Final Pa. Budget Fails to Make Up Lost Ground

By Sharon Ward, Third and State

The Pennsylvania Budget and Policy Center has released a full detailed analysis of the 2013-14 state budget plan spending $28.376 billion, roughly $645 million (or 2.3%) more than in the 2012-13 fiscal year.

Governor Tom Corbett signed the budget into law late in the evening of June 30, 2013. Overall, the plan is $64 million less than the Governor proposed in February, reflecting nearly $113 million in reduced spending for public school pensions and school employees’ Social Security payments along with a shift of $90 million in General Fund spending off budget to other funds.

2013-14 General Fund Summary

The plan includes a small increase to basic education funding, $122.5 million overall, with $30.2 million allocated to 21 school districts through a supplemental allocation, on top of the $90 million increase in the Governor’s proposal.

After many years of cuts, most programs received small increases in the Governor’s proposed budget, which remained in the final plan.

Changes to pension benefits for current employees, the cornerstone of the Governor’s original budget proposal, did not occur. The Legislature does not seem inclined to tamper with benefits for current employees. A proposal to move to a 401(k)-style retirement plan for new employees gained traction later in the session but was not adopted. This proposal may return in the fall.

Also abandoned was an $800 million education initiative to be funded through the sale of state liquor stores. While the privatization vs. modernization debate held center stage until the last week of the session, the school funding component was quickly abandoned and was not part of legislative proposals. Privatization is likely to be considered in the fall, as well.

For the first time in two years, there were no major cuts to services for vulnerable Pennsylvanians; however, a bill that would expand Medicaid coverage in 2014, a state option under the federal Affordable Care Act, was left undone. Legislation including the Medicaid expansion won bipartisan support in the Senate, but the House stripped out the expansion provision from the bill. When the bill returned to the Senate, a last ditch effort to restore the Medicaid expansion provision failed in a dramatic Senate committee vote on July 3.

Finally, a transportation funding package that would repair crumbling infrastructure and give a much needed shot in the arm to Pennsylvania’s flagging job growth failed to pass the House, despite overwhelming support in the Senate.

Get all the details from PBPC's budget analysis.

Lives Are on the Line in PA’s Medicaid Expansion Debate

By Chris Lilienthal, Third and State

Cover the Commonwealth: Lives on the Line RallyLast week, hundreds of people from across Pennsylvania took the Capitol by storm to put faces to the debate over expanding Medicaid health coverage in Pennsylvania.

The "Lives on the Line" rally featured a number of speakers who talked about the stress of working full-time without health insurance. One woman named Petrina has diabetes, but her employer doesn't offer health insurance. She had to fight back tears as she talked about the struggle to control her insulin. She is understandably terrified.

Mary Lou struggles to get through the days, given that she's needed new glasses for years.

Cheryl from Washington County recently incurred thousands of dollars in ER charges and has no idea how she'll ever pay it back.

And it goes on…

Cover the Commonwealth: Lives on the Line RallyAll of the speakers would have the security of knowing they can see a doctor when they get sick if Pennsylvania opted to take a federal opportunity provided by the Affordable Care Act (ACA) to expand Medicaid coverage in 2014 to adults with incomes up to 138% of the federal poverty line (roughly $32,000 for a family of four).

The federal government will pay 100% of the cost of new enrollees for the first three years—2014, 2015 and 2016—and will cover 90% of the costs by 2020.

Hundreds of thousands of Pennsylvanians will be eligible for health coverage under expansion, cutting the state's uninsured rate in half. Acting on this opportunity will create jobs, strengthen Pennsylvania’s economy, and make its citizens healthier and more financially stable. Get all the facts about the expansion in a new fact sheet prepared by the Pennsylvania Budget and Policy Center (PBPC).

Despite the tremendous upside, Governor Corbett has yet to decide on whether the state will expand, and there are only a couple weeks left before the Legislature breaks for the summer. That’s why the Cover the Commonwealth Campaign (of which PBPC is a member) organized last week’s Capitol rally.

And it was a success, generating good press coverage. The Governor’s office and legislators took notice, and the crowd was fired up. But more needs to be done to keep the pressure on Harrisburg to do the right thing.

You can help by calling your state legislators at 1-800-515-8134 and the Governor at 717-787-2500. Tell them: My name is ___ and I'm calling because Pennsylvania needs to accept federal funding to expand Medicaid. Thank you.

