Why expand Medicaid in Pennsylvania? For families.
Hundreds of thousands of uninsured families would get health insurance. The federal government would pay for it. The state's fiscal and economic health would benefit.
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.
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?
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.
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.
Erin Cusack/Maternity Care Coalition
Read more about The Public's Health.