New Castle News

Closer Look

April 1, 2013

Corbett against Medicaid expansion

HARRISBURG — For now, Gov. Tom Corbett has decided against embracing an expansion of Medicaid that could extend taxpayer-paid health care coverage to hundreds of thousands of low-income adult Pennsylvanians.

The 2010 Affordable Care Act pledges to shoulder the lion’s share of the cost of the expansion, but Corbett says he is still concerned about the cost to Pennsylvania taxpayers. He cautions that the federal government cannot always be trusted to deliver on its funding promises to states.

Here is a look at the validity of some of his claims about the Medicaid expansion:

The Claim: “When it comes to Medicaid spending in this country, we are No. 2 in Pennsylvania, out of all 50 states.”— Gov. Tom Corbett, March 19, on the Dom Giordano Program on WPHT-AM in Philadelphia.

The Facts: Corbett is citing a National Association of State Budget Officers report that collects state government’s self-reported figures. The report shows that the proportion of Pennsylvania’s total spending on Medicaid, including federal funds, as a part of its total spending was higher than any other state in 2012, aside from Missouri.

But those figures can be misleading for a couple of reasons. One reason, as NASBO cautions, is that a more complete understanding of government spending within a given state would require an analysis of local government spending, which NASBO does not do. Plus, different states get different levels of federal Medicaid dollars per enrollee.

So, a better comparison may be just state dollars. From that perspective, Pennsylvania, the sixth-most populous state, ranks fifth in Medicaid spending behind New York, Ohio, California and Texas, according to NASBO’s figures.

The Claim: “Per recipient we average about $7,400 a year. The average in the country is about between $4,400 and $5,400.”— Gov. Tom Corbett, March 19, on the Dom Giordano Program on WPHT-AM in Philadelphia.

The Facts: Those figures, from 2009 data assembled by the Kaiser Family Foundation, include Medicaid costs for the elderly and disabled, whose per-enrollee costs are several times higher than the cost of Medicaid-paid health care for an adult.

Expanding Medicaid under the Affordable Care Act does not expand benefits for the elderly and disabled; it expands health care for adults, and the cost per adult enrollee in Pennsylvania is much lower, $3,692. That was in the middle of the pack among states. When the Corbett administration calculated the cost of the Medicaid expansion, it says it used a figure that included only the cost of health care for adults.

The Claim: “Our initial estimates show that a Medicaid expansion under the ACA would cost Pennsylvania almost $1 billion of new state taxpayer dollars through fiscal year 2015-16 — ultimately rising to a total cost of $4.1 billion of new state taxpayer dollars by the end of fiscal year 2020-21.” — Gov. Tom Corbett, Feb. 5, letter to U.S. Health and Human Services Secretary Kathleen Sebelius.

The Facts: The $4.1 billion figure from the Corbett administration includes costs for more than just the expansion of Medicaid eligibility. Corbett administration officials acknowledge that that figure represents the administration’s projection of both a Medicaid expansion and costs associated with a health insurance exchange, as well as other requirements of the Affordable Care Act that will happen regardless of whether Corbett embraces the Medicaid expansion.

The House Democratic Appropriations Committee’s analysis of Corbett’s figures concludes that just $384 million in state costs are attributable to the Medicaid expansion through the end of the 2020-21 fiscal year.

The Claim: “This expansion would potentially add another 800,000, taking it up to 3 million people. That would be 1 in 4 people on Medicaid in Pennsylvania.”— Gov. Tom Corbett, March 19, on the Dom Giordano Program on WPHT-AM in Philadelphia.

The Facts: The 800,000 figure includes the impact of other elements of the Affordable Care Act that will take effect in Pennsylvania, regardless of whether Corbett supports an expansion of Medicaid eligibility. The projected increase in Medicaid enrollees that Corbett is describing includes people who are already eligible for Medicaid and are expected to enroll after coming into contact with the health insurance marketplaces that are being set up in each state next year under a provision in the ACA.

The Kaiser Commission on Medicaid and the Uninsured estimates that 542,000 Pennsylvanians, primarily low-income working adults, would get insurance coverage under the Medicaid expansion. It estimates that an additional 178,000 Pennsylvanians who are already eligible for Medicaid would wind up getting Medicaid coverage through the insurance marketplace.

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