Gov. Tom Corbett is proposing a way for about half a million low-income Pennsylvanians to get access to health insurance, but only if the federal government signs off on reforms to the state's traditional Medicaid program.
The proposal includes replacing Medicaid co-pays with monthly premiums that will range from zero to $25 a month per person based on a recipient's income. The governor also wants to require working-age Medicaid recipients, with some undefined exceptions, to show they're looking for work or getting job training.
A separate program extending private health insurance to low-income Pennsylvanians will hinge on federal approval of such reforms.
"This isn't expanding an entitlement," Corbett said. "This is a different program and this is one that makes common sense."
He would not share any contingency plans if the U.S. Department of Health and Human Services rejects the proposal.
"If they go — when they go along with this — I'm going to be very positive, because I see no reason that they shouldn't go along with a program like this," Corbett said.
If reforms are approved by the federal government, Corbett administration officials said they'll launch a program to allow 520,000 low-income Pennsylvanians who would be eligible for Medicaid under an expanded program to shop for private health insurance in the state's health care exchange.
Federal funding would help subsidize such plans. Private option enrollees would pay monthly premiums based on their income and could reduce the payments if they participate in wellness programs.
Researchers and lawmakers have raised the prospect that per-patient Medicaid plans are cheaper than private health coverage. But Corbett said competition among private insurers will keep costs down in the new state-based program to expand health insurance to low-income residents.
"If you're talking about 500,000 people that would be able go out on a private exchange and purchase insurance, that competition always lowers prices," he said.
The Hospital and Healthsystem Association of Pennsylvania was among the biggest forces pushing for a Medicaid expansion in the commonwealth. Its president, Andy Carter, expressed tentative optimism about the proposal, even with Corbett stressing that it won't expand Medicaid.
"The words are less important to me than the results," Carter said. "If virtually every Pennsylvanian has coverage, that's what I intend to celebrate. What words we use are less important."
He said hospitals support the broad themes of the proposal and now must follow the details of the plan as it is negotiated between state and federal officials. One thing to watch is how the state will change the benefits available to Medicaid recipients.
"Depending on which ones are not available, that can be very important in determining how successful people are getting access to the coverage they need," Carter said. "Because if you have coverage but you need services that aren't covered, but you really need those services, that can be a problem."
Corbett administration officials say there's no timeline for the plan's implementation.
