Healthy PA falls short

The governor’s plan for Medicaid expansion would shortchange low-income Pennsylvanians, argues AARP’s JIM PALMQUIST

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Recent reports show Pennsylvania’s Medicaid enrollment has increased by more than 18,000 people since the October launch of the Affordable Care Act’s online health care marketplace. That’s a small measure of good news for hardworking Pennsylvanians who continue to wait for state and federal officials to reach agreement on Gov. Tom Corbett’s Healthy Pennsylvania proposal.

Right now, 500,000 uninsured state residents are hoping Pennsylvania soon joins 26 other states (including all of our neighbors) that have already accepted federal funding to pay the cost of expanding state Medicaid programs under the terms of the health care law.

For these Pennsylvanians who earn up to $16,000 a year and have inadequate or no health coverage through their employers, the clock is ticking. By not having a plan in place by 2014, Pennsylvania already has forfeited one year of full federal funding for Medicaid expansion.

During that time, Gov. Corbett has released and fine-tuned his Healthy Pennsylvania plan that would use the promised federal subsidies to help the uninsured buy their own private policies through commercial carriers. Now, after months of public hearings by the state Department of Public Welfare and a public comment period by the federal Centers for Medicare and Medicaid Services that has just closed, all the interested parties await a decision from Washington.

The problem is, Healthy Pennsylvania would not just expand health coverage to Pennsylvanians with lower incomes. Because the plan would make dramatic changes to the Medicaid system in Pennsylvania and place conditions on new Medicaid enrollees, CMS must agree to changes which would “waive” provisions of current law.

AARP has carefully reviewed the governor’s application for this waiver, and we have serious concerns about the potential barriers to coverage that it would create for some of the state’s most vulnerable residents, as well as the way Medicaid benefits would be reduced and restructured under the plan.

Most significantly, Healthy Pennsylvania seeks to charge individuals with low incomes premiums for coverage that could actually exceed what individuals with higher incomes pay through subsidized coverage in the marketplace. This is just not acceptable.

Yes, exemptions are proposed for participants with the lowest incomes, seniors and other specified groups, which would be an important protection for some of the most vulnerable. However, the proposed monthly premiums could still exemption. In fact, existing federal law protects individuals with incomes less than $17,500 (150 percent of federal poverty level) from these types of premium requirements without the type of waiver that Pennsylvania is seeking.

Another problem with Healthy Pennsylvania is an effort to tie health coverage to work searching. Even though Gov. Corbett withdrew his proposal to make performing work-search activities a condition of eligibility, the plan still calls for a voluntary, one-year pilot program that allows different premiums to be charged based on whether individuals participate in the pilot program. Even this modified proposal remains discriminatory in nature and inconsistent with the goal of the Medicaid program to provide access to health care for low-income people regardless of work-related activities.

Finally, Healthy Pennsylvania’s proposed overhaul of the state’s Medicaid benefit packages raises red flags. Although efforts to simplify and streamline the state’s Medicaid system are certainly worthwhile and commendable, any changes in benefits should not limit access to necessary care. By proposing to consolidate the state’s existing 14 Medicaid benefit packages for adults into just two alternative benefit packages, we fear that the Healthy Pennsylvania plan would actually reduce needed coverage for vulnerable enrollees. Similarly, it would not provide wrap-around benefits for individuals receiving premium assistance to buy their own private policies. This would eliminate many important benefits that are standard under Medicaid, such as non-emergency transportation.

Ultimately AARP’s concerns are based on a single guiding principle. We believe Pennsylvania should use the available federal resources to provide Medicaid coverage to 500,000 uninsured residents who earn up to $16,000 a year without conditions and without restricting the essential benefits in Medicaid.

Pennsylvania has already chosen to forfeit one year of full federal funding for Medicaid expansion, leaving hard-working residents in the unfortunate position of having too few resources to qualify for health insurance subsidies and too much income to be eligible for Medicaid. That injustice must not be allowed to continue.

AARP and other advocates have provided CMS with suggested ways to enhance the governor’s Healthy Pennsylvania proposal. We remain confident that continued collaboration and open communication between state and federal officials can improve Healthy Pennsylvania to better address the needs of Pennsylvanians with low incomes while making Medicaid successful and financially sustainable for the long term.

Jim Palmquist is volunteer president of AARP Pennsylvania.

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