HARRISBURG – Gov. Tom Corbett’s top Department of Public Welfare official smiled and once again offered a variation of a statement that she had made countless times already in the past 24 hours to lawmakers pressing her for answers.
“At this time we’re moving down the path to look at all ways we can allow Pennsylvanians to have access to affordable, quality health care,” Bev Mackereth told members of the House Appropriations Committee Wednesday, the day after she testified before the Senate Appropriations Committee.
That path will take Corbett to Washington to meet with U.S. Health and Human Services Secretary Kathleen Sebelius about whether Pennsylvania should undertake a massive expansion of Medicaid’s health care coverage, largely to low-income adults, under the 2010 Affordable Care Act.
The meeting – possibly in late March or early April, Corbett’s administration says a date isn’t set yet – will be closely watched by people on both sides of the debate.
The federal government would foot nearly all of the cost of providing health care to hundreds of thousands of additional Pennsylvanians by widening Medicaid’s income eligibility guidelines to 133 percent of the federal poverty level, or about $31,300 for a family of four.
But Corbett, a Republican who sued unsuccessfully to throw out the 2010 law, is not embracing that option, which is available to every state as a result of a U.S. Supreme Court decision last summer that said the law could not force states into an expansion.
Corbett maintains that the expansion would require a tax increase because of future costs the state might have to shoulder, unless the federal government allows Pennsylvania the ability to tailor the program’s medical benefits to different types of people it covers.
“I can’t recommend it right now on the facts that I have right now,” Corbett told a Fox Business News interviewer Thursday. “If the facts substantially change, then I would have to reconsider where we are, but I don’t see that.”
Corbett, along with many lawmakers, also worries that the federal government’s promise to pay the lion’s share of the tab – 100 percent of the cost for newly eligible enrollees for the first three years, and gradually shrinking to 90 percent after that – can’t be trusted.
Still, Corbett is under pressure to do something about health care, as more than half the nation’s governors join the expansion, consider it or look for alternatives. The AARP, hospital executives and Democratic lawmakers all support the expansion. Many Republicans in the GOP-controlled Legislature either oppose it or say they are undecided, but a growing number support it.
“I’m going to push the governor on it,” said one supporter, Senate Banking and Insurance Committee Chairman Don White, R-Indiana.
Time is ticking: The money from the federal government starts flowing next year.
With Corbett up for re-election next year, Democrats routinely remind Corbett that he ended a subsidized health care program for 40,000 adults called adultBasic and that his administration apparently stopped Medicaid coverage for thousands of eligible adults and children– if not tens of thousands – amid an effort to root out waste.
A meeting with Sebelius could be productive.
Two other governors – Republican Rick Scott of Florida and Democrat Mike Beebe of Arkansas – returned to their states in recent weeks after meeting with Sebelius, seemingly bearing concessions.
In Beebe’s case, it was the ability to use Medicaid funds to purchase private insurance for people who would be newly eligible, an idea designed to win over the state’s Republican-controlled Legislature. For Scott, it was a willingness to allow Florida to enroll tens of thousands of older, long-term care patients into a Medicaid program run by managed care organizations.
Beebe already supported the expansion when he met with Sebelius; Scott changed his position after meeting with the former Kansas governor.
It’s not necessarily clear whether Beebe and Scott had to fight for those concessions, or whether Sebelius agreed to the sweeteners precisely to get Florida and Arkansas to join the Medicaid expansion, said Alan Weil, the executive director of the National Academy for State Health Policy in Washington, D.C.
But it is clear that she wants states to join.
“It’s some deal-making, but it’s also some showmanship,” Weil said. “It’s a win-win to do this. (The Department of Health and Human Services) wants the win, but the governor also wants to stand up in front of the state and say, ‘Here’s the concession I got from HHS.’ I just don’t know how much of it’s real and how much of it’s show.”
Corbett is expected to bring his own requests to a meeting with Sebelius. The question is whether Sebelius will be flexible enough for Corbett.
“I would say they’re absolutely trying to be as flexible as possible,” said Joan Alker, the co-executive director of Georgetown University’s Center for Children and Families in Washington, D.C. “But there are some lines that (Sebelius) will not cross.”