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Budget Hearings Kickoff with Medicaid Debate

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The Governor’s Office and Senate Democrats aren’t on the same page when it comes to expanding Medicaid under the federal Affordable Care Act.  Based on the exchanges that played out on the opening day of state budget hearings, they may not even be reading from the same book. 

When pressed for answers as to why the administration isn’t planning to expand the Medicaid program, Budget Secretary Charles Zogby told the Senate Appropriations Committee that it would cost the state an extra $200-million dollars next year and more than $4-billion dollars within the next decade. 

“I don’t know where that money comes from,” Zogby said while noting that not enough attention is being paid to the cost side of the Medicaid equation. 

Senate Minority Appropriations Chair Vincent Hughes (D-Philadelphia) noted a “huge gulf” between the analysis of the administration and the analysis of legislative Democrats. “Our analysis indicates that the implementation of Obamacare saves $200-million because the feds are now paying for state dollars on the General Assistance population, saves about $140-million in state payments for county health services, and saves about $100-million in uncompensated care costs.” 

Hughes pressed Budget Secretary Zogby for a public vetting of the numbers the administration has been crunching.

State Senator Larry Farnese (D-Philadelphia) later found irony in Zogby’s complaints about how unresponsive the Obama administration has been to the governor’s Medicaid questions, while the Corbett administration has not responded to Senate Democrats’ request to see their fiscal analysis.

The House and Senate Appropriations committees will continue to hold budget hearings through March 7th.

No Medicaid Expansion, Corbett Seeks Reform

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Pennsylvania will not pursue an expanded Medicaid program until the federal government reforms the system.  Governor Tom Corbett made his intentions known during Tuesday’s budget address before the General Assembly.  “We cannot afford to expand a broken system,” Corbett announced.  “Right now, without expansion, the cost to maintain our current Department of Public Welfare programs will increase by $400-million dollars.  The main driver in that cost increase is Medicaid and long-term care.” 

The Affordable Care Act expanded Medicaid to cover people up to 138% of the federal poverty line, but a Supreme Court ruling made it an option for the states. 

Until reforms are made, Corbett is opting out.  “The federal government must authorize real flexibility and innovative reforms that empower us to make the program work for Pennsylvania,” he says.  The governor has written the federal government to express his concerns.   

But the move has irked Senate Democrats, as Medicaid expansion supporters say it would cover at least a half-million more Pennsylvanians, save on uncompensated care costs and inject billions of federal dollars into the state’s economy.

Vincent Hughes

State Sen. Vincent Hughes

“The governor is walking away not just from the number one health care issue that is confronting us, but the number one job creation issue that exists in front of us,” Senator Vincent Hughes lamented in the wake of Corbett’s budget speech. 

The federal government has promised to pay 100% of the cost of the Medicaid expansion for the first three years, but the Corbett administration says the state’s administrative costs would approach $1-billion dollars over that time, and they are not interested in raising taxes or cutting programs to make up the difference.

Last December, Corbett also passed on a state-run health insurance exchange, under the new federal health care law.

RadioPA Roundtable

Radio PA Roundtable 12.14.12

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On this week’s Radio PA Roundtable, Brad Christman and Matt Paul break down Governor Tom Corbett’s big decision on a health care exchange and look ahead to possible Medicaid expansion under the Affordable Care Act.  Also, Matt speaks with US Seantor Bob Casey about the gift card regulations he’s pushing this holiday season.

Radio PA Roundtable is a 30-minute program featuring in-depth reporting on the top news stories of the week.

Click the audio player below to hear the full broadcast:

[audio:https://s3.amazonaws.com/witfaudio/radiopa/Roundtable12-14-12.mp3]

Will PA Take Medicaid Expansion Option?

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Governor Tom Corbett has already decided against a state-based insurance exchange under the Affordable Care Act, but he’s still mulling whether to take an option to expand Medicaid.  The federal health care law expanded Medicaid to cover people up to 138% of the federal poverty line, but the courts have since made in optional for the states.

The federal government would pick up the vast majority of the tab, and state Senate Democratic Appropriations Chair Vincent Hughes (D-Philadelphia) is urging the governor to opt-in.  “That is a $4-billion dollar windfall for the people of Pennsylvania.  That’s $4-billion dollars of new investment in our health care network across the Commonwealth,” Hughes tells reporters.

Supporters say it will ensure health care coverage for hundreds of thousands of Pennsylvanians, save on uncompensated care costs and stimulate the economy.  Critics say it will financially burden the Commonwealth, and question how the federal government can truly fund its share of such a massive Medicaid expansion when it’s $16-trillion dollars in debt. 

In a statement, Governor Tom Corbett said he will continue to seek guidance from the US Department of Health and Human Services on the costs, impacts and flexibility involved in the state’s options.

State Holds Off on Controversial Co-Pay for Now

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The state was taking some heat for a plan to require an income based Medicaid co-pay for families with disabled children.  The plan is now on hold, and families of children with autism and other disabilities will not have a co-pay until further notice.

The Department of Public Welfare is reviewing the plan.  Spokeswoman Donna Morgan says they had preferred the option of a premium, but would need federal approval. They had requested a waiver last year, but had not gotten a final answer. The department will renew its efforts to get a waiver to impose a premium.

Morgan says a premium would be a flat fee and easier for families to budget. She says they have been hearing from advocates and stakeholders that they would prefer a premium instead of a co-pay.

The department will notify families once a decision is reached.

Morgan says the program invests over 700 million dollars a year for over 48 thousand families and the state needs to make it sustainable.

Senior citizen woman

Nursing Homes Worried About Cuts in Governor’s Budget

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The gap between the cost of care and reimbursements has been growing for nursing homes  and they’re worried about cuts in the Medicaid reimbursement rate in Governor Corbett’s proposed budget.

While a 4% reduction may sound like a small number to some,    Dr. Stuart Shapiro, President of the Pennsylvania Health Care Association, says it will be the straw that breaks the camel’s back for nursing homes.  He says they’re already underpaid by Medicaid.  He says the gap has grown by 27% in the last year.

In the past, Dr. Shapiro says Medicare used to cover some of that gap.  But with the recent Medicare cuts of 20% in Pennsylvania, the nursing homes cannot sustain any more losses under Medicaid.

He says additional cuts in reimbursements may mean tough decisions for nursing homes about taking people on Medicaid. Dr. Shapiro says they face a real dilemma about how many individuals on Medicaid they can take.  About two-thirds of nursing home residents are on Medicaid.

Dr. Shapiro says it’s not only nursing homes that will be affected.  He says it’s putting pressure on the county facilities, which are already quite full.  He says it’s also putting pressure on hospitals, because individuals who should be discharged to a nursing home may have difficulty finding a place to go.

Dr. Shapiro says they hope to work out a solution in talking with lawmakers and the Governor.  He says “no matter how tough times we have, we’ve made a promise to our elderly that we would take care of them, that we would provide quality care, and now is not the time to break that promise.”