Republican Governors Opt-In to Medicaid Expansion

By Sharon Ward, Third and State

There is growing bipartisan agreement that the optional expansion of Medicaid provided by the Affordable Care Act is too good an opportunity to pass up.

This month, the Governors of Arizona and North Dakota, both Republicans, announced their intention to opt-in to the Medicaid expansion, joining their counterparts in Nevada and New Mexico. To date, 14 states have decided to expand Medicaid in 2014, and another seven are leaning toward expansion. Pennsylvania remains among the 21 undecided states.

Support for Medicaid Expansion Growing

Here’s what Arizona Governor Jan Brewer had to say about Medicaid:

By agreeing to expand our Medicaid program just slightly beyond what Arizona voters have twice mandated, we will:

• Protect rural and safety-net hospitals from being pushed to the brink by their
   growing costs in caring for the uninsured;
• Take advantage of the enormous economic benefits – inject $2 billion into our
   economy – save and create thousands of jobs; and,
• Provide health care to hundreds of thousands of low-income Arizonans.

Saying ‘no’ to this plan would not save these federal dollars from being spent or direct them to deficit reduction. No, Arizona’s tax dollars would simply be passed to another state – generating jobs and providing health care for citizens in California, Colorado, Nevada, New Mexico or any other expansion state … With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms … Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead. I’m committed to doing this, and I want you on my side. Let’s work together in an atmosphere of respect and do what is BEST for Arizona.

For Pennsylvania, the expansion of Medicaid is projected to bring in $17 billion in new federal investments by 2019, while expanding coverage to between 482,000 and 683,000 uninsured adults.

When Governor Corbett gives his budget address on February 5, he will offer a glimpse into the state’s plans to take advantage of this opportunity. Opting-in will create jobs, strengthen our health care system and provide health coverage to working parents, veterans, and seniors.

Governor Corbett and the Pennsylvania General Assembly should consider the benefits and savings that come with a Pennsylvania Medicaid expansion as well as the price of forgoing this opportunity – fewer jobs, a weakened health care delivery system and hardworking people without affordable insurance.

Mind the gap: Opting Out of Medicaid Expansion Leaves Low-income Families Behind

By Michael Wood, Third and State

Federal health care reform is moving forward thanks to the U.S. Supreme Court’s ruling last year – and it is a great deal for Pennsylvania. Unless the state decides to “opt out,” Medicaid coverage will be expanded to include many Pennsylvanians who are uninsured.

One group that will benefit immediately are parents with incomes up to 133% of the federal poverty level ($25,390 for a family of three). The benefits don’t end there: others who don’t receive health coverage through their work will be able to buy insurance on a competitive health marketplace or exchange – making coverage more affordable.

However, if Governor Corbett prevents the Medicaid expansion, it will create a coverage gap for families between 46% and 100% of poverty, as the chart below shows (click on it for a larger view).

Those families between 46% and 100% of poverty earn too much to qualify for Medicaid (for a family of three, this means earning over $8,781 but less than the federal poverty line of $19,090). These families won’t receive Medicaid coverage, and they won’t receive subsidies to buy health coverage.

We all benefit when more people have health coverage. Let’s make the right decision in Pennsylvania and expand Medicaid coverage.

Will Pennsylvania Take Full Advantage of Health Reform?

By Chris Lilienthal, Third and State

With the election decided, it is now clear that the Affordable Care Act is here to stay. That’s great news for Pennsylvanians, some of whom have already begun to benefit from the health reform law, and many others who will see more gains as major provisions take effect in 2014.

As Judy Solomon writes at the Off the Charts Blog, a key provision of the law will allow states to expand Medicaid to cover low-income adults earning up to 133% of the poverty line, with the federal government covering most of the costs:

The question now is whether some states will squander this opportunity to cover millions of uninsured Americans.

Coverage for more than 11 million poor, uninsured adults is at risk if states don’t expand Medicaid, according to the Urban Institute.

Status of Health Reform Medicaid Expansion

As you can see in the chart above, Pennsylvania is among the states that have not made a clear decision on the Medicaid expansion. 

Failing to expand Medicaid would squander the opportunity to boost our state economy. The Kaiser Commission on Medicaid and the Uninsured estimates that the Medicaid expansion in Pennsylvania will amount to at least $17 billion in additional federal dollars invested in the state between 2014 and 2019. By contrast, as Solomon writes, the “Congressional Budget Office estimates that if all states adopt the expansion, they will spend only 2.8 percent more on Medicaid from 2014 to 2022 than they would have spent without health reform.”

