By Kate Michelman and Carol E. Tracy
Pennsylvania is facing a 1.3 billion deficit and the annual state budget is due June 30. The obvious solution is to expand Medicaid, but some Pennsylvania legislators won't consider it.
When Governor Corbett rejected expanding Medicaid as designed under the Affordable Care Act ("ACA"), the state gave up millions of dollars in federal funds that are still available, ready to be disbursed. By expanding Medicaid, even temporarily, Pennsylvania lawmakers could immediately draw down $600 million dollars for the 2014-15 budget - $500 million more than Governor Corbett's Executive Budget - which would slash the 1.3 billion deficit considerably.
Of course, Medicaid expansion would also mean that the 600,000 Pennsylvanians left in the "coverage gap" without access to healthcare could actually see a doctor.
Refusing to expand Medicaid immediately in the face of a budget crisis not only means forgoing $500 million dollars in readily available revenue, but also maintaining an unacceptable status quo that means some of the most vulnerable Pennsylvanians receive the least help.
Currently, because Pennsylvania didn't expand Medicaid, the qualification cut-off for "traditional" Medicaid for non-disabled parents is 38% of the federal poverty level, or about $9,000 a year for a family of four.
Meanwhile, the ACA provides families of four earning between $24,000 and $95,500 a year with tax subsidies to assist them with purchasing a private insurance plan through the online marketplace. Families with incomes between $9,000 and $24,000 are left uninsured.
Refusing to expand Medicaid as intended under the ACA has created a bizarre system where a mother of two children who earns $10,000 a year does not qualify for subsidized coverage, while a childless single person earning $44,000 a year does.
Healthy mothers mean healthy families. Women's lack of access to healthcare contributes to ailments that cause premature births, infant mortality and maternal mortality. With recent research showing that pregnant women and infants in Philadelphia suffer higher incidence of maternal and infant mortality than the rest of the country, we can't afford to continue to play politics with health policy.
Health shouldn't be determined by geography.
Every state touching Pennsylvania's borders has expanded Medicaid. To be clear, the 600,000 working-poor Pennsylvanians in the coverage gap are stuck there simply because they live in Pennsylvania.
In addition to improving health and adding $500 million dollars in revenue, expanding Medicaid would create approximately 35,000 jobs.
State budget secretary Charles Zogby recently admitted that if the state attempts to balance the budget with only existing revenues, there would be no new funding for basic education, higher education or to reduce waiting lists for services for people with intellectual disabilities.
Governor Corbett has been fighting against the Affordable Care Act since he filed an unsuccessful lawsuit against the law as attorney general back in 2010. How much longer and how much more is he willing to sacrifice to the game of partisan politics?
Medicaid expansion in Pennsylvania need not disrupt the approval process for Healthy PA, the alternate plan Governor Corbett submitted for federal review. (Healthy PA proposes to use the federal funds earmarked for expansion to provide a new form of coverage to low-income Pennsylvanians while cutting and limiting current benefits.) Policy experts point to New Hampshire as an example of a state that temporarily expanded Medicaid while negotiating an alternate waiver.
The budget crisis is frightening, but it is at least forcing the Pennsylvania legislature to reveal what they value most. They can choose partisan gamesmanship over the financial health of the Commonwealth and literal health of 600,000 citizens, or they can improve the health of working men and women, create jobs, and lay claim to $500 million additional federal dollars while slashing the budget deficit.
It seems clear it's time to choose responsible governance over petty politics and expand Medicaid in Pennsylvania.
About the Women's Law Project and WomenVote PA:
The Women's Law Project is a Pennsylvania-based non-profit women's legal advocacy organization focused on high-impact research, litigation and advocacy. The Women's Law Project has offices in Philadelphia and Pittsburgh. For more information go to www.womenslawproject.org.
Carol E. Tracy is Executive Director of the Women's Law Project and co-chairs, with Kate Michelman, of WomenVote PA.