Gov. Corbett's plan for a market version of the Medicaid expansion envisioned by Obamacare seeks far more change than any other state has tried, health experts said Friday, raising questions about its effectiveness and likelihood of federal approval.
In details posted for the first time Friday, Corbett described specifics of how he would use billions of dollars in new federal funds to provide health coverage for an estimated 500,000 uninsured residents while at the same time reforming the current Medicaid program with an eye on savings.
Twenty-five states have agreed to expand Medicaid, beginning Jan. 1, 2014, up to 138 percent of poverty: about $16,000 for an individual or $32,500 for a family of four. Above that, subsidized private insurance may be purchased on the exchanges set up by the Affordable Care Act.
Pennsylvania, which aims to begin its program one year later, is now one of three states that plan to use new Medicaid money to subsidize private insurance for at least some of those low-income residents on the exchange. That requires a federal waiver - Arkansas' has been approved and Iowa's is pending. The 23 provisions in Pennsylvania's proposed waiver are more than either of the others'.
"The longer the list," said Patricia Boozang, a managing director of Manatt Health Solutions who consulted on Arkansas' plan, "the more complicated the proposal."
The Corbett administration has said that it based its proposal on Arkansas'. But health policy analysts said that it contains several provisions that have not been approved before. Among them are work-search requirements for most able-bodied adults and monthly premiums, on a sliding scale, for many individuals earning more than $5,745 a year.
It also contains several provisions intended to ensure personal responsibility but that some analysts said could backfire. Premiums would be reduced, for example, depending on how many hours that beneficiaries work, whether they engage in certain healthy behaviors, and if they consistently pay their premiums on time.
Missing premium payments more than three months in a row, on the other hand, would terminate coverage and make them ineligible for the next three months.
"People making such a small amount of money are going to be a very high risk of missing a few payments and getting dropped," said David Grande, a senior fellow at University of Pennsylvania's Leonard Davis Institute of Health Economics.
Joan Alker, a researcher at the Georgetown University Health Policy Institute who has analyzed past Medicaid waivers, said she thought the proposal was excessively punitive and also required additional bureaucracy and government involvement, two reasons that Republicans have opposed Obamacare.
"I think this is a very irresponsible proposal," she said. "The governor is jeopardizing federal money that's at stake by proposing to waive parts of federal law that he knows the administration is not going to waive, and it is counterproductive with respect to the goals he intends to achieve."
The proposal is posted at www.dpw.state.pa.us/healthypa, where comment will be accepted for 30 days; six public hearings begin on Dec. 19, in Erie, with Philadelphia's set for Jan. 3.
Republicans and Democrats in Harrisburg had little to say about it on Friday. An exception was Sen. Vincent J. Hughes (D., Phila.), who said Corbett had not made a serious proposal.
"I think it is an attempt to try to fool people to get folks to believe that the governor is not unsympathetic to taking care of low-income working people," Hughes said. He predicted that the Obama administration would reject it and that Corbett would then blame the president, saying " 'Well, we tried.' "