HARRISBURG -- For months, Gov. Tom Corbett has said that without concessions he will not expand Medicaid eligibility in Pennsylvania under the federal health care law.
Now the Obama and Corbett administrations are increasingly taking their closed-door discussions into public view, as officials from both camps pitch reporters on the reasonableness of their positions.
In a call Thursday with Pennsylvania reporters, an official with the U.S, Department of Health and Human Services said the state could greatly reduce its number of uninsured people, using mostly federal money, by deciding to make more residents eligible for Medicaid health coverage. The state estimates it would add more than 800,000 new people to Medicaid by expanding eligibility.
Paul Dioguardi, director of the Office of Intergovernmental and External Affairs, pointed to a study by the RAND Corporation, a global research organization, that found expanding Medicaid eligibility would draw billions of additional federal dollars to Pennsylvania while extending health coverage to all but 5 percent of non-elderly Pennsylvanians -- compared with 8 percent without expansion -- by 2016.
"In the weeks ahead we will continue to work with Pennsylvania to create a state-specific solution that expands security for working Pennsylvanians and improves the state's health," Mr. Dioguardi said. "We're hopeful Governor Corbett and the state legislature will say yes to the incredible deal they're being offered."
The Corbett administration, meanwhile, has briefed Capitol reporters on its requests that the federal government allow it to make significant changes to its existing Medicaid program. In a meeting last week, two top officials described topics the administration has raised as potential areas of adjustment, such as job training for able-bodied recipients or small premiums or co-pays for people on the higher end of the income scale.
"Fundamentally, we're starting our conversations with HHS and [Centers for Medicare & Medicaid Services] saying, before we even start down the path of expansion or exchange or whatever it might be, you've got to give us the flexibility to reform the program that we have," said Jennifer Branstetter, director of policy and planning for the governor. "How do you bring them into a system that's fundamentally flawed and broken and unsustainable for taxpayers?"
With Medicaid accounting for 27 percent of Pennsylvania's general fund budget, the Corbett administration says it needs permission to change how the program works. Officials characterize Pennsylvania's program as particularly generous, covering a series of optional services and costing the state more than most. A report from the National Association of State Budget Officers lists Pennsylvania's Medicaid spending -- as a percentage of total spending in 2012 -- as higher than that of all states but Missouri.
Ms. Branstetter and Todd Shamash, a deputy chief of staff, said Mr. Corbett wants to increase access to health care but that he and his representatives, including acting secretary Beverly Mackereth of the Department of Public Welfare, have encountered resistance from federal officials. Mr. Corbett met in April with HHS Secretary Kathleen Sebelius.
"For months now, whether it's Secretary Mackereth or whether it was the governor when he met with the secretary down in D.C., we put what we believe are substantive topics on the table to say, if you work with us here, I think we can increase access," Mr. Shamash said. "If it has to be about expansion of an entitlement program and traditional benefits, it's hard to make headway."
Christine Cronkright, a spokeswoman for Mr. Corbett, said Thursday that state officials were told this week that they might have an option of covering some of the affected population with private insurance from the health insurance markets, known as exchanges, created under the law.
Mr. Diguardi, the HHS official, said agency officials are having regular conversations with their counterparts from Pennsylvania but have no specific proposals before them.
"We're always open to discussing with states changes that they'd like to make to their existing program or changes they'd like to make under the extension of Medicaid under the Affordable Care Act," he said. "We've done so with a number of states who are putting in lots of innovative reforms to their Medicaid programs."
He pointed to the case of Arkansas, where officials are seeking to use federal Medicaid funding for private insurance sold on the exchanges.
"We felt it was consistent with the goals of the program and with the goals of the Affordable Care Act, and so we're working with them to finalize that proposal," he said.
Karen Langley: email@example.com or 717-787-2141.