Karen Heller: A costly rebuff to Medicaid

Posted: February 11, 2013

One in six Pennsylvanians lacks health insurance. These people are your neighbors and relatives. They serve food and sell clothing. They work in malls and casinos. They provide care for the young and elderly.

People without health insurance routinely delay treatment. They get sicker, work less, suffer more, and die sooner.

Their ranks doubled in this region in the last dozen years. The Affordable Care Act would make 631,000 more Pennsylvanians eligible for Medicaid coverage next year, many of them making $10 an hour and just getting by.

During the first three years, the federal government picks up 100 percent of the tab, with support gradually falling to 90 percent afterward. Said Laval Miller-Wilson of the Pennsylvania Health Law Project: "This is a once-in-a-generational opportunity to get people coverage."

Last week, Gov. Corbett called it "financially unsustainable for the taxpayers," and strongly suggested he was saying no to Medicaid expansion.

He is the first governor of a blue state to reject the coverage for now. He is brutally wrong to do so. Six Republican governors, including those of Ohio, Michigan, and Arizona, accepted the expansion. New Jersey's Chris Christie has yet to announce his intentions.

Corbett was among the state attorneys general who unsuccessfully sued the government over the health-care law. He has been consistent in his vision of smaller government, and an advocate of privatization and business.

In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius last week, he wrote: "We can serve more of our citizens in Pennsylvania, but only if we are given the independence and flexibility to do so." His office later clarified that "we should instead look to help and incent employers to keep coverage for their workers and create new jobs."

In rejecting the expansion for now, the Pennsylvania Health Law Project, an advocacy group for low-income, elderly, and disabled residents, estimates the commonwealth will lose $17 billion in federal aid during the first six years while almost three-quarters of a million residents are denied coverage. (Eventually, subsidies from the federal government will decline and state contributions will rise.)

Yet Pennsylvanians, through federal taxes, will pay for the expansion regardless.

Which means we'll subsidize health coverage for residents of neighboring Ohio, New York, and Maryland while watching our residents go without.

The move will hurt our most vulnerable workers, as well as small and middle-sized businesses that can't afford insurance but would benefit from Medicaid-covered workers, the very companies Corbett tends to champion.

Medicaid expansion is good for the commonwealth's finances, which would benefit from an almost 6 percent tax levied on Medicaid-managed care plans while saving on multiple state programs now serving the uninsured.

"How is Pennsylvania different from Ohio and New York?" asked Villanova law professor Michael Campbell, an authority on public health. "I think it's a matter of values. How do you say no to a patently good deal? Do you think all folks have a right to health care?"

Medicaid is strong in preventive care, managing chronic illnesses like diabetes and asthma that, left untreated, result in sicker patients and larger bills.

Without preventive health, hospital costs will soar, along with insurance rates, which will be passed along to the insured.

Again, it's bad business. People need health insurance. Just ask anyone without it. Healthy employees work and pay taxes, improving the state's welfare. It's a path out of poverty, which ultimately reduces the cost for other state programs.

"People will not be as healthy. It's shortsighted," said Carol Goertzel of Pathways PA, which serves 6,500 low-income residents in the region moving toward employment, better housing, and self-sufficiency. "People will miss work because they're less well. It's just not very wise. It would be far more financially proactive for the health of our citizens to go with the expansion."

And, besides, we're paying for it anyway.

Contact Karen Heller at 215-854-2586 or kheller@phillynews.com, or follow on Twitter at @kheller.

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