8 Questions and Answers about Healthy Pennsylvania
(Harrisburg) —On Thursday, the federal Centers for Medicare and Medicaid servicesapproved Governor Corbett’s Healthy Pennsylvania plan, which could bring health insurance coverage to more than 600,000 Pennsylvanians. But there’s a lot of details that still need to be worked out.
What does the decision by the federal government actually mean?
There’s two answers to this question.
First, it changes the current Medicaid program, cutting the number of plans from 14 to two, a high-risk and low-risk pool. About 55,000 will also be ineligible for Medicaid and will have to find private insurance, whether through the Affordable Care Act exchange or the state’s new set-up (depending on income.
Second, it sets up a “demonstration”, or what some might call an experiment. Those who make up to 133% of thefederal poverty linewill be able to get health care coverage from private insurers through the state, in a similar process to the Affordable Care Act exchanges.
Who might offer coverage?
According to a handout from the state, in Cumberland, Dauphin, Franklin, Lebanon, Perry and Juniata counties, United Healthcare, Aetna Better Health, Gateway Health, Vista, and Capital Blue Cross could offer coverage, while in Adams, Berks, Lancaster, and York counties,Geisinger Health Plan, United Healthcare, UPMC, Gateway Health, Vista, Capital Blue Cross are the list of options.
What’s different about this coverage compared to coverage some might already have under the Affordable Care Act?
Really, not much.
Every plan in the “demonstration” is going to have to meet minimum standards set by the Affordable Care Act, and once enrolled, you’ll primarily deal with the insurance company, not the government.
What’s the cost?
As to the cost to enrollees, premiums are set at two percent of annual income, starting in 2016 (the cost doesn’t change in 2015). But those getting coverage through Healthy Pennsylvania may already have insurance through the Affordable Care Act, and at a minimal cost.
One advocate says for those near the poverty line, it could be as cheap as $.30 – $.40/month. Two percent of income for those near the poverty line comes out to about $20/month for a single person household, or $40/month for a four person household.
The plan allows for premiums to be reduced through incentives, like an annual check-up, or job training. There’s more to come on this.
What’s left out in the proposal?
“Non-emergency medical transport”will likely get the headlines. The state got a waiver for covering this for 2015. Non-emergency medical transport could be a ride on public transportation or in an ambulance to your primary care doctor or hospital, as long as its not a life-threatening issue. Pennsylvania asked for a five year waiver, and CMS gave it one year. Iowa also received a similar waiver.
Waiver documents indicate how this impacts health outcomes will be scrutinized at the federal level.
This isn’t an outright Medicaid expansion, so hundreds of thousands may also go without coverage through the Healthy Pennsylvania plan.
How much could the state save?
In the fiscal year that runs until June 30, 2015, the budget signed by Governor Corbettrelies on $125 million in savings from the plan. $7 million in that savings was assumed to come from cuts to a program for the disabled that did not make it through the federal process.
The Corbett administration says Healthy PA will save the Commonwealth $4.5 billion over the next 8 years, but further details were not immediately available.
What are the politics of this?
In an election year, this question is inevitable.
Governor Corbett will likely claim he got insurance coverage for more than 600,000 low-income Pennsylvanians while saving the state money, but that is a view from 30,000 feet.
Some of those who are getting coverage through Healthy Pennsylvania may already have coverage through the Affordable Care Act, and now will have to shift to plans that could be more expensive than their current coverage.
Meanwhile, Tom Wolf’s campaign hasalready tweetedthat, if elected, he would expand Medicaid completely, instead of using Corbett’s plan. If he wanted to scrap the plan, he would have to give the federal government six months notice, and provide a way to keep those who are covered on insurance in the future. Complete Medicaid expansion has also received criticism because of the costs in the future – the federal government can start reducing its grants to states to 90% of cost after 2016.
What’s next?
The state has to formally notify the Centers for Medicare and Medicaid Services that accepts the conditions set. Then, it has to develop a plan on how it will get evaluated, and come up with a plan for incentives for healthy behaviors, plus monitoring of premiums and copayments.
Ben Allen is a general assignment reporter and a member of the Transforming Health team. He appeared on Smart Talk to discuss Healthy Pennsylvania. You can listen to the program below.
