Extending Medicaid: Corbett's broader plan comes with strings attached

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If Gov. Tom Corbett has his way, 520,000 low-income Pennsylvanians will become eligible for subsidies to help them buy health insurance. That's good news for those uninsured people, but the picture is not as clear for the 2 million individuals who already are receiving Medicaid, the publicly funded program that covers the poor, disabled and elderly.

On Monday, the governor announced a program he calls "Healthy Pennsylvania," which ties together the fates of current Medicaid recipients and low-income adults who don't have health insurance now.

Mr. Corbett long has maintained that he would not allow Pennsylvania to expand the pool of residents eligible for Medicaid coverage under the federal Affordable Care Act, Obamacare. That's still his position, but it is somewhat semantic.

It's true that under his plan, new customers would not go onto the Medicaid rolls. However, the state would use federal funds available through Obamacare to give subsidies to people whose incomes are up to 133 percent of the federal poverty level. For example, a family of four with a household income of $31,322 would qualify. Currently, Medicaid is not available to childless adults or parents whose incomes are at 50 percent of the federal poverty level or higher, so the subsidies would be a big help to that pool of Pennsylvanians, who would be buying insurance in the marketplace.

The governor would impose new requirements on both current Medicaid recipients and the newcomers. Co-pays would be eliminated for doctor visits, except for a $10 fee if patients go to the emergency room for treatment they should have sought from a primary care physician. Also, there would be monthly subscription fees for the insurance based on a sliding scale, with the poorest people paying nothing and the highest sum limited to $25 per individual or $35 per family. Patients could cut their fees if they participate in weight-loss or smoking cessation programs and other good-health initiatives.

These smart measures give patients incentives to visit their family doctors instead of seeking more expensive ER care and to take steps to stay healthy.

Even the governor's proposal that all able-bodied recipients participate in job searches or job training programs may prove to be reasonable.

The impact of other proposed changes is a bit more complicated. As Welfare Secretary Beverly Mackereth explained, the state's 14 different Medicaid options would be reduced to two, one each for high-risk and low-risk patients. She said during a briefing Monday that Pennsylvania has provided better coverage -- including care by podiatrists and chiropractors as well as funeral benefits -- than many states, but that some benefits may be curtailed. The new plans would include vision, dental and prescription benefits.

The federal Department of Health and Human Services must agree that Pennsylvania can revise its Medicaid program or the state won't participate in the subsidy plan for health insurance on the exchanges.

The Corbett proposal has some good ideas, but until existing Medicaid subscribers have a complete understanding of what the new insurance would cover and how it compares to what they have now, it is difficult to know whether it's a good deal for all Pennsylvanians.

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