health care

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:

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. 

Uncompensated Care Costs Rise at PA Hospitals

By Chris Lilienthal, Third and State

More than a year ago, the Corbett administration decided to end the state's adultBasic program, which provided affordable health insurance to about 40,000 low-income Pennsylvanians who were unable to obtain coverage from an employer or through other programs.

We worried at the time that many of those newly uninsured would delay treatments until a health condition snowballed into a more serious and costly problem, sending more people to the emergency rooms of our community hospitals.

The Pennsylvania Health Care Cost Containment Council released a report this week showing that uncompensated care costs at hospitals did in fact rise in the 2010-11 fiscal year, when adultBasic ended. Uncompensated care totaled $990 million — an 11% increase over the prior year.

Dave Wenner at the Harrisburg Patriot-News has more:    

Let the Games Begin: PA Senate Announces Details of Budget Proposal

By Sharon Ward, Third and State

Action on the state budget began in earnest Monday with state Senator Jake Corman, chairman of the Appropriations Committee, releasing important details on the Senate budget plan that will be advanced this week.

The proposal would increase Governor Tom Corbett's budget proposal by $500 million, with total spending rising from $27.15 billion to $27.65 billion for 2012-13. The Senate plan rejects $191 million in fund transfers and new revenue and proposes new spending cuts of $165 million. Those spending reductions were not yet detailed.

According to a Capitolwire.com report (subscription required), the Senate budget plan:

Nowhere to Go, More Addicts on the Street and a Ringing Irony

Based on blog posts by Chris Lilienthal originally published here and here at Third and State.

The Philadelphia Inquirer reports this morning on the impact of Pennsylvania Governor Tom Corbett's proposed budget cuts on the lives of people in Southeastern Pennsylvania. Who is getting hit? Adults with disabilities, the homeless, people with mental-health illnesses, HIV patients needing hospice care, children aging out of foster care, and seniors, among others.

Miriam Hill, The Philadelphia InquirerPeople who will be affected by Corbett's cuts:

Brittany Stevens doesn't talk a lot, but she's a bit of a social butterfly. She was a prom queen and, after a recent performance of the musical Fela!, she spontaneously hugged the dancers, nearly tackling them in excitement.

But Brittany, 21, who is disabled and suffers from seizures, incontinence, hearing loss, and other problems, spends most of her days alone in her North Philadelphia home, while her mother, Harlena Morton, goes to work as a high-school counselor.

Morton had hoped to find Brittany a job in a workshop that employs disabled adults. Now that Gov. Corbett has proposed large cuts to social services programs, Morton fears that Brittany and thousands like her will never get off waiting lists for those spots and for other services...

In Philadelphia, the cuts total about $120 million, not including reductions in medical care, city officials say; across Pennsylvania, $317 million, according to state officials.

The Return of Bigfoot: Telling the Truth about Welfare Spending in Pennsylvania

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

BigfootYou may remember that the Commonwealth Foundation put out a report about welfare spending a couple of weeks ago that we likened to “Bigfoot” because it found something in the Department of Public Welfare — massive fraud, millions of non-working adults — that just didn’t exist.

I had a chance to debate Matt Brouillette of the Commonwealth Foundation on WITF’s Radio Smart Talk, and I thought it might be a good time to share the facts and give you my four big ideas about how we push back on the destructive framing that the “Bigfoot” report perpetuates.

First, let me give a shout out to the people who called in to Smart Talk to set the record straight on welfare spending and challenge Matt directly on his use of the welfare frame. It was clear to the listeners that Matt was quite deliberately trying to invoke the image of Ronald Reagan’s welfare queen by describing welfare as everything from afterschool programs to autism services. The audience wasn’t buying it and we shouldn’t allow it.

The first step  when talking about this issue, is to define welfare accurately.

1. Welfare is cash assistance.

The Future of Health and Human Services in PA

Sharon Ward, director of the Pennsylvania Budget and Policy Center, was on WITF's Radio Smart Talk this week to discuss the state of health and human services in Pennsylvania. She squared off with Matt Brouillette of the Commonwealth Foundation.

She explained that it was important for the commonwealth to spend taxpayer money wisely, but that current policies were resulting in eligible Pennsylvanians, including thousands of children, losing their health care.

Rather than taking away health care from children or jeopardizing the nursing care of seniors, state policymakers should look at alternatives, including closing tax loopholes and ending corporate welfare.

You can listen to the show at WITF's web site. Let us know what you think in the comments section.

Governor's Budget Moves PA in Wrong Direction

Governor Tom Corbett delivered his 2012-13 budget address to a joint session of the state Legislature today. We are still working on our budget analysis at the Pennsylvania Budget and Policy Center. Check our web site later Tuesday evening.

In the meantime, check out Sharon Ward's op-ed below on the Governor's budget originally published in the Allentown Morning Call.

Must Reads: Where Is the Shared Sacrifice?

A blog post by Mark Price, originally published at Third and State.

When the economy is as weak as it is today, the prudent approach to the state budget is a balanced approach that looks to cut spending and raise additional revenue. A Patriot-News editorial this morning points out that nonprofit groups providing services to victims of domestic violence and rape, as well as people with severe health problems, have been particularly hard hit by the last several years of budget cutting.