Failing to expand Medicaid would also cost Pennsylvania real money that would otherwise be saved by reducing what the state spends to provide health care in emergency rooms and health clinics to people without insurance. 

Governor Corbett and the Legislature should take steps to expand Medicaid in 2014. It will help thousands of working parents and other adults in Pennsylvania get the quality health care they need and give the state’s economy a real boost.

Health Care for Those With Pre-Existing Conditions Available

Gov. Corbett has tossed about 200,000 Pennsylvanians off medical care since his inauguration fifteen months ago.  He ended Adult Basic and slashed funding for Medicaid administered by the Department of Public Welfare.  This year’s $30 million cut to DPW follows his $426 slashing in 2011. This means many elderly, poor and disabled citizens are on their own.  There is a program for those with pre-existing conditions however:  The Pre-Existing Condition Insurance Plan, part of the Affordable Care Act.

I mentioned this problem to Joanne Grossi of HHS at the recent White House Community Partnership Summit and she followed up by having this information sent to me by HHS.

People who have had difficulty finding health coverage or have been turned down for coverage

because of a pre-existing condition and feel like they are out of options are not out of luck.

They may now be eligible for a new program created by the Affordable Care Act-the

Pre-Existing Condition Insurance Plan (PCIP). PCIP is one way the Affordable Care Act helps

uninsured people with pre-existing conditions get high quality care at affordable prices. PCIP is

designed as a bridge to 2014 when the nation transitions to a new marketplace and all

Americans-regardless of their health status-will have access to affordable, quality health

coverage through a competitive marketplace for health plans called a Health Insurance Exchange.

This health coverage program is administered at the state level in 27 states and by the federal

government in 23 states and the District of Columbia.

Plan Eligibility

To qualify for this program, a person applying for coverage must be: a U.S. citizen or reside here

legally; have been without health coverage for at least 6 months before applying; and have a

pre-existing condition or have been denied coverage because of a health condition. Eligibility is not

based on income and enrollees are not charged a higher premium because of a medical condition.

Coverage

The Pre-Existing Condition Insurance Plan provides people with a pre-existing condition

comprehensive health coverage at the same price that healthy people pay. It covers primary and

specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing

care and preventive health and maternity care.

Premiums may vary depending on where you live, your age, and which health plan you choose.

Enrollees may be responsible for paying a deductible and some cost-sharing expenses.

Life-Changing Results

This coverage program is already changing-and saving-the lives of enrollees across the country

and helping them finally receive treatment for conditions that have plagued them for years. James

of Katy, Texas was diagnosed with brain cancer last year. James was able to join the Pre-Existing

Condition Insurance Plan in Texas and he received the medical treatment that he needed.

More Information

Each state may use a different method to determine whether a person has a pre-existing

condition or has been denied health insurance coverage. For more information, including

eligibility, plan benefits and rates, and how to apply, visit www.pcip.gov and click on “Find Your

State.” Then select your state from a map of the United State or from the drop-down menu. The

PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826

(TTY 1-866-561-1604).

Six Months after the End of adultBasic

A blog post by Sharon Ward, originally published at Third and State.

It has already been six months since Pennsylvania pulled the plug on the adultBasic health insurance program for 37,588 people. The Pennsylvania Budget and Policy Center recently took a look at what happened to the Pennsylvanians who lost their adultBasic coverage on the first of March. While some found health insurance elsewhere, many have simply fallen through the cracks.

In all, fewer than 40% of former adultBasic enrollees have enrolled in Medical Assistance or Special Care, a low-cost, limited benefit product offered by Pennsylvania’s Blue Cross/Blue Shield plans. These were the two options most touted as alternatives for adultBasic enrollees.

According to data provided by the Pennsylvania Departments of Public Welfare and Insurance, only 12,814 former enrollees signed on to the Blues’ Special Care – about 34% of those enrolled in adultBasic when it ended. Special Care came at a cost four times more expensive than adultBasic, and with limits on medical coverage including a four-doctor-visits-per-year cap that may have kept it out of reach for most adultBasic enrollees.

Only 1,513 qualified for health coverage under Medical Assistance – 4% of those enrolled in adultBasic when it ended. AdultBasic was designed to provide health coverage to working adults who didn’t qualify for Medical Assistance but weren’t provided job-based health coverage. Still, many adultBasic enrollees might have qualified due to special circumstances: pregnancy, a diagnosis of breast or cervical cancer, or a disability. Despite a thorough review of cases by the Department of Public Welfare, fewer than expected adultBasic recipients are enrolled.

