsylvania is joining 27 states plus Washington, D.C., in agreeing to collectively accept nearly a trillion dollars in federal Medicaid expansion money, which the 2010 Affordable Care Act authorized; the expansion was a linchpin in President Barack Obama’s plan to expand health care access to uninsured populations. Through August, U.S. Medicaid enrollment was up by almost 15 percent, or more than 8 million, over last year’s numbers, thanks to the states that expanded their Medicaid programs starting Jan. 1.
Pennsylvania was not one of them.
Mr. Corbett, like many Republican governors, was hostile to the Affordable Care Act. When he was Pennsylvania’s attorney general, Mr. Corbett’s office joined a lawsuit with 25 other states seeking to overturn the “individual mandate” provision of the ACA, which is the provision that requires people to obtain coverage if they can afford it or be subject to a penalty.
After he took office as governor, he resisted the Medicaid expansion, even though the federal government had committed to paying for the entire cost of additional enrollees through 2016 and more than 90 percent of costs thereafter, but Mr. Corbett said a straightforward expansion was unsustainable; the state’s existing Medicaid program accounts for about 30 percent of Pennsylvania’s annual general fund budget and already serves more than 2 million people.
Medicaid expansion in each state was key to Mr. Obama’s health care overhaul, in that it was expected to help insure 17 million Americans who were previously unable to obtain or afford health insurance, but a U.S. Supreme Court decision in 2012 rendered the Medicaid expansion optional for states.
In Pennsylvania Medicaid isn’t a program based on strict income eligibility; instead it is available to only certain vulnerable and disabled populations, such as families with children younger than 21, disabled individuals, victims of domestic violence and pregnant women.
Under Healthy PA, which the federal government approved in August, three months before the gubernatorial election, those populations will still maintain their Medicaid coverage, ending up in a high-risk or low-risk health plan.
Ms. Richman said on Friday that Mr.Wolf envisions a single benefits template, not the high- or low-risk plan and not the “private coverage option” commercial benefit plans — for all eligible Pennsylvanians, regardless of income or health status. The state would still work with its various Medicaid managed care plans to administer those benefits, Ms. Richman said.
The undoing of Mr. Corbett’s Health PA private option also means the undoing of the contracts that have already been executed with the insurance carriers.
“We really don’t have a right to intervene in those contracts as of yet,” Ms. Richman said, but given that those carriers, with the exception of Harrisburg’s Capital BlueCross, are already serving Pennsylvania’s existing Medicaid population, they know what’s coming and should be able to pivot quickly.
“There’s going to be confusion … there’s going to be mistakes,” she said of the planned launch, then abandonment of Healthy PA. “We will have to go in and now work around that.”
The Wolf team will “make sure [that] no one loses benefits,” she said.
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