The last couple of years, especially 2011, have been tough ones because of state funding cuts, and this year might not be much better. As lawmakers and the governor look at another difficult budget — introduced in February — they need to think hard about what further reductions in funding to charitable groups will mean in communities across the state...

Some of the testimonials in the latest survey [by the United Way] show the grim reality for many people seeking help:

A shelter director said, “For the second year in a row, our shelter has turned away more battered women and their children than we were able to house, due to lack of beds.”

“We are unable to provide health center services as we were before. A nurse is only at the center 16 hours per week vs. 40 hours,” one service stated.

“We’ve had to tell people wanting to get their GED that they had to seek services elsewhere,” a provider said.

“Ms. Smith has ALS and needs a device to be able to communicate in her last days. However, she is on a waiting list to borrow the equipment she needs,” added another.

Don't Weaken PA's Oversight of Health Insurance Rate Hikes

Many states have taken steps to ensure that there is a meaningful review of proposed health insurance rate increases for small businesses and individuals.

Pennsylvania, however, is headed in the opposite direction with legislation in the House and Senate that would keep more consumers in the dark and undermine the state’s ability to review most rate hikes.

House Bill 1983 and Senate Bill 1336 would extend rate review to insurance providers that currently escape any scrutiny, but they also reduce the Insurance Department’s authority to review and disapprove rates. The bill would give insurers license to raise individual and small business rates by 9.99% annually without any review at all. Small employers already struggling from the recession cannot afford continual rate increases and deserve to have better protection than this bill affords.

You can get more details in a memo that Pennsylvania Budget and Policy Center Director Sharon Ward wrote to editors and reporters today.

Under current state law, the Pennsylvania Insurance Department has some authority to review rate increases. It is not a perfect system, but the Department has used it effectively to perform rigorous reviews of numerous rate proposals. According to a recent Government Accounting Office study, in 2010, 37% of rate filings were reduced or withdrawn after Insurance Department review, ranking Pennsylvania 9th in the nation.

Instead of curtailing the Department’s authority, lawmakers should improve upon it with greater transparency, citizen input and meaningful review of all rate proposals.

Census Data: For Record Number of Americans, Recession Is Far From Over

Poverty has been rising for much of the last decade
View more charts
from the Center on Budget and Policy Priorities, interpreting the Census data

National poverty rate hit 15.1% last year, the highest level since 1993

As the recession took its toll last year, more Americans fell into poverty, saw their incomes decline and joined the ranks of the uninsured, according to new data from the U.S. Census Bureau.

The Census Bureau released the results of its annual Current Population Survey today in a new report — the first to include a full year of data from the Great Recession.

During 2010, the poverty rate increased to 15.1%, the highest level since 1993, with a record-breaking 46.2 million American adults and children living in poverty. Median household income also declined, and the number of individuals without health insurance increased again, now approaching 50 million.

Public programs continued to play an important role in blunting the full force of the economic downturn. An estimated 3.2 million Americans were kept out of poverty through unemployment insurance coverage, while public health programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) helped to fill the gap as employment-based coverage declined once again.

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.

Building a Competitive Insurance Marketplace in PA

A blog post from Christopher Lilienthal, originally published on Third and State.

So have you ever used Travelocity to book a flight? Or the Consumer Reports web site to research a new car?

Then you probably know the value of comparative shopping. I, for one, never book a flight before comparing just about every option and airline. What is the cheapest day of the week to fly, which airline offers nonstop flights, how long will I be in the air?

As Antoinette Kraus of the Pennsylvania Health Access Network (PHAN) wrote in an op-ed last week:

Sites like Travelocity have made air travel, car rentals and hotel bookings more convenient, competitive and affordable.

The same can't be said for health insurance, but that's about to change. The federal Affordable Care Act calls for the creation of competitive health-insurance marketplaces by 2014 to provide individuals and small businesses with a place to buy high-quality, affordable health coverage.

Pennsylvania's Insurance Commissioner is holding hearings this month to gather public input on what the state's new health insurance marketplace should look like. Hearings were held outside Pittsburgh and Philadelphia earlier this month, with the third and final hearing happening today near Harrisburg. Sharon Ward of the Pennsylvania Budget and Policy Center will be one of the testifiers at that hearing.

State Cuts to Education, Health Care Will Slow Recovery

A blog post from Christopher Lilienthal, originally published on Third and State.

We have written about the negative impact that deep cuts to state funding will have for Pennsylvania children, seniors and our economy. Now a new report from the Center on Budget and Policy Priorities shows that we aren't alone.

At least 38 of the 47 states with new 2011-12 budgets are cutting K-12 education, higher education, health care, or other key public services, according to the report. As Policy Analyst Erica Williams writes at the Center's Off the Charts Blog:

While states continue to face rising numbers of children enrolled in public schools, students enrolled in universities, and seniors eligible for health and long-term care services, most states (37 of 44 states for which data are available) plan to spend less on services in 2012 than they spent in 2008, adjusted for inflation — in some cases, much less.

State lawmakers no doubt faced tough decisions this year, with revenues still far below pre-recession levels and emergency federal aid all but expired. Still, our review shows that the cuts are unnecessarily harmful, unbalanced, and counterproductive.

Pennsylvania is among that group spending less in 2012 than in 2008 (adjusted for inflation):

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