Friday, August 1, 2014
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All Pennsylvanians Will Pay a Steep Price if We Don't Expand Medicaid

If Pennsylvania were looking for new slogan, it might consider this: "Our state needs workers!" In 1950, there were 8.7 working adults in Pennsylvania for every person aged 65 and older. Today, that number has dropped to fewer than four. It's clear from this demographic shift that Pennsylvania should be doing everything it can to retain and increase its workforce. Our tax base and our economy depend on it.

All Pennsylvanians Will Pay a Steep Price if We Don’t Expand Medicaid

If Pennsylvania were looking for new slogan, it might consider this: “Our state needs workers!” 

In 1950, there were 8.7 working adults in Pennsylvania for every person aged 65 and older.  Today, that number has dropped to fewer than four.

It’s clear from this demographic shift that Pennsylvania should be doing everything it can to retain and increase its workforce.  Our tax base and our economy depend on it.

Why, then, isn’t Pennsylvania expanding its Medicaid program?  The federal government will pay the full-freight cost for Medicaid expansion this year, next year, and the year after. Why are we alone of the Middle Atlantic group of states in not taking the federal funds and supporting our healthy adults?

To be eligible for Medicaid in New York, New Jersey, Ohio, Maryland, Delaware, and West Virginia, a healthy single adult resident must earn less than $15,282 per year (about $7.35 per hour, working 40 hours a week and 52 weeks a year). 

In Pennsylvania, a single adult is only eligible for Medicaid if he or she is disabled or pregnant.  A healthy state resident who works full-time for minimum wage ($7.25 per hour in Pennsylvania) in a job that doesn’t provide health insurance will be too poor for health insurance through Obamacare yet will not be eligible for Medicaid coverage. 

If I were a poor, healthy young adult in Pennsylvania, I would consider looking for work in a surrounding state.  All of them, except New York, have been creating new jobs faster than Pennsylvania.  And while I was looking, I would have the security of knowing I had health insurance through Medicaid.

Governor Corbett stated in his February 4 budget address that he does not support expanding Medicaid coverage because he doesn’t want adults who are poor and healthy to be placed into that program.  Instead, he wants them either to enroll in a private plan through the federally administered health insurance exchange or to go into another type of private plan.  He also wants healthy very-low-income adults to pay something for this non-Medicaid coverage, and he wants them to look for work.  (The earliest the plan could take effect is January 1, 2015, and then only if the federal government approves.)

If I were a 27-year-old who had been trying without success to find low-wage work, the cost of health insurance would pose an insurmountable burden.  My best bet would be to look for a better “deal” that would be available almost anywhere else nearby - in Maryland or Delaware or Ohio or New Jersey or West Virginia – where the job prospects are improving more quickly, and I would qualify for health coverage while I was looking.

While recent attention has focused on the immediate negative impact of the Governor‘s decision on the health of Pennsylvanians, the potential for economic harm is equally important.  The future financial security of our state depends on having an ample supply of healthy, young workers.  We can’t afford to drive them away. 

And the Governor’s decision may leave us with a less healthy population over time.  If we further deplete Pennsylvania’s, and Philadelphia’s, cohort of young people by creating real disincentives for them to stay, we will be left with a less healthy population.  Less healthy means more expensive in the long run.  That expense is paid through taxes on workers and employers.  Yet if we have fewer workers, we will have more difficulty spreading the tax burden.  It’s a bad cycle.

Not expanding Medicaid is wrong on several fronts.  It makes no economic sense.  And it is bad for everyone’s health.


From Obamacare to Medicare to managed care, read more of The Field Clinic here »

Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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