By Amal Bass, WLP Staff Attorney
With the uncertainty of the 2012 elections behind us, we know that the Affordable Care Act (ACA) — known to many friends and foes alike as “Obamacare” — is here to stay, with most of its provisions having passed constitutional muster under U.S. Supreme Court review. Nevertheless, Pennsylvania has stalled on the implementation of this important law, despite having already accepted millions of dollars in federal funding to prepare for it. To protect the health and well-being of Pennsylvania’s residents, the Corbett Administration and the Pennsylvania General Assembly must act now to determine how the Commonwealth will handle key features of the ACA, including the establishment of an insurance exchange and the expansion of Medicaid eligibility.
The ACA will create state-based marketplaces for private insurance that will make affordable coverage available to small businesses to purchase for their employees and to individuals who do not qualify for Medicaid and who do not receive health insurance through their employers. These exchanges are scheduled to open for enrollment on October 1, 2013, with coverage beginning on January 1, 2014. States have three options: set up their own exchanges, partner with the federal government, or have the federal government set up and run the state’s exchange. Although Pennsylvania had announced its intention to build a state-run exchange a year ago, it did not submit a Declaration Letter to the U.S. Department of Health and Human Services (HHS) by November 16, 2012, as required. Last week, the Obama Administration extended the deadline to December 14, 2012 for states to submit blueprints for such exchanges for approval by HHS. The states that intend to partner with the federal government have until February 15, 2013 to submit their plans to HHS.
The Corbett Administration has not indicated what it intends to do about the establishment of an insurance exchange. Bills are pending in the General Assembly, but there has been no action on them. The Commonwealth is thus far behind several other states that are taking the necessary steps to set up these exchanges on time. Without clear direction from the governor and without appropriate legislation, it is likely that Pennsylvania will not set up a state-run exchange in a timely manner, resulting in either a federally-run or partnership exchange. Federal involvement in the Commonwealth’s exchange may be in the best interests of Pennsylvanians, or it may not be — but it is certainly not in Pennsylvania’s best interests for the Governor and the General Assembly to ignore one of the most important issues in years.
The Corbett Administration has also remained silent on whether the Commonwealth intends to expand Medicaid eligibility to 138 percent of the federal poverty level, with the federal government paying a large portion of the costs as part of the Affordable Care Act. In National Federation of Independent Business v. Sebelius, the Supreme Court upheld most of the Affordable Care Act, but weakened the Medicaid expansion provision by making it so that states that refuse to comply do not lose all of their Medicaid funding. Medicaid expansion would provide health coverage to working families that cannot otherwise afford private insurance and would bring more than $17 billion in federal dollars into Pennsylvania’s economy. Representative Dan Frankel (D-Allegheny) has introduced legislation, H.B. 2557, to enable Medicaid expansion, but the bill has not yet passed. If Pennsylvania declines to participate in Medicaid expansion, many poor individuals, many of whom are women, will be left without health coverage.
Pennsylvania’s refusal to engage in ACA implementation, including its silence on the establishment of an exchange and the expansion of Medicaid, shows its disregard for the health of the women, men, and children who live in the Commonwealth. It is time for the Corbett Administration to take Pennsylvania residents’ health and well-being seriously.
For more information on the ACA and WLP’s work on access to health care, see WLP Health Care Reform and WLP’s Report, Through the Lens of Equality: Eliminating Sex Bias to Improve the Health of Pennsylvania’s Women.