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This week a top aide to Pennsylvania Governor Tom Corbett said that if the governor winds up accepting the expansion of Medicaid under ObamaCare, it probably won't be until 2015. If that's how it happens, it will mean hundreds of thousands of Pennsylvanians needlessly going without health insurance for another couple years, and it basically guarantees that Medicaid expansion will be a huge issue in the 2014 election for Pennsylvania governor.

President Johnson signs Medicaid
Medicaid is the public health insurance program for people living in poverty. It was signed into law by President Lyndon Baines Johnson in 1965, but it wasn't until 1982 that all 50 states were enrolled in the program. It's not looking much better for the Medicaid expansion under President Obama's health insurance reform law known as ObamaCare. Part of ObamaCare expands eligibility for Medicaid to make it available to people making up to 133% of the poverty level. It was originally designed so that if a state didn't expand Medicaid it would lose all the funds it received for the program to make sure that all 50 states would participate, but the Supreme Court's 2012 ruling on the law said that penalty was unconstitutional, giving states the choice to opt in or not.

According to the Pennsylvania Budget and Policy Center, the Medicaid expansion would cover between 600,000 and 800,000 people in PA who currently have no health insurance, lowering the state's uninsured rate by half. As I wrote in a previous blog about a universal health care proposal in the Pennsylvania Legislature, the Kaiser Family Foundation reports that as of 2011 there were well over one million Pennsylvanians with no health insurance. Nearly a quarter million of the uninsured are children. Step aside, cliche right-wing talking points, because over 800,000 of them are in families with at least one person employed full-time. And step aside, racist right-wing talking points, because over 900,000 of them are white. Chris Lilienthal of Third and State recently wrote about the benefits Medicaid provides to people in need:

Medicaid supports better public health by providing comprehensive health coverage to children, seniors and people with disabilities. Since 2011, The New England Journal of Medicine has published two studies by Harvard researchers showing that expanding Medicaid coverage improves health outcomes for enrollees.

One study showed that expanding health coverage reduced the death rate among enrollees by 6.1%. The study compared three states that expanded Medicaid between 2000 and 2005 with three similar, neighboring states (including Pennsylvania) that did not. Researchers found that Medicaid enrollees in expansion states lived longer because they were able to seek preventive care, take prescribed medications, and receive other necessary medical treatment.

Another study — of Oregon’s 2008 Medicaid expansion — showed that Medicaid enrollees have better health and financial security than non-enrollees. Oregon’s expansion was limited to 10,000 adults, chosen randomly from a waiting list. One year after expansion, enrollees were 25% more likely to report that they were in good health or better compared to people left on the waiting list. Enrollees were 40% less likely to report having to borrow money or skip payment on other bills due to medical expenses.

In his budget address earlier this year, Governor Corbett said "At this time, without serious reforms, it would be financially unsustainable for the taxpayers, and I cannot recommend a dramatic Medicaid expansion." It was widely reported that Corbett had officially decided not to expand Medicaid, but I felt that his wording left a little wiggle room. My intuition proved right a couple months later when it was reported that the Corbett administration was in talks with US Health and Human Services Department Secretary Kathleen Sebelius about the possibility of using the funds for the Medicaid expansion on private health insurance, allegedly because Medicaid is financially unsustainable. But Pennsylvania Health Access Network Director Antoinette Kraus says private insurance costs more. I don't know in what universe the more expensive option counts as more financially sustainable. To me, it seems more like a purely ideological move to limit services provided by the government as much as possible and extend the private sector's reach into traditionally public services.
Gov. Corbett
The Associated Press now reports that PA Department of Public Welfare Chief Beverly Mackereth says that "even if" Corbett decides to pursue the Medicaid expansion - still far from a certainty - she doesn't think it would be possible to negotiate it with the federal government and implement it before 2015. So because Corbett's anti-government philosophy causes him to prefer the more costly (in time and money) option to expand private insurance over more efficiently expanding public insurance, there are hundreds of thousands of people in Pennsylvania who are going to have to go without preventive care, prescribed medications, and other necessary medical treatment for a couple more years. Some will even die because of this policy decision. Apparently Corbett would be fine with these lives being saved by giving people private insurance, but if it's public insurance from the government saving their lives that's tyranny or something.

I don't know if there was much doubt this would be case, but this virtually guarantees that Medicaid expansion will be a major issue in the 2014 election for governor, a race in which Corbett's not looking so hot right now as it is. Up until now it was a more likely possibility that Corbett would at least do the private insurance expansion in time for the election so that, even if it was a bunch of crap, he could take to the campaign trail with tales of how he fought to use the Medicaid expansion funds for a more fiscally responsible alternative to insuring the impoverished. Now, not only will his Democratic opponent be armed with the point that the private insurance is more expensive and therefore actually less efficient/fiscally responsible, but if Mackereth is right his Democratic opponent will also be armed with the rhetorical device of the people who could have insurance right now, today, if Corbett went with the more sensible Medicaid expansion instead of prioritizing his extremist anti-government political ideology over saving the lives of people living in poverty. I feel kind of cold pointing that out since the lives of people that could be saved count for so much more than campaign bargaining chips, but those lives unnecessarily being put at risk is still a powerful demonstration of the damage done by Corbett's governing philosophy. The best Corbett might say in his defense is that the issue doesn't matter because the expansion will happen the year after the election regardless of its outcome, but those uninsured people will still stand as a living testament to Corbett's perverse priorities as governor.

Please take a few minutes to check out Counterpoint PA, my new Internet video newscast about Pennsylvania politics with progressive commentary.

Originally posted to ProgressivePatriotPA on Thu May 16, 2013 at 03:04 AM PDT.

Also republished by DKos Pennsylvania, Pittsburgh Area Kossacks, and Philly Kos.

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