We want to give full and hearty applause to Gov. Tom Corbett, who announced Monday that he has a plan to reform Medicaid and expand health coverage for the poor. His office has made clear, though, that he is not embracing the federal Medicaid expansion, as many hoped. So, right now, our applause will be less than hearty.
Under the Affordable Care Act, the feds have encouraged states to expand Medicaid participation; in exchange, the feds will cover 100 percent of the cost of expansion for the states for two years, and 90 percent in subsequent years.
Corbett has maintained that the swelling roles of Medicaid recipients would make the cost of even the subsidized plan too expensive for the state.
So far, 24 states have accepted the expansion, although few Republican governors have. Their refusal is one of their weapons in their fight against “ObamaCare.” So Corbett’s willingness to address Medicaid is encouraging.
Rather than the federal expansion, though, Corbett is proposing a plan that he says would reform Medicaid. It would use Medicaid expansion dollars to pay for new participants to get private insurance. It would require participants to contribute to the cost — $25 to $35 monthly — and set up requirements such as job searches and job training for people to be covered.
There are few concrete details so far, and it is subject to federal approval. Arkansas and Iowa have similar proposals, still pending approval.
We have concerns about key aspects of the plan, outlined in a white paper from Corbett’s office.
First, Medicaid isn’t broken. Many Republicans have called for “reform” and like to refer to it as a broken system. The bottom-line cost — $400 billion in 2011 — is huge, but, in point of fact, Medicaid is widely regarded as a cost-effective way to provide health care to low-income people, as well as the disabled, the elderly and children. (In Pennsylvania, 81 percent of Medicaid recipients are in the latter three categories.)
Corbett’s plan stresses personal accountability. He not only requires participants to pay a premium, but suggests that discounts on premiums would be given for healthy behaviors and choice.
“Beneficiaries should … have a strong role in their own individual health outcomes,” his reform paper states, “thereby increasing personal responsibility.”
We won’t argue with encouraging healthy behaviors, but we do have a problem tying medical coverage to health outcomes. Health relies on many factors, only some of which people can control. Encouraging healthy choices is one thing; making poor, disabled and elderly people accountable for their health has the potential to be far worse than any death panel that Sarah Palin imagined in her vision of health reform.
Corbett’s insistence on adding a job search/job training requirement to health coverage is unlikely to pass federal muster, but the implication in this requirement is disturbing, suggesting that the poor are lazy or want a free ride.
We hope that Corbett’s plan leads to more people getting good health care. That’s the only outcome that matters.