Gov. Tom Corbett’s version of Medicaid expansion would make Pennsylvania the only state in the union to require working poor people to look for better jobs in order to get government-subsidized health insurance.
Corbett administration officials say the job-search requirement is part of a broader effort to induce people to make healthy choices and drive down the costs of health care.
Corbett’s deputy chief of staff, Todd Shamash, said that while Pennsylvania is the first to ask to implement a work-search requirement, it is not the first state to ask for flexibility in expanding Medicaid.
Until Arkansas got federal approval, no state had been allowed to funnel the expansion through the insurance exchanges established as part of the Affordable Care Act, he said.
Pennsylvania is following Arkansas’ lead and hopes to use the exchanges to provide coverage for about 500,000 people with incomes up to 133 percent of the poverty level who are not now signed up for Medicaid.
One in six Pennsylvania residents — about 2.2 million people — are currently enrolled in the program, according to the state department of public welfare.
Secretary of Public Welfare Beverly Mackereth said she has been in regular contact with federal officials as the state was preparing its plan. The state has received no assurance that the plan will be approved, she said, but federal regulators have reacted positively to the fact that Pennsylvania is crafting a wide-reaching plan, she said.
Under the Corbett plan, the state gets rid of most co-pays in Medicaid, replacing them with premiums up to $25 per month for individuals and $35 per month per household.
People will get discounts for getting physical exams and filling out risk assessments that identify chronic medical issues for preventative treatments, Shamash said.
Also, under the plan, people who work 20 hours or less a week will be required to complete 12 work-search activities a month, said Jen Branstetter, secretary of policy and planning for the governor. Job-seekers would be expected to track their search activities for six months and then report them to the state, she said.
The process would be like the reporting procedures for people receiving unemployment benefits, according to a description of the plan released in September.
“We’re not reinventing the wheel,” Shamash said.
Pennsylvania began requiring that people getting cash assistance from Temporary Assistance for Needy Families actively seek work in 2012, said Kathaleen Gillis, a spokeswoman in the department of public welfare.
The year before the work-search rule was added, 314 people were booted from TANF because they had gotten jobs.
In 2012-13, after the state began requiring the job searches, 891 applications were denied because the people were working, Gillis said.
“While we cannot directly attribute this increase in employment to the law, the department can show a link between the change in the law and the number of employed clients denied benefits,” Gillis said.
In the meantime, said Gillis, 2,571 have been kicked out of the cash assistance program in the past year for failing to actively look for work.
Corbett administration officials estimated that half of the 500,000 people who would be newly eligible for Medicaid are already employed. Mackereth said it’s unclear how many work fewer than 20 hours a week.
The Corbett administration argues that the job-search requirement makes sense because of research that shows poor people who are forced to look for work will be healthier than if they didn’t have to seek jobs.
Advocates who have been lobbying for Medicaid expansion say the governor’s proposal will drag out the process, and adding wrinkles like the job-search requirement casts doubt on whether the plan will be approved by federal officials.
“Our biggest concern under this plan is the timeframe,” said Antoinette Kraus of the Pennsylvania Health Access Network. “The Corbett administration decided at the 11th hour to craft a complex plan, in comparison to other states like Ohio and New Jersey that decided to go the traditional route and expand Medicaid to working adults.”
The Corbett plan is described as a five-year plan beginning in January 2015. That’s a full year after most other people will gain health insurance under the federal Affordable Care Act. Corbett’s delayed plan means that after Jan. 1, while many Pennsylvanians will get better access to health insurance, working poor adults will not.
“If (Corbett) was going to do this, he should have done it a year ago,” said state Rep. Mark Longietti, D-Mercer County. “These are the people who are doing what they are supposed to be doing — working.”
Longietti does not object to the government providing incentives to encourage people to look for better jobs. But he questions how the state will monitor whether people are complying with the law.
Kraus said the job-search requirement aims to solve a problem that doesn't exist, because many of those who stand to benefit from the expansion of health coverage are already working.
“The Corbett administration’s proposal seems risky given how much is at stake in Pennsylvania,” she said.
There will be six public hearings on the plan over the next two months. The first is Dec. 19 in Erie.