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Medicaid, coming front and center

By - Last modified: January 31, 2013 at 9:14 AM
Heather Stauffer
Heather Stauffer

We haven't talked about Medicaid expansion for a while. Let's change that.

• Pennsylvania is one of 12 states classified as Undecided or No Comment, according to this site.

• 18 states (plus the District of Columbia!) are Participating, and five states are leaning toward Participating.

• 10 states are Not Participating, and five states are leaning toward Not Participating.

(I'd have put us in leaning toward Not Participating.)

Anyway, assuming everyone heads the way they're leaning and the Undecideds split half and half, that's 29 Participating to 21 Not Participating.

I believe this is the appropriate time to confess that, last week, someone asked me how many states still hadn't signed up to expand Medicaid and my shot-in-the-dark guess was 10. Obviously, Pennsylvania has a lot more company than I thought it did. In my defense, the recent news that Arizona threw its lot in with the Participants unduly influenced my thought process. (By the way, here's an interesting read about Arizona's decision.)

There's no deadline for states to make the Medicaid decision, so we could remain in Undecided indefinitely — but if Gov. Corbett hasn't said yes by the time the 2014 gubernatorial race really heats up, what do you think are the odds that expanding Medicaid won't be a major campaign issue? Personally, I'd put two "very"s in front of "small."

Also, the necessity of getting out the word of health insurance marketplaces is coming to the forefront in preparation for the big Oct. 1 rollout, and where the Medicaid lines fall is materially important in those messages. Medicaid has been largely in Corbett and Department of Public Welfare Secretary Gary Alexander's bailiwick so far, but expect major public discussion soon.

In that fray, you'll see hospitals solidly in the for section. And that's an understatement. They backed the Patient Protection and Affordable Care Act in a sort of quid pro quo — it has significant reductions in certain funding important to them, but those were supposed to be offset by the increase in Medicaid eligibility and corresponding decrease in charity care.

Long-term care and senior service facilities, however, are not necessarily gung-ho about the prospect of expanding Medicaid. In an October statement, Dr. Stuart H. Shapiro, president and CEO of the Pennsylvania Health Care Association and Center for Assisted Living Management, said doing so "could put at-risk programs that help children, homebound elderly and seniors in nursing homes, and physically and mentally disabled Pennsylvanians."

Shapiro characterized Medicaid as a "Hobson's choice," saying, "Without new tax revenues or program cuts, there is simply no way to expand Medicaid" and warning that "if more people join Medicaid without additional revenues to pay these program, then our social safety nets won't just fray, they will tear apart."

Shapiro mentioned something I don't recollect knowing: That Pennsylvania spends a larger percentage of its state budget on Medicaid than 48 other states.

It took me a while to find the info, and I'm not sure what year he's referencing, but he's essentially right: In 2012, according to the National Association of State Budget Officers, only Missouri spent a larger percentage of total expenditures on Medicaid than we did, at 35 percent to our 33.3 percent. The national average was 23.9 percent. Also in the heavyweight class were Florida at 30.6 percent and Arizona at 31.1 percent.

A November report from the Kaiser Family Foundation estimated the overall cost of a full Medicaid expansion in Pennsylvania from 2013 to 2022 at $1.96 billion more, or 1.4 percent higher, than not expanding Medicaid. In December, HHS told governors that they cannot expand eligibility to less than the full 133 percent of federal poverty level and still receive the much-touted initial 100 percent matching funds.

A Kaiser Family Foundation poll released on Jan. 23 showed that nationally 52 percent of Americans would like to expand Medicaid fully and 42 percent prefer to keep Medicaid as it is today. Among Democrats, the breakdown was 23 to 75 percent, respectively, and among Republicans it was 66 to 27 percent.

I have not seen state-level numbers on the question.

Aaaaand … there's so much more to say on this. But I have to stop somewhere.


PPACA gave employers a March 1 deadline to inform employees about the health insurance marketplaces that debut Oct. 1, but that deadline was just rescinded.


I intended, as presaged last week, to write again about The Commonwealth Fund and SABEW health care conference. But then the above "quick Medicaid update" mushroomed. Check back next week.

There is, however, one tidbit that I can share to end today's monster: You've heard of the Medicare Sustainable Growth Rate and the problems it causes every year and the many calls to fix it once and for all, right?

While at said conference, I heard that some insiders call the SGR "the gift that keeps on giving." It seems the recurring nature of the threat can be relied upon to keep hospital lobbyists busy — something that Congress has little incentive to discourage.

Heather Stauffer covers Lancaster County, nonprofits and health care. Have a tip or question for her? Email her at You can also follow her on Twitter, @StaufferCPBJ.

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