Tuesday, October 21, 2014
Inquirer Daily News

Falling through the cracks in Pennsylvania

I'd like to mention the people left out, because Pennsylvania chose not to expand its Medicaid program in 2014. Thanks to the Kaiser Family Foundation, we have national and state-specific estimates of people who fall into this coverage gap in 25 states not expanding Medicaid this year. KFF estimates that 4.8 million people nationally-nonelderly, poor, and uninsured-will be left out of the ACA health reforms. Six per cent of them live in Pennsylvania.

Falling through the cracks in Pennsylvania

It’s tempting to get lost in the politics of Gov. Corbett’s proposed plan to expand Medicaid (see here for scathing commentary, here for gentler one) or the wonky “weeds” of the plan itself (see here for excellent analysis). 

But I’m not going to do that now.  Instead, I’d like to mention the people left out, because Pennsylvania chose not to expand its Medicaid program in 2014. Thanks to the Kaiser Family Foundation, we have national and state-specific estimates of people who fall into this coverage gap in 25 states not expanding Medicaid this year.  KFF estimates that 4.8 million people nationally—nonelderly, poor, and uninsured—will be left out of the ACA health reforms.  Six per cent of them live in Pennsylvania.

Across the state, 281,000 adults fall into this coverage gap. Of those, 180,000 are white; 62,000 are black, and 29,000 are Hispanic.  The vast majority (81%) are adults without dependent children; 42% are women.  And fully 60% are in a family with at least one worker.  They are ineligible for subsidies on the individual market (because they are below poverty level) and will most likely remain uninsured because they have no affordable coverage options.

The story of Gov. Corbett’s proposed plan is still unfolding.  To implement the plan, Pennsylvania needs a federal waiver of multiple Medicaid requirements. By rule, the waiver application must undergo a one month public comment period in Pennsylvania (six hearings are scheduled across the state), then another one-month federal comment period after it is submitted. If all goes according to plan, Gov. Corbett proposes a January 2015 start date.  But to 281,000 people in Pennsylvania, that’s a long wait.

Editor's Note: Cross-posted on the Voices@LDI blog of the Leonard Davis Institute of the University of Pennsylvania.


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Robert I. 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
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