HARRISBURG, Pennsylvania — A top aide to Gov. Tom Corbett said expanding Medicaid eligibility in Pennsylvania under a sweeping federal health care law probably would not take effect before January 2015, even if the governor embraces the idea that would provide taxpayer-paid health care insurance to hundreds of thousands of residents.
Beverly Mackereth, Corbett's Department of Public Welfare chief, told the Pittsburgh Post-Gazette on Friday that the administration would need until 2015 to negotiate with the federal government and create the program.
Still, Mackereth told the newspaper that the timeline remains ambiguous, and is predicated on negotiations, agreements and the creation of the program going well. "And those are huge 'ifs,'" she said.
The revelation seemed to be the first that lawmakers had heard of it, even among Corbett's fellow Republicans who control the Legislature. Senate Public Health and Welfare Committee Chairwoman Pat Vance, R-Cumberland, said she first heard about it Monday and that it had not been a subject of discussion among Republican senators.
Democratic lawmakers say waiting until 2015 would mean the loss of $4 billion in 2014 for Pennsylvania and they vowed to keep pushing Corbett to expand Medicaid next year.
"I think Pennsylvania citizens would have a big problem — a big problem — if $4 billion targeted toward Pennsylvania found their way somewhere else across the county, especially in a tight budget situation," Sen. Vincent Hughes, D-Philadelphia, said Monday.
In addition, Pennsylvania's hospitals could lose nearly $34 million in federal funding next year that they've received in the past to help offset the cost to treat uninsured patients, according to rough estimates Monday from the U.S. Department of Health and Human Services.
The 2010 health care law assumes that more residents will have Medicaid or private health insurance and that hospitals will see fewer uninsured patients and need less financial assistance. But the law had also assumed that all states would expand Medicaid, which a U.S. Supreme Court ruling last year effectively made a state-by-state decision.
In Pennsylvania, a Medicaid expansion would require approval from the Legislature.
The federal government would foot nearly all of the cost of providing health care to hundreds of thousands of additional Pennsylvanians by widening Medicaid's income eligibility guidelines to 133 percent of the federal poverty level, or about $31,300 for a family of four. The federal law initially promises 100 percent funding to expand Medicaid eligibility beginning Jan. 1, 2014, primarily to extend insurance to low-income working adults.
After three years, the federal government begins to drop its portion of the cost to 90 percent.
Debate around whether to expand Medicaid eligibility is figuring into a spending plan for the fiscal year that starts July 1. Senate Majority Leader Dominic Pileggi, R-Delaware, said last week that the deadline to decide whether the budget will reflect a Medicaid expansion "is fast approaching."
Thus far, top Republican lawmakers have not taken a position on a Medicaid expansion, preferring Corbett take the lead.
Last month, the Legislature's nonpartisan fiscal analysts reported that an expansion of Medicaid eligibility would boost the state's finances by hundreds of millions of dollars a year, echoing the conclusions of previous studies sponsored by health care groups that support a Medicaid expansion.
It also undercut a primary concern of Corbett's, who is opposing a Medicaid expansion out of concern over the cost to Pennsylvania taxpayers. Corbett also has warned that the federal government cannot necessarily be trusted to follow through on its promises to send money to the states. As attorney general in 2010, Corbett unsuccessfully sued in the federal courts to throw out the law.
So far, the Corbett administration has produced no analysis that looks just at the cost of a Medicaid expansion or that counts any resulting economic benefit. But it also has warned that a solid projection cannot be made until more is known from the federal government about the program's rules, and Corbett's budget secretary, Charles Zogby, said he doesn't think it would have any financial benefit in the next fiscal year.
Still, Mackereth told the Post-Gazette that Corbett aides began drafting several models of a program to expand Medicaid eligibility after meeting April 2 with U.S. Health and Human Services Secretary Kathleen Sebelius.