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Here's why Gov. Corbett should expand Medicaid in Pennsylvania
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When word came down on June 28 that the Supreme Court had upheld the Affordable Care Act, a patient being seen at the Squirrel Hill Health Center burst into tears. Like many patients at the center, she is low-income, has multiple chronic health conditions and struggles to maintain her insurance, as well as her health.
She shed tears of relief knowing that the Supreme Court decision would allow tens of thousands of patients across Pennsylvania to become newly eligible for Medicaid coverage. Yet we will benefit from these provisions of the health care law only if Gov. Tom Corbett chooses to accept the Medicaid expansion funding that the federal government will provide to states beginning in 2014.
The governor has not yet made a decision, but on behalf of patients like ours and the estimated 458,200 uninsured low-income adults who would be covered should the governor accept the additional dollars, we would like to make the case for moving ahead with Medicaid expansion.
While the existing Medicaid program remains unchanged, from 2014 to 2017 the federal government would assume the full cost of expanded coverage with no additional cost to the state. The new program would cover individuals with household incomes up to 133 percent of the federal poverty level, or $29,326 for a family of four.
Even after full implementation of the expansion in 2019, the federal government would continue to assume 90 percent of the expansion costs going forward, as opposed to 46 percent of current Medicaid costs. An extensive analysis of the impact of Medicaid expansion by the Kaiser Foundation estimates that, when it is fully implemented, Pennsylvania would pay an additional 1.4 percent over current levels to decrease the percentage of uninsured residents by 41.4 percent.
So why bother insuring more people, especially when the state is cutting back existing Medicaid benefits to those at the lowest income levels, including vulnerable children? Wouldn't it be cheaper to just let the uninsured fend for themselves? Even that 1.4-percent increase would stress an overstretched state budget.
The answer is that uninsured Pennsylvanians create an economic burden on us all. Forced to go without basic primary and preventive health care, they end up sicker, spread more contagious disease, use the emergency room more and require costly hospitalizations that can be avoided with the outpatient interventions and preventive care available to insured patients.
These folks are not riding free: We all pay top dollar for their poor and ineffectual health care through Emergency Medicaid, which covers their hospitalizations and which comes out of our tax dollars, and through higher premiums for those with insurance. This is a tragic waste of money and resources and is a contributing factor to the spiraling health care costs that threaten to sink our economy.
Beyond economics, the reality is that those who would be eligible for Medicaid under the expansion are not some frightening "other." They are us. They are our family members, friends and neighbors.
They are the divorced woman not yet old enough for Medicare and not skilled enough for a high-paying job whose cancer will go undiagnosed until it is too late. They are the young adult lucky to have a part-time job but who has no benefits. They are the cashier in the store we patronize, the waitress at our favorite restaurant, the man who mows our lawn. However tempting it may be, we cannot simply turn and look the other way because they are part of our community and we are part of theirs.
In the end, everyone would benefit from Medicaid expansion. Community health centers like the one in Squirrel Hill, which already provide high-quality care to more than 700,000 low-income Pennsylvania residents, would be reimbursed for more of our services and so would be able to see more patients. Hospitals would shoulder less of the burden of uninsured patients who wash up on their doorsteps in dire need of services. With greater prevention and earlier intervention, public health would improve and health costs would come down -- or at least rise less than they otherwise would.
The final question here is not whether Pennsylvanians will pay for the expansion, but only whether we will benefit from it. Medicaid expansion is now the law of the land. If Pennsylvania does not participate, our federal tax dollars will still fund the expansion, but they will help only residents of other states, with no benefit to our own communities.
Our governor has a choice to make. We implore him to expand Medicaid in Pennsylvania as a fiscal and public health benefit.
First Published July 20, 2012 12:00 am