After six months, 62% of adultBasic enrollees, 23,261 individuals, are not enrolled in the two main alternative programs offered by the Pennsylvania Department of Insurance when the program closed.

Leaving people uninsured brings with it significant costs: to the individuals, and to the public who pays for their medical treatment at hospitals and, when the uninsured become the unemployed, for additional social services.

Under the federal Affordable Care Act, many former adultBasic enrollees will have access to insurance that they can afford when competitive insurance marketplaces open in January 2014. But that is a long time to wait for those who have fallen through the cracks.

Study Shows Medicaid Has Positive Health, Financial Impacts

( – promoted by John Morgan)

A blog post from Emma Lowenberg, originally published on Third and State.

This just in: providing the poor with medical insurance has a positive impact!

This isn’t news, exactly, but the argument for insuring low-income people has gotten a big boost from a groundbreaking new study in Oregon. This is good news for advocates of affordable health insurance, especially at a time when many are fighting state efforts to trim health care services for the poor.

As The New York Times reports, the study became possible because of an unusual situation in Oregon:

In 2008, the state wanted to expand its Medicaid program to include more uninsured people but could afford to add only 10,000 to its rolls. Yet nearly 90,000 applied. Oregon decided to select the 10,000 by lottery.

Economists were electrified. Here was their chance to compare those who got insurance with those who were randomly assigned to go without it. No one had ever done anything like that before, in part because it would be considered unethical to devise a study that would explicitly deny some people coverage while giving it to others.

But this situation was perfect for assessing the impact of Medicaid, said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Dr. Baicker and Amy Finkelstein, professor of economics at M.I.T., are the principal investigators for the study.

Previous studies have examined people with health insurance and those without, but researchers had difficulty controlling for things like high rates of smoking, obesity, and diabetes found in higher rates among people without insurance.

In the Oregon study, researchers discovered a marked difference in the health habits, feelings, and finances of those enrolled in Medicaid and those who were not.

According to numbers highlighted by The New York Times, those who had Medicaid were 35% more likely to visit a doctor than those who were not covered.  Women with coverage were 60% more likely to have mammograms and 70% more likely to have a clinic that they regularly visit. The number of people with coverage who reported good or excellent health increased by 25% in 2008, and they were 40% less likely to report deteriorating health than those in the uninsured group.

The remarkable differences extended to the financial realm as well – those who had Medicaid coverage were 25% less likely to have an unpaid bill sent to collections and 40% less likely to borrow money or skip other bill payments to pay for health care costs.

In 2010, Oregon was able to expand coverage to the remaining 80,000 applicants, effectively ending the experiment.  Researchers are currently probing their data to discern longer-term health effects of insurance – on weight, blood pressure, and cholesterol, for example.  What this will show us remains to be seen. If the current findings are any indication, though, the link between health insurance and well-being will likely be strengthened.

Indiana’s Ban on Planned Parenthood Imperils All Medicaid Funding

The Obama Administration has taken action against Indiana because of a recent law defunding Planned Parenthood.  Unfortunately for Gov. Mitch Daniels who heralded and signed the law, Medicaid prohibits such legislation:

Dr. Donald M. Berwick, administrator of the federal Centers for Medicare and Medicaid Services, said the state law imposed impermissible restrictions on the freedom of Medicaid beneficiaries to choose health care providers. The freedom of choice, he said, is generally guaranteed by the federal Medicaid law.

(disclosure:  I serve on the Board of Directors of Planned Parenthood Association of Pennsylvania, Planned Parenthood Pennsylvania Advocates and Planned Parenthood Pennsylvania PAC)

Of the 85,000 patients served by Planned Parenthood Indiana last year only 5,580 received abortions.  Like every other Planned Parenthood operation most of its services are for routine medical care.  Many of our patients are young, minority or both.  Poor women, especially, use Planned Parenthood clinics for gynecological examinations, pap smear, cancer screenings and contraceptives.  Indiana, in an unconstitutional attempt to deny women of their right to abortion, is cutting off all of these other services which is clearly against Medicaid law.

Indiana responded by saying it intends to break the law risking $4 billion of federal funding for the state’s Medicaid recipients.  This would include the elderly in long term care facilities and the poor who depend on the program for medical care.  All of this to stop 5,580 abortions per year.  Ironically the defunding will increase the number of abortions due to the absence of education and family planning, major services provided by Planned Parenthood.