Nearly 800 public comments - overwhelmingly negative - about Gov. Corbett's alternative Medicaid expansion proposal were submitted online by Friday's deadline, far more than for other states that offered less complicated plans.
With the federal comment period over, the U.S. Centers for Medicare and Medicaid Services technically could act at any time. But public-policy experts say that the complexity of this plan - the only one in the nation to link an expansion of coverage for a new population to changes in insurance, including benefit cuts, for some current Medicaid recipients - will likely lengthen negotiations that typically take months.
Corbett's proposal to use federal Medicaid dollars to buy private coverage for an estimated 500,000 uninsured Pennsylvanians with incomes up to 138 percent of poverty level - $16,105 for an individual, $32,913 for a household of four - would not start until Jan. 1.
The federal website for public comment tallied 789 responses to his proposal, though more than 100 were off topic, blank, or continuations of other responses. Letters and e-mails were not included.
According to an analysis of responses two days before the deadline by Community Legal Services of Philadelphia, 95 percent of those that expressed an opinion were opposed, with 3 percent in favor and 2 percent mixed.
The most common responses said that Pennsylvania should accept a straightforward Medicaid expansion as envisioned by the Affordable Care Act before the U.S. Supreme Court made it optional; two dozen states, including New Jersey, have done so. Many also expressed concern about reduced benefits for current Medicaid recipients.
"Pennsylvania's plan will discriminate against people with disabilities in a number of ways," one commenter wrote, apparently referring to the $1,000 annual limit for durable medical equipment ($2,500 for "high-risk" recipients). "The largest impact will be stopping people from receiving quality medical equipment, especially decent manual wheelchairs that will not damage the users' shoulders, arms, and back."
Others criticized premiums that in some cases would exceed those for insurance purchased by higher-income people through the Obamacare exchanges, and linking work-search activities to financial incentives that would not be available to all. The elimination of coverage for chiropractors, podiatrists, and optometrists also drew criticism.
The Pittsburgh Post-Gazette reported Friday that the coverage may be restored. An administration spokesman could not be reached for comment late Friday.
Although not a direct comparison, because the comment system recently changed, the total responses appeared to be far greater than for "private option" proposals that were approved last year for Iowa and Arkansas, both smaller states that made simpler requests to waive parts of federal Medicaid law. Corbett said he used Arkansas' plan as a model.
A letter opposing several parts of the proposal that was submitted this month was signed by 35 groups, including the Children's Dental Health Project, Easter Seals, HIV Medicine Association, and the National Alliance on Mental Illness, along with six of its local chapters.
Georgetown University Center for Children and Families, which also circulated letters addressing other states' plans, said that 11 groups had signed on for Michigan's letter, 23 for Iowa's, and 27 for Arkansas'.