Questions persist about Corbett's health-care plan

Depending upon whom you listen to, Healthy Pennsylvania, Gov. Corbett's plan to reform and expand the Medicaid program is a disappointing flip-flop; a good plan in need of tweaking; a bureaucratic nightmare; or all of the above.

Those were some of the opinions voiced at a public hearing - one of six statewide - held a little over a week ago at the National Constitution Center on the administration's plan to extend health insurance to as many as 500,000 commonwealth residents.

Pennsylvania, which did not take money to expand Medicaid in 2014, is one of three states seeking a waiver and approval from federal officials to implement its own plan starting Jan. 1, 2015.

The proposal contains 23 waiver requests and would likely involve the creation of a new bureaucracy to monitor its many requirements.

"Healthy PA may not be perfect," former Philadelphia Health Commissioner Stuart H. Shapiro read from his statement at the hearing. "But as I say simply, let's fix it, not nix it."

Nixed-not-fixed is how many health-care laws are first received. In 1965, Medicare was demonized as socialized medicine and the downfall of America. Delayed for weeks, Medicare Part D was considered a disaster in 2005. Now, both programs are madly popular with seniors.

And then there is the Affordable Care Act. It's way too early to say how history will judge it. Certainly the launch of its website will go down as a debacle beyond belief.

But since website fixes were made in December, more and more people have bought coverage online. As the Jan. 1 deadline passed, more than 2 million people had successfully enrolled for health insurance.

So where does Healthy Pennsylvania fit into the picture? People from the political right are mightily displeased that Corbett has expanded coverage at all, doing a full twisting flip on his anti-expansion pledge.

People on the left say he didn't stick the landing. "We have a lot of concerns," said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project.

Among those is a work-search obligation that is mandatory to get insurance under Medicaid. Healthy Pennsylvania requires newly eligible adults 21 and older who work less than 20 hours a week to register with the state's online job site. Medicaid recipients also must complete 12 work searches a month for six months to keep their insurance.

The feds have never granted a waiver that included a work-search provision. Will Pennsylvania be the first?

"It's hard to understand, given what we think is the federal government's response to that, why it continues to remain in the proposed waiver application," Miller-Wilson said.

The work-search regulation would likely mean creating more bureaucracy. And that leads advocates to wonder why a Medicaid program already overloaded with administrative requirements would add more.

The state is also asking to replace co-payments with premium payments in its Medicaid program. Iowa has been allowed to do something similar. But Miller-Wilson noted that two states that did impose Medicaid premiums - Oregon and Wisconsin - had steep drops in enrollment.

"In Oregon, even modest premiums resulted in the disenrollment of nearly half [46 percent] of the affected consumers from Medicaid within nine months," he said.

The Delaware Valley Healthcare Council supports Corbett's attempt to expand Medicaid, said Curt Schroder, its regional executive. But it also has reservations about the current proposal. For starters, it would like to see any expansion start in July.

In the last five years, Schroder said, the cost of uncompensated care for hospitals has risen 40 percent, reaching $363 million in 2012. Without a Medicaid expansion, hospitals expect that number to rise by $30 million more this year.

"The fact that there are so many waivers being requested in this proposal" could really create a barrier to access to coverage to insurance as well as delays and more uncompensated care to hospitals," Schroder said. "We want to see a waiver that Health and Human Services will be able to approve and will be able to approve in time for a July 1, 2014, implementation."

This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.