Deprecated: mb_convert_encoding(): Handling HTML entities via mbstring is deprecated; use htmlspecialchars, htmlentities, or mb_encode_numericentity/mb_decode_numericentity instead in /var/www/html/wp-content/plugins/super-cool-ad-inserter/inc/scaip-shortcode-inserter.php on line 37
Since the Affordable Care Act went into full swing last fall, those who’ve been able to acquire health insurance report a common symptom: feeling like a weight has been lifted off their shoulders.
“I’m not panicked about getting injured or sick anymore,” says Julie Goodenough of Crafton, who says she previously couldn’t obtain insurance because of high cholesterol. “Anytime I got behind the wheel of my car, I thought, ‘What if I get in an accident?’ Anytime I got a cold, I thought, ‘What if this turns into something serious?’ My life feels a lot more secure now.”
Not everyone has been so fortunate. Some Pennsylvanians still can’t afford health care, even with new incentives offered by the federal government, and yet aren’t quite poor enough to be eligible for Medicaid, a longstanding program that covers health costs for low-income people. The resulting “coverage gap” might trap as many as 500,000 state residents — and advocates say Gov. Tom Corbett is to blame.
Currently, individuals making more than $11,490 a year — or families of four making $23,550 — are ineligible for Medicaid. The ACA included a provision expanding Medicaid to individuals earning $15,900 or less, and families earning $32,400 or less.
That expansion could extend Medicaid to cover 52,322 uninsured individuals in Allegheny County alone, according to U.S. Census data. But Corbett has declined to take advantage of the program, proposing his own alternative instead. That makes Pennsylvania one of 24 states that have opted out.
The federal government has pledged to pay for 100 percent of the expansion for the first three years and 90 percent in the following years. Since January 2014, Pennsylvania has rejected $4.8 million in federal funding per day, says the Pennsylvania Health Access Network. But Republican critics warn that already-strapped states may struggle to pay their 10 percent share of the bill once it comes due.
Corbett’s alternative, Healthy Pennsylvania, would use federal Medicaid dollars to give qualifying Pennsylvanians a chance to purchase insurance directly from private companies, instead of a marketplace set up under the Affordable Care Act. This plan requires approval from the U.S. Department of Human Services; there is no deadline for that decision.
“This is a Pennsylvania solution that reforms a broken and financially unsustainable program,” Corbett said in a statement. Healthy Pennsylvania, he said, “reduce[s] government bureaucracy by using the private health-care market, and create[s] health-care choices for consumers. I will not accept Washington’s ‘one-size-fits-all’ approach for Pennsylvania, and I will not expand an entitlement program.”
In the meantime, Shayla Collins waits in limbo.
A Pittsburgh native, Collins returned in 2008 to help take care of her mother, who was living with Alzheimer’s. Since that time, Collins has been able to find only temporary and part-time work; she’s been unable to get health insurance as a result.
For Collins, getting covered would be about more than having a safety net in case of an emergency. She’s already dealing with chronic pain and several other health issues that have kept her from getting a job that provides health benefits.
“It’s a vicious cycle,” says Collins, 56. “There aren’t a lot of jobs I can do because I have a lot of physical problems. I can’t do any heavy lifting because of my back. I could actually try to get a retail job if I didn’t have all these problems. But I can’t stand for long periods of time.”
Collins currently goes to a health clinic with sliding-scale fees for basic health needs. She has a laundry list of things she would do if she could get health insurance.
“At the very least, I could start getting things looked at,” Collins says. “I could start physical therapy for my hip and my shoulder. Most places are going to want to get an X-ray to find out what’s wrong. Can I afford an X-ray without insurance? Absolutely not.”
By granting health-care access to those like Collins, proponents say, expanding Medicaid would infuse $43.3 billion into the state’s economy. According to the Kaiser Family Foundation, which specializes in health-policy research, other predicted benefits include $2.3 billion in federal payments to local hospitals, which support the proposal. (Hospital ERs must provide free care to those who have no coverage.)
Activists haven’t given up the fight.
“We’re awaiting a decision on the governor’s Healthy PA plan,” says Erin Ninehouser, education and outreach director for the Pennsylvania Health Access Network. “It looks like it’s not going to come soon, so we’re asking lawmakers to move ahead with an expansion of Medicaid while we wait.”
State legislators are currently considering HB 1492, which would expand Medicaid in accordance with the Obama administration’s plans, but only until Corbett’s plan is approved. If Corbett’s plan isn’t approved, the expansion would remain in effect, but the legislation includes provisions allowing the state to opt out of the expansion if federal government drops funding. The bill was passed by the House Human Services Committee earlier this month, by a 12-11 vote; three Republicans voted in support.
“Expanding Medicaid is absolutely the right thing to do, and passing this legislation now allows it to have serious consideration before the budget deadline,” said Rep Gene DiGirolamo (R-Bucks), who sponsored the legislation and a related amendment, in a statement. “This proposal allows the administration to continue negotiating with the federal government [and] gives the state the ability to draw down much-needed federal money.”
If HB 1492 fails, Ninehouser thinks expanding Medicaid could be used in state budget negotiations to help avoid a forecasted $1.2 billion budget deficit. Proponents say expanding Medicaid would generate more than $400 million in government savings for the next fiscal year.
“Coverage could be expanded right away. There’s no reason to keep people waiting,” says Ninehouser. “The money is there. The need is there.”
This article appears in Jun 18-24, 2014.
