The Tribune Democrat, Johnstown, PA

March 4, 2013

Debate swirls around Medicaid expansion

John Finnerty
CNHI

HARRISBURG — Gov. Tom Corbett stands alone as the only governor of a large northeastern state to suggest he will not approve an expansion of Medicaid that would provide coverage to hundreds of thousands of residents.

Corbett is not without support though, as a small group of Republican lawmakers issued a public plea for the governor to stand firm. Meanwhile, Democrats and advocates on Monday said there is little reason for Pennsylvania to opt out before expansion because there is nothing that would prevent the state from dropping out of the expanded Medicaid program once the federal government’s full funding elapses.

Corbett is working on setting up a meeting to discuss his concerns about Medicaid expansion with Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, but a Corbett spokeswoman said Monday that the meeting has not taken place and has not been scheduled.

“They are working on it,” Corbett spokeswoman Christine Cronkright said.

Eight Republican governors have agreed to the Medicaid expansion – including governors in the neighboring states of Ohio and New Jersey, as well as those in Arizona, Florida, Nevada, Michigan and North Dakota. The Associated Press reported that Corbett may be hesitant to support the Medicaid expansion due to concern that he will face opposition from an anti-Medicaid expansion candidate in the Republican primary next year. Days later, Politico suggested that factors might motivate Corbett to reverse course and approve the Medicaid expansion.

The Corbett administration has estimated that participating in the Medicaid expansion that would add 800,000 people to medical assistance would cost Pennsylvania $1 billion through 2014-15 and a total of $4.1 billion. Advocates maintain that the Medicaid expansion would pay the way for $43 billion in federal contributions, beginning with three years in which the federal government would pay 100 percent of the expansion.

“Regardless of the federal government’s claims, the presumption that they will cover 100 percent of the costs of full expansion is simply not true.  Regardless of any other costs under the (Affordable Care Act) that we’d have to bear, there are still IT and staffing costs, costs for additional clients coming into the system that may have been eligible before, and costs for those we believe will drop employer-based coverage,” Cronkright said.

Pennsylvania is not the only state where the decision of whether to accept the money has created controversy. In Florida, while the governor has signaled that he wants to accept the money, a House committee voted on Monday to pass on Medicaid expansion, citing many of the concerns raised by Corbett and other Republicans in Pennsylvania.

Seven Republican lawmakers released a joint statement urging the governor to stand firm against Medicaid expansion, arguing that it makes no sense to embark on a costly expansion of government services that depends on federal government funding.

“I don’t trust that the federal government will keep its word,” said Rep. Fred Keller, R-Union, one of the lawmakers who co-signed the letter penned by Rep. Tim Krieger, R-Westmoreland.

“Many voices have been raised in recent days urging Governor Tom Corbett to reverse his sound decision to reject the ObamaCare Medicaid expansion. Unfortunately, some of those voices have come from Republicans lured, once again, by the promise of ‘free’ money,” Krieger wrote in the letter. “Regardless of one’s capacity to suspend reality and believe the federal government’s promise to make the payments, the money to pay for all of this still comes out of the same pocket, the taxpayer’s. If Governor Corbett doesn’t stand up for Pennsylvania’s silent majority, the men and women who work to support their families and pay taxes, who will?”

Proponents of expanding Medicaid said it will chiefly benefit the working poor – the Maternity Care Coalition developed a list of likely job titles of those who would benefit from expansion, including child care workers, cashiers, library assistants, waiters and waitresses, hairdressers, housekeepers, cooks and hotel desk clerks.

Keller said he has heard little advocacy from constituents in favor of Medicaid expansion. “Most of the comments I’ve heard have been from people saying we shouldn’t be dumping more money into a broken system,” Keller said.

On Monday, the Democratic policy committee convened one of a series of hearings intended to hear testimony about the effects of Medicaid expansion. Another hearing is scheduled tonight in Williamsport.

Members of the committee said that much of the debate has failed to mention a couple of key points.

The state can begin expansion and then drop it if there is any reason to believe the federal government is not going to fund it at the promised levels.

Rep. Chris Sainato, D-Lawrence, said that Pennsylvania officials ought to view the expansion proposal as an opportunity for a free pass to provide coverage for hundreds of thousands of people, which can then be dropped without penalty.

 “We have three years to see if it is working,” Sainato said. “Our decision should not be made for three years.”

And though the governor’s explanation for declining expansion mentioned that Corbett wanted the Department of Health and Human Services to offer states flexibility in managing Medicaid, there has been no public explanation about how the governor would like to tailor the program, members of the committee said.

“I’m just praying that the flexibility isn’t to keep people like me in a nursing home,” said Cassie James, director of national advocacy and policy for Liberty Resources, a nonprofit that lobbies for those with disabilities.

James testified earlier in the hearing that Medicaid expansion “would be a blessing,” and that “not taking it is almost criminal.”

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