In late August, the details of the national government’s terms and conditions for Pennsylvania’s “HealthyPA” Medicaid expansion plan.. Unfortunately, Governor Tom Corbett (R-PA) now joins the ranks of other Republicans in Iowa and Arkansas, who have been seemingly hoodwinked into believing the national government was interested in compromise.
The Foundation for Government Accountability’s (FGA) policy experts, senior fellow Josh Archabault and Director of Research Jonathan Ingram, predicted the HealthyPA plan would be stripped of “most of the provisions that have been used to sell the plan to the public,” such as work requirements.
Corbett’s application requested 24 waivers, of 15 different federal law provisions. How many were approved? Technically, zero, as no single waiver was approved without conditions.
Writing at Say Ahhh!, a weblog mantained by Georgetown University’s Center for Children and Families, university professor Joan Alker was originally concerned Corbett wasn’t willing to compromise enough to get expansion. However, from a quick scan of the agreement, it seems that the governor was deadset upon getting to “yes,” and many of the waiver requests he originally sought have been dropped.
The final agreement included only four waivers — one of which was the ability to enroll beneficiaries in managed care, which doesn’t actually even require a waiver.
As Alker mentions in her weblog, one of Corbett’s requested waivers didn’t even require permission, and the other three were completely watered down. The final agreement granted to Pennsylvania is even more restrictive, denying the state access to Qualified Health Plans (QHPs) on the state exchange.
Even before expansion, the Medicaid program in Pennsylvania was projected to cost taxpayers $40.9 billion per year by 2022. This is over a 70 percent increase, up from $24 billion today. That number will increase at least another $20 billion.
There is very little research or data yet on the budget neutrality of the deal, and unfortunately that means the only information we have is “the feds” telling us that it will be so. The Government Accountability Office (GAO) has repeatedly stated that the budget-neutrality provision is faulty, and has led to billions more being spent on Medicaid than projected.
States, unlike the federal government cannot print money, and every additional dollar spent on Medicaid will be one less dollar for public safety, education, roads, and or tax relief.
By denying access to QHPs, the number of plan designs in the state will be reduced to a single low-risk plan, and a single high-risk plan.
Originally, Corbett also requested enrollees be temporarily dropped from their plans, if they did not pay their premiums. The Centers for Medicare and Medicaid Services (CMS), instead decided that applicants could re-enroll immediately without delay, eroding any meaningful personal responsibility or “skin in the game” provision.
CMS also denied his request to retain the option of levying premiums upon those making less than 100 percent of the federal poverty level.
Effectively, premiums are mentioned as mere suggestions, as it’s stated that “an individual may not be denied an opportunity to re-enroll due to nonpayment of a premium for a prior period.”
Corbett submitted the weakest terms possible to define “work,” and even then, the national government denied his compromise. There is nothing to tie searching for work to the receipt of Medicaid in PA.
Reducing Access to Care
In 59 of 67 Pennsylvania counties, primary care shortages have already been identified by the federal Health Resource and Services Administration. If, as in Arkansas, the new plans pay more for new Medicaid enrollees, providers will move able-bodied adults to the front of the line, kicking the truly needy who remain in traditional Medicaid to the back. We’ve seen in other expansion states how this can have deadly consequences.
Seniors aren’t immune to the impact either, as Obamacare’s Medicaid expansion is partially funded by cuts to Medicare Advantage. Hundreds of thousands of seniors in the Keystone State will be forced to switch plans, and will not be spared the costs of supplemental coverage.
Corbett’s “HealthyPA” plan is nothing more than Medicaid expansion by a different name. The denial of any flexibility from the federal government should be a clear warning to other GOP governors like Mike Pence (R-IN) and Governor Gary Herbert (R-UT), or any others considering Medicaid expansion.
Kristina Ribali ([email protected]) is the Digital Outreach Director for the Foundation for Government Accountability.
“Centers for Medicare and Medicaid Services Special Terms and Conditions Agreement with Healthy Pennsylvania,” Centers for Medicare and Medicaid Services: http://heartland.org/policy-documents/centers-medicare-and-medicaid-services-special-terms-and-conditions-agreement-healt