What does the future hold for traditional Medicaid? Some believe that, in the future, traditional Medicaid and commercial insurance will converge so that patients who move from Medicaid to commercial insurance will see no disruption in coverage, service, or the provider networks from which they receive medical treatment. While full convergence may still be a long way off, there are strategies that policy makers can begin to implement now on the pathway to a healthy Pennsylvania.
First, it is important to minimize coverage gaps. Pennsylvania should opt to continue Medicaid eligibility until the end of each month to allow beneficiaries to maintain coverage until they are covered under a commercial health plan (known as a qualified health plan) at the beginning of the following month. This provides individuals experiencing an increase in income with a smooth transition to commercial insurance enrollment at the end of their Medicaid coverage period.
Another strategy is to ensure continuity of care and of providers for traditional Medicaid recipients. For example, Pennsylvania could require insurers that offer both qualified health plans and traditional Medicaid to use the same provider networks in each. It could also require insurers to honor the current treatment plans of patients.
Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations—and costs—go down.
In Philadelphia and its suburbs, hospital stays and days have dropped steadily—down about 12 percent*—since the enactment of the Affordable Care Act in March 2010. On the measure of less hospital care, could Obamacare be working?
As the leader of the region’s hospital association, I can assure you that hospital leaders are indeed working to achieve the goals of the Affordable Care Act. They are rethinking how their organizations deliver health care. They are investing in new ways to keep patients healthier, to keep them out of the hospital. If hospitals were airlines, it would be like changing the wings on the airplane while in flight.
When it comes to health coverage, 116,500 low-income adults in southeastern Pennsylvania, the vast majority of them working, are betwixt and between. Andre Butler, a banquet server, is one such uninsured Philadelphian, caught in Pennsylvania’s coverage gap.
Adults like Andre don’t qualify for Pennsylvania’s Medicaid program because they are single, or they are part of families with annual incomes greater than 33 percent of the federal poverty level (about $5,118 a year for a family of two).
What about getting coverage through the Health Insurance Marketplace? There’s no help for Andre here either. To get help paying for your health insurance, you have to earn at least $11,490 a year ($23,550 for a family of four).
Can Corbett’s Medicaid Plan Bring Coverage to the 116,500 Working Uninsured in Southeastern Pennsylvania?
The southeastern Pennsylvania health care community is encouraged by Governor Corbett’s unveiling of Healthy PA, the administration’s plan to strengthen Pennsylvanians’ access to affordable, high-quality health care.
Of crucial importance are the plan’s provisions for providing health coverage for Pennsylvanians earning up to 133 percent of the federal poverty level. The success of Healthy PA will depend in large part on finding innovative, sustainable ways to maintain our state's existing Medicaid health care safety net while also providing new, affordable, comprehensive health coverage options for low-income uninsured Pennsylvanians. In the Healthy PA plan, these new coverage options would be made available through the state's health insurance marketplace, or exchange.
Healthy PA’s exchange-based coverage options must be affordable for the individuals involved, who are earning less than $15,800 annually, as well as for the state budget, the commonwealth, and health care providers. The hospital community looks forward to additional details about how the Healthy PA framework will access and use the federal funds, available under the Affordable Care Act, to expand coverage for low-income Pennsylvanians, bring economic stimulus to our state, and reduce the burden of uncompensated care for hospitals.
Curt Schroder is the regional executive, Delaware Valley Health Care Council of HAP, the association for southeastern Pennsylvania hospitals.
Pennsylvania is in the midst of a discussion about whether to expand Medicaid under the health reform law to cover residents up to 138% of the federal poverty level. Because Medicaid covers care for many of the commonwealth’s neediest patients, hospitals have a lot at stake. But so does the economy of the entire state.
To get a better idea of what expanding Medicaid would mean, we commissioned a study by a major national research organization, RAND Health. Their report has been followed in the last week or so by two similar studies released by respected research groups in Pennsylvania—the Pennsylvania Economy League, and the commonwealth’s Independent Fiscal Office.