Support Medicaid plan
While all eyes were on Pennsylvania recently as Gov. Corbett announced his state-specific plan to provide health coverage to more than half a million uninsured residents, some critics misconstrued important facts in a rush to judgment of a rather creative proposal.
As an advocate for the care of the state's most frail and elderly residents, I applaud the governor's "Healthy PA" proposal. It's an innovative and thoughtful way to expand health insurance to those who need it most, and it does so in a way that doesn't further overburden Medicaid, which already is bursting at the seams.
Those who oppose the plan - namely, those who favor a vast and costly expansion of Medicaid - blame the governor for bending to ideological interests. But that criticism overlooks a few very vital truths.
First, Pennsylvania already spends nearly one-third of its budget on Medicaid. Only one other state spends a high percentage of its budget on the public health-care program.
Second, Medicaid already significantly underpays doctors, hospitals, nursing homes, dentists, and other health-care providers - to the point where some providers can't afford to care for those on Medicaid.
In a recent study published in Health Affairs, nearly one-third of the commonwealth's doctors said they are not accepting new patients on Medicaid. That's limiting patients' access to care, especially in rural communities.
This is also true in the long-term care community. Pennsylvania's skilled nursing centers, which care for the frailest and sickest elderly residents, are paid $9,500 a year less per patient than it costs to provide that care. And two-thirds of all nursing center residents are on Medicaid.
If a nursing center accepts Medicaid residents, it has to increase significantly the cost of care for its private-paying residents, forcing hardworking seniors to spend their savings much faster than they should.
As Pennsylvania's elderly population grows, the demand for long-term care services is also growing. "Healthy PA" ensures that the frail elderly remain a priority by targeting limited Medicaid dollars for older Pennsylvanians. This move assures that the elderly and disabled will not have to wait in line for services as the poor drain dollars away from these vulnerable populations.
Third, while the federal government under the Affordable Care Act has pledged to cover the full cost of Medicaid expansion from 2014 to 2016, states will have to contribute to the cost of these newly eligible participants starting in 2017.
Even with the federal dollars, the independent Kaiser Commission estimates that Pennsylvania's anticipated cost exceeds $700 million over the next six years.
Additionally, Kaiser estimates that Pennsylvania will need an additional $1.3 billion to cover the cost of "woodworking" Medicaid enrollees. These are people who currently are eligible for Medicaid and have never enrolled, but will come out of the woodwork to obtain coverage once the health-care mandate takes effect. The federal government only pays half the cost of their coverage.
The governor's plan also rightly preserves the state's Children's Health Insurance Program (CHIP), created under Gov. Robert Casey and expanded under Govs. Tom Ridge and Ed Rendell. CHIP is a partnership between the state and private insurers that has worked so well for 20 years that the federal government made it a national model. Moving children from CHIP to Medicaid will limit access to doctors and hospitals, disrupt longstanding provider-patient relationships, and possibly stigmatize families involved in the program. It will also mean that the federal government, which currently pays 67 cents on every dollar, will only pay about half, costing Pennsylvania millions in Medicaid dollars.
Some "Healthy PA" opponents have balked at the requirement that individuals show they are looking for work before qualifying for coverage. Most individuals already have to meet that mandate in order to receive unemployment compensation; why not the same for taxpayer-funded health insurance?
In his first budget address in 2011, Corbett said the state should fund the "must-haves," not the "nice-to-haves," meaning we shouldn't expand programs we cannot afford. He was right then, and he's right now. Unless we are willing to pay higher taxes, we cannot afford Medicaid expansion.
If the goal is providing insurance coverage and truly creating a "Healthy PA," not expansion of government, state and federal legislators should put partisanship aside, embrace Corbett's plan, and help get it across the finish line with the U.S. Health and Human Services Department. Those are the cards on the table; let's make them the winning hand.
Stuart H. Shapiro, M.D., is the president and CEO of the Pennsylvania Health Care Association and Center for Assisted Living Management. E-mail him at email@example.com.