Why expand Medicaid in Pennsylvania? For families.

Gov. Corbett, joined by Speaker of the House Sam Smith (left) and Lt. Gov. Jim Cawley, delivering his budget address on Tuesday. He said he was not ready to expand Medicaid. (Matt Rourke / Associated Press)

On Monday, Ohio Gov. John Kasich, a conservative Republican, said “yes” to his state receiving billions of federal dollars to increase health-care coverage through Medicaid expansion. The following day, Republican Gov. Tom Corbett, in an unsurprising but still disappointing turn of events, announced he was “not recommending”  that Pennsylvania accept this money at this time – a statement that could leave hundreds of thousands of uninsured families out in the cold.

Since 2010, the public debate on health reform – plagued by myths, political ideology, and not a few unfounded claims – has devolved from a conversation about solving the problem of the uninsured, to a game of partisan bickering and infighting. Now, with election season behind us and the implementation of most important provisions of the Affordable Care Act (ACA) less than a year away, Pennsylvania faces the largest public policy decision regarding Medicaid in decades, as does New Jersey: Should the state expand Medicaid and health coverage as part of landmark health care reform?

In 1965, when President Lyndon B. Johnson amended the Social Security Act to enact Medicaid, the federal government promised an unprecedented state-federal partnership that would provide health insurance to millions of uninsured Americans. Although all 50 states would eventually join the program by 1982, only six would set the precedent by joining Medicaid in its inaugural year. Pennsylvania was one of them. As a result, thousands of uninsured Pennsylvanians had access to life-saving health care for the first time.

Today, one in five residents in Pennsylvania receives health coverage through Medicaid. In addition, almost half of all births in Pennsylvania, and 35% of children, are covered by this critical program. While Medicaid and the Children’s Health Insurance Program (CHIP) together provide a strong base of health coverage for low-income children and pregnant women – as Medicare does for the elderly – eligibility for low-income adults ages 18 to 64 remains extremely limited. And pregnant women’s coverage ends almost immediately following birth.

The Affordable Care Act's Medicaid expansion, which increases the number eligible for coverage by significantly raising the income limit, to 138 percent of the federal poverty level ($26,344 for a family of three), is key to providing coverage to millions of uninsured adults.

Who are the people who would benefit from Medicaid expansion?

Despite many misconceptions, most of the uninsured are working people in low-wage jobs, often with families to support. They are our children’s child care providers, our parents' nursing aides, and our paramedics. A disproportionate number are women, who make up the majority of the service, child care, and other industries that typically do not offer employer-based health insurance. Currently there are an estimated 613,000 uninsured residents in our Commonwealth who would be Medicaid-eligible in 2014; 411,100 of them are uninsured workers. And families? A projected 131,000 uninsured parents in Pennsylvania could gain health coverage under the proposed expansion.

We know that the inability to access health care jeopardizes a family’s employment and financial security. We also know that the failure to treat parents’ mental and physical health conditions can contribute stressors that may adversely impact their children's health and well-being. Furthermore, research shows that children are three times more likely to have health insurance if their parents have health insurance. This means that if we cover parents, we cover kids – and promote healthy families and communities overall.

What would the Medicaid expansion mean for maternity care? Giving women greater access to Medicaid, before and between births, will significantly lower risk factors, such as diabetes and smoking, that worsen birth outcomes.

For the nearly dozen states that have already turned down the expansion, citing high costs as a barrier, the numbers simply do not add up.The federal government will cover 100% of the expansion costs through 2016, and is projected to invest $17 billion in Pennsylvania during the first six years of the expansion. By 2020 and thereafter, Washington will continue to cover 90 percent of the costs, a significantly better deal than the 55 percent federal match that Pennsylvania now receives for Medicaid (and will continue to get for programs that are not part of federal health reform).

Given these calculations, perhaps the appropriate question is not “How can we afford to expand Medicaid,” but “How can we afford not to”?

The Affordable Care Act that was passed by Congress and signed into law by President Obama assumes that the majority of uninsured Americans will gain coverage in 2014 from either the Health Insurance Exchanges, where those making between 100 and 400 percent of the federal poverty level will receive subsidies to purchase insurance, or the Medicaid expansion, which would cover the poorest people.

Every state will still have an exchange; Gov. Corbett two months ago opted to have Washington, rather than Harrisburg, run the Pennsylvania exchange. Whether or not to expand Medicaid, however, was made optional by the U.S. Supreme Court in its ruling last year that upheld the health-care law overall.

If Pennsylvania foregoes this unprecedented opportunity, the state’s lowest-income uninsured residents, parents, and working families will be largely excluded from the benefits of health-care reform. And the fiscal and economic impact will prove colossal, hurting health-care providers, businesses, and of course, the pocketbooks of Pennsylvania residents whose tax dollars will be diverted, more and more, to pay for uncompensated care in Pennsylvania and to fund the Medicaid expansion in other states.

Just like in 1965, Pennsylvania should set the precedent for the country and lead the way in providing health care to its low-income women, families, and workforce. It’s not just a political or an economic question: it’s a health equity issue, and one that gets to the very heart of why we needed, and fought so hard, to provide health care to the uninsured in the first place.

Wouldn’t it be nice to say, for the first time in our state’s history: Pennsylvania’s got you covered?

Erin Cusack is community engagement coordinator, and Bette Begleiter is deputy executive director, of the Maternity Care Coalition, www.maternitycarecoalition.org a Philadelphia nonprofit that works to improve maternal and child health and well-being.


Who is Eligible for Medicaid:
2013 (before expansion) vs. 2014 (if expansion is accepted)


Family Size


Current Medicaid

0-46% federal poverty level


Expanded Medicaid

0-138% federal poverty level



$15, 415










Erin Cusack/Maternity Care Coalition

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