Wolf’s Medicaid decision gives Pennsylvania a fresh health care start

On Monday, Governor Tom Wolf announced his plan to begin the transition from Healthy PA to a traditional Medicaid Expansion, a decision that will eliminate the red tape, delays and benefit cuts that have frustrated patients and providers since Healthy PA's rocky start on January 1.

From the perspective of the Pennsylvania Health Access Network, as advocates and as enrollment assisters, today's announcement is great news for the Commonwealth.  As a navigator organization, our helpline receives over 500 calls a week from people looking to apply for coverage. More than half have been Healthy PA eligible, and our enrollment assisters have been working round the clock to help these folks apply and enroll.

But it hasn't been easy — and the challenges have gone beyond those normally expected in a first-year rollout of a new program.  That's because Healthy PA wasn't designed with simplicity in mind. Under former Governor Corbett's direction, Healthy PA established an entirely new and distinct managed care system for Private Coverage Option plans, adding administrative challenges for insurers and confusion for consumers.

At the same time, Healthy PA segregated benefits, establishing one set for people with higher health needs and another — a very restrictive package — for those deemed "healthy" or those who simply couldn't navigate the new health screening questionnaire used to move people into one plan or there other.

While evidence, and common sense, tells us that insurance works best when the risk is broadly shared among the healthy and the sick, Healthy PA rejected that approach in favor of managing two separate risk pools. Doing so was unwise and untenable, and forced Pennsylvania's existing managed care plans to administer three different benefit packages (Healthy Plus, Healthy, or Healthy PA PCO) across two separate systems (HealthChoices and Healthy PA PCO). Such duplication is inefficient and more costly to manage.

For new Healthy PA applicants to receive the more generous Healthy Plus benefit package, they must meet the categorical requirements or complete an invasive and lengthy health screening questionnaire. Individuals with severe mental illness or chronic substance abuse issues may under-report their symptoms due to fear of stigma, leaving them stuck with a plan that will not meet their needs. Having inadequate coverage for behavioral health treatment does not make the need for care go away – it only delays preventive and maintenance care, forcing individuals to the emergency room for situations that could have been mitigated by adequate benefits.

Healthy PA has left individuals with fewer choices and tools to take care of their health care needs, and we know that will only lead to worse health outcomes and higher costs. Studies show that interruptions in Medicaid coverage lead to greater emergency room use and significant increases in hospital care for manageable conditions.

In just a few short months, Healthy PA has jeopardized the health of low-income Pennsylvanians by disrupting and cutting enrollees' benefits, delaying coverage for new applicants and piling on new layers of red tape that patients and providers are forced to fight through every day. It has made getting covered, and accessing care harder, not easier.

By acting to move Pennsylvanians into one benefit package, eliminating the invasive health screening questionnaire, and simplifying the process, Governor Wolf is acting in the best interests of patients and taxpayers. Our view, which is shared by a majority of voters, is that traditional Medicaid expansion has always been the best route to creating jobs, covering families and growing our economy.

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