The Healthy PA plan could endanger services for Pennsylvania’s most vulnerable citizens
January 4, 2014 9:40 PM
By Susan Friedberg Kalson
Imagine you are a low-wage working Pennsylvanian, juggling multiple jobs to keep your head above water, not eligible for Medicaid but unable to afford insurance. The Affordable Care Act was supposed to offer relief in the form of federally funded expanded Medicaid coverage for adults with incomes up to 133 percent of the federal poverty level. Since Gov. Tom Corbett rejected Medicaid expansion, you awaited with great anticipation his alternative proposal, announced a few months ago as Healthy PA.
On the face of it, Healthy PA addresses some of the problems facing the 500,000 Pennsylvania residents who would have been covered had Medicaid been expanded as designed in the ACA. The governor proposes that rather than being covered through the existing Medicaid system, this pool of adults become eligible for subsidized purchase of commercial insurance products in the new insurance marketplace. What could be wrong with allowing low income individuals to buy commercial insurance instead of putting them on a government-administered plan?
Yet Healthy PA includes key elements which would actually undermine one of the state’s strongest allies in providing high-quality health care for hard-to-serve populations. The 50 community health centers across the state, operating 250 sites in urban and rural areas alike, will be hard-hit if the proposal is accepted as written. That’s because it would eliminate the cost-based reimbursement system by which Medicaid must pay community health centers and instead suggests that these small nonprofits must negotiate satisfactory rates with the big insurers — if they are even willing to accept the health centers as providers at all.
Each year, community health centers serve more than 700,000 vulnerable Pennsylvanians, 92.2 percent of whom have incomes below 200 percent of the federal poverty level and 68.4 percent of whom live below the federal poverty level entirely. Our numbers are growing daily, yet we also have a long track record of providing high-quality, cost-saving care, saving an average of $1,263 per patient per year for Medicaid-insured patients over those seen in other settings and serving 12 percent of Pennsylvania’s Medicaid population for only 1.2 percent of the total Medicaid ambulatory care expenditure in 2010. We are specifically designed to serve the needs of our own community members, whether they are older adults in subsidized urban housing, farm workers in isolated rural areas or new refugees arriving in our cities. Required to take every patient, regardless of insurance status or ability to pay, we embrace this directive, providing patient-centered care that addresses the actual needs of our patients.
Our services include everything from prenatal care to geriatrics, behavioral health and oral health care, lab and pharmacy access, and care coordination. We must report annually on our quality outcomes as well as our finances. We are effective, transparent and absolutely dedicated to our shared mission of lowering barriers to care for all.
In addition to undermining the revenue stream that allows community health centers to provide these integrated, patient-focused services, Healthy PA includes other troubling provisions. By capping the number of allowed visits to primary care physicians but allowing unlimited emergency room visits, the proposal would hobble years of effort to direct patients to the very practices where they can receive continuous, coordinated management of chronic conditions, treatment of acute illness and the preventive care proven to keep people healthier at a lower cost than unnecessary ER services.
By allowing insurers to opt out of including us in their networks of providers, the proposal threatens to eliminate community health centers entirely as a resource for the patients who know us and trust us to provide excellent, dignified, evidence-based care for themselves and their families, regardless of their life situations.
The least complicated means to provide access to insurance with the federal funds available is to expand the current Medicaid program. In the absence of that option, we would hope that the proposal Gov. Corbett submits to the federal government for approval reflects the contributions of our community health centers and ensures that we have a role in providing care.
For more than 40 years, Pennsylvania’s community health centers have provided high-quality care that is tailored to the specific patient populations we serve. At Squirrel Hill Health Center, we care for the majority of refugees being resettled in Allegheny County, comprising 25 percent of our patients. We work hard to address the complex needs of these newcomers, we have worked equally hard to shape our services to meet the needs of our other vulnerable low-income patients, whether they were born in the mountains of Nepal or right here in Pittsburgh. Many of these patients could be at risk of losing access to our services if Healthy PA goes forward as proposed.
Pennsylvania’s residents — all of Pennsylvania’s residents — deserve the right to health care as good as any in the country. At this critical moment, we urge the Corbett administration not to under-mine our community health centers, its most important ally in providing primary health care to our neediest neighbors.
Susan Friedberg Kalson is CEO of Squirrel Hill Health Center and chairs the Legislative Affairs Committee of the PA Association of Community Health Centers (firstname.lastname@example.org).
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