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Why Corbett might embrace Obamacare: Governor cagey on allegations of illegally kicking thousands off Medicaid
The feds are investigating whether the Corbett Administration improperly kicked thousands of Pennsylvanians off Medicaid, and the governor seems nervous. Could the scrutiny prompt conservative Corbett to accept healthcare reform's Medicaid expansion?
Why Corbett might embrace Obamacare: Governor cagey on allegations of illegally kicking thousands off Medicaid
Last month, the U.S. Supreme Court ruled to support the Affordable Care Act's controversial individual mandate to buy health insurance. But the justices also delivered conservative governors more wiggle room to opt out of the law's enormous expansion of healthcare for the poor, declaring it unconstitutional for the federal government to require states to participate in an expanded version of Medicaid as a condition of participating in the entire program.
Some conservative Republicans are vowing to reject that part of the law: Florida Gov. Rick Scott and Texas Gov. Rick Perry quickly announced that their states would not participate. Yet there's a possibility that Republican Gov. Tom Corbett may quietly acquiesce. He's still deciding whether to accept Obamacare's Medicaid expansion, which is set to provide health insurance to a huge chunk of currently ineligible poor people ― estimated at up to 682,880 Pennsylvanians―living under 133 percent of the federal poverty line.
“There is no decision on that, and we are still reviewing the law,” says Department of Public Welfare spokesperson Donna Morgan.
Conservative governors say their states cannot afford the increased cost to the state-federal program, which in Pennsylvania could be a hike of between 1.4 percent and 2.7 percent in state Medicaid spending. The federal government, however, will pick up most of the tab, starting at 100 percent in the first three years of implementation, through 2017, and gradually declining to 90 percent by 2020.
And so: What of Corbett?
Pennsylvania's governor does have a solid track record of cutting healthcare for the poor.
- Last year, Corbett eliminated the state's adultBasic program, which covered 40,000 poor Pennsylvanians who weren't quite poor enough to qualify for Medicaid. Some of these folks would be, incidentally, eligible for coverage under the Medicaid expansion.
- Corbett's new budget eliminated the $205-a-month General Assistance to the most vulnerable Pennsylvanians, including victims of domestic violence, recovering drug addicts, and the temporarily disabled. And, as the Inquirer last week revealed, the Corbett Administration has introduced a cumbersome new benefits application for the related Medical Assistance program system that advocates allege could lead to thousands of people getting benefits cut. In addition, the Pennsylvania Health Law Project estimates that a new work requirement for Medical Assistance will lead to 15,000 low-income parents losing coverage because if they work they will make just enough money to no longer qualify.
- And then there's Medicaid. Corbett has already used new and little-understood powers under Act 22 to mandate co-pays for subsidized childcare and introduce new rules like one that limits recipients to one pair of dentures per lifetime. And, in what has become a long-simmering but yet-to-boil-over scandal, the Corbett administration quietly kicked tens of thousands of Pennsylvania children off the program. The state's initial figures recorded 130,000 people kicked off Medicaid, including 89,000 children, between August 2011 and January of this year. They later reduced the number to 56,000. A directive from Harrisburg, welfare workers say, required them to review a backlog of documents in a matter of weeks and created a bureaucratic mess that led to coverage being improperly cut.
A new federal investigation backs up worker claims.
The Centers for Medicare and Medicaid Services (CMS), in a June 14 letter first reported by the Associated Press and since obtained by City Paper, requested more information from the Corbett administration to determine whether “federal guidance and state procedures” may have been violated.
“A large number of cases,” the letter noted, “were closed for 'failure to provide information' or 'failure to return renewal form' at a time when DPW has reported that it was unable to process within appropriate timeframes all the information beneficiaries had submitted to verify their eligibility.” The letter cites an August 2011 state audit that discovered a major backlog at one County Assistance Office where information verifying individuals' Medicaid eligibility was not "scanned into the system and electronically linked" to the respective individuals' files.
According to the letter, DPW told CMS officials that they were undertaking a "review of 12,000 closed cases to determine whether any had been closed inappropriately" at an April 18, 2012 meeting. That includes 3,000 pregnant women and newborns. CMS, according to the AP, has not yet received a response from the Corbett administration. The federal government wants to know if the state has completed its review.
It's no secret that Corbett opposes the Affordable Care Act, a.k.a. Obamacare, a still potent-political football. As state Attorney General, Corbett joined counterparts in filing suit against the law. But the Corbett administration seems acutely spooked by accusations that it illegally threw thousands of children off Medicaid.
Asked about the CMS letter, a DPW spokesperson complained that an Inquirer reporter was “reading too much into this.”
Any decision to block Obamacare's Medicaid expansion will undoubtedly rekindle media and political criticism of the governor's record. Could this push a cautious Corbett to buck the right-wing national winds and accept the Medicaid expansion?
“I think that's the million-dollar question,” says Community Legal Services staff attorney Kristen Dama. “He didn't come out like a lot of conservative governors did and issue a knee-jerk reaction to the ACA ruling and say, 'We're not going to expand Medicaid.'”
Indeed, Corbett's criticism of the Supreme Court ruling has been remarkably low-key.
“While I am disappointed with this ruling, respect for the law and for the process of the law ― even when we disagree ― is part of our democracy,” he said in a statement. “My administration will do all we can to ensure the negative impact of this law affects the lives of Pennsylvanians as little as possible.’’
Compare this to what erstwhile presidential candidate and Texas Gov. Rick Perry told Fox News explaining his decision to reject the Medicaid expansion.
“We're just not going to be a part of again socializing healthcare in the state of Texas and going in direct conflict with our founding fathers' wishes and freedom.”
Hospitals in Pennsylvania, like in states nationwide, are certain to exert heavy―and perhaps decisive―political pressure to push Corbett to sign on. They are counting on the increased Medicaid coverage to counter the law's sharp cuts in reimbursements for care provided to the poor and uninsured. But Corbett's particularly ugly record on Medicaid, and the potential violation of federal law, could make him eager to accommodate Obamacare and steer clear of TV cameras.
“Corbett will feel significant pressure on the Medicaid front because of his past decisions on that matter,” says Muhlenberg College political-science professor Christopher Borick. If Corbett's decisions appear to be “leaving a larger share of Pennsylvanians without coverage, he runs the risk of increased public backlash. He knows the Republican base will be behind him if he rejects Medicaid expansion, but he has to tend to the broader public as he starts to focus on reelection.”
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