Proceed with caution: Corbett’s Medicaid plan risks severe side effects

The Corbett Administration continues to paint a rosy picture of its alternative Medicaid expansion plan, Healthy PA, and of what it will mean for those it will cover. The administration promises that the plan – which will radically reduce the benefits of 1.2 million adult enrollees – will "support independence" and "increase health care choices" for low-income Pennsylvanians.

Patients, advocates and providers are right to oppose the plan's many harmful elements, and it is important that the public understand what the proposal will do to our friends, our families, and countless patients in Pennsylvania.

Among the 1.2 million adults who are covered by Medicaid in Pennsylvania (Healthy Pennsylvania does not apply to children) are many in desperate need of ongoing medical care. That's important to remember for two reasons: 1) it demonstrates the vital role Medicaid plays in allowing our most vulnerable residents to survive and thrive, and 2) it provides a context for assessing the impact of Healthy PA.

Among the more dangerous elements, the plan would impose new limits on the number of blood tests and radiology scans a Medicaid beneficiary can receive. This would jeopardize the care of people in treatment for cancer and make it harder for people managing diabetes to monitor their blood sugar levels. The result would be worse health outcomes and more expensive treatments down the road.

Healthy PA would also restrict current enrollees' access to many medical devices such as wheelchairs, meaning that many people with disabilities would encounter new hurdles when they try to access the services and supports they need to live and work independently. This would leave them with less independence, not more.

Perhaps worst of all, Healthy PA places beneficiaries in different coverage tiers according to an assessment of their level of health risk – an extremely limited "low-risk" package and a more generous "high-risk" plan. It uses an impractical and untested screening tool to assign people to one or the other.

Assignment to a plan is based on an online questionnaire that asks a series of highly personal questions about medical history. There is no exception for people with mental health conditions or with a history of domestic violence, substance abuse or other stigmatizing medical conditions. Failure to complete the survey results in automatic placement in the "low-risk" plan. If the patient needs care that is not covered by the plan's meager benefits package, his or her doctor is forced to navigate a maze of bureaucratic requirements to attest to the need for the more comprehensive services.

These benefit cuts, combined with new layers of red tape that will frustrate patients and providers, are only part of the story. Healthy PA will also establish an entirely new managed care system to cover newly eligible Pennsylvanians earning below 138% of the federal poverty level. The system will operate independently of the existing Medicaid managed care system and of the federal insurance exchange, but it will need to interact seamlessly with both to ensure that people don't slip through the cracks. Given the spotty records of past Pennsylvania efforts to link different health systems, this will be quite a challenge.

We should proceed with caution regarding Health Pennsylvania. The ability of 1.2 million low-income adults to live with dignity and independence is at stake.

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