Feb. 21, 2020 / Weekly Roundup

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Weekly Roundup
#Listrak\DateStampLong# The latest news from the State Capitol
Medicaid, a Multi-Week Review (Part 2)

In my last report, I reviewed the difference between Medicaid, the safety-net health insurance program for low-income Pennsylvanians, and Medicare, the health insurance program for all Americans over the age of 65. I also reported that 20% of Pennsylvanians receive Medicaid benefits at a total cost in this budget year of $30 billion. In this report, we will discuss the 2015 Medicaid expansion.

Under the federal Affordable Care Act (ACA), states are authorized to expand the eligibility requirements for Medicaid, permitting residents living up to 138% of the poverty level to qualify for benefits. In 2019, 138% of the poverty level for a family of four was $35,535.

Under the ACA, the federal government initially picked up 100% of the expenses associated with the expanded Medicaid program. Over time the federal contribution has slowly decreased according to a predetermined schedule, with the federal reimbursement to states leveling out at 90% in 2020. The 3% decrease in federal funding in 2020 is projected to cost Pennsylvania an additional $132.7 million in the 2020-21 budget year.

Gov. Wolf elected to accept the federal assistance and ordered the expansion of Medicaid in 2015. Since that time, Pennsylvania’s expanded Medicaid population, i.e., those living at 101-138% of the poverty level and claiming Medicaid benefits, has added over 700,000 Pennsylvanians to our state’s Medicaid rolls. An upside of that increase is that the state’s rate of uninsured individuals has decreased from 10.2% in 2010 to 6.4% in the year following Medicaid expansion. Not all of that decrease in the rate of uninsured can be attributed to expanded Medicaid, but the expansion has likely contributed to that reduction.

Nationally, 35 states and the District of Columbia have chosen to expand Medicaid. Those that have not expanded Medicaid do not receive the additional federal money. The same states have also avoided what they believe to be the liability of subsuming so many additional people into the state-funded healthcare safety net.

Twelve states have enacted laws that would place limitations on eligibility for Medicaid benefits. The most common limitation is the enactment of work requirements, which prohibit eligibility for able-bodied, working-age adults who are neither pregnant nor caring for young children from qualifying for Medicaid benefits unless they first prove that they are working or actively seeking employment. After enacting work requirements, states observed a significant decrease in the number of people applying for benefits who fit within the expansion criteria, i.e., 101-138% of poverty level. Employment among the same population cohort increased. This would appear to indicate that expanded Medicaid has an inverse relationship to many people’s willingness to work.

In 2018, Gov. Wolf vetoed legislation that would have added work requirements to Medicaid in Pennsylvania. I supported that legislation and was disappointed in the governor’s veto. Although I believe in the safety net, I also believe the safety net should be reserved for only the neediest cases and should never be a barrier to individual initiative. With the opening and expansion of Medicaid eligibility, the real policy question is whether Medicaid will continue to be just a safety net, or will it be a means of shifting responsibility for medical insurance away from the individual and onto the government. If a person can work and earn the money needed to cover their own medical insurance, why should state taxpayers cover that expense for them if they choose not to work?

Work requirements, for those states which enacted them, are currently on hold pending review by the federal courts.
Budget Hearings Focus on Spending, Mismanagement

Citing concerns with overspending and mismanagement in the current year’s budget, members of the House Appropriations Committee kicked off this year’s budget hearings by grilling administration officials about their actual funding needs for the upcoming 2020-21 fiscal year.

Earlier this month, Gov. Tom Wolf proposed a $36 billion budget, which represents a spending increase of more than $2 billion over the current year’s enacted budget. Nearly $1 billion of that increase is the result of the administration’s overspending in this year’s budget. The committee met with officials from the departments of Revenue, Aging, State, Military and Veterans Affairs, Corrections, and Labor and Industry.

Several major state agencies are on next week’s agenda, beginning with the Department of Environmental Protection at 10 a.m. Monday, Feb. 24. Other state agencies scheduled to appear include the departments of Conservation and Natural Resources, Transportation, Agriculture, Health, and Community and Economic Development. For a full schedule of these and other remaining hearings, or to watch live streams or archived video of the hearings, click here.

Additional information about the 2020-21 state budget proposal may be found here.
HealthierPA Initiatives Signed into Law

Two measures advanced by the House earlier this year as part of our HealthierPA Initiative are now law.

Act 6 of 2020 will help improve cancer treatment options for patients with Stage IV metastatic cancer by requiring insurance companies to cover the medication and treatments prescribed by the patient’s doctor, regardless of what their insurance plan typically covers.

The law recognizes time is of the essence for patients fighting cancer. They should not have to get sicker and sicker before being allowed to try something their doctor is recommending that could extend the length and quality of their lives.

Act 7 of 2020 will help protect infants who receive donated breast milk through milk banks. Banked donor milk is used in neonatal intensive care units (NICUs) and by outpatients with medical issues. When a mother’s own milk is unavailable in the NICU, the use of banked donor milk has been shown to decrease mortality rates and the incidence of serious complications.

The new law will require the state Department of Health to regulate milk banks, which are entities that gather, process and distribute mothers’ milk for medically fragile newborns. Milk banks would be required to medically screen donors and to contact the health care provider of the donor’s baby to verify adequate growth. The donor milk must be processed to inactivate pathogens (pasteurized), and post-processing bacterial cultures must be performed. The law does not regulate breast milk donors or affect informal milk sharing that may occur.
Committee Discusses Bill to Better Coordinate Fire, EMS Services

The House Veterans Affairs and Emergency Preparedness Committee held a public hearing this week on a proposal to create a Pennsylvania State Fire Commission to better coordinate resources and services.

The bill is based on a recommendation offered by the Senate Resolution 6 Commission to ensure fire and EMS coverage, which is provided by volunteers in the majority of the state’s communities, remains available across the state.

Testifiers at the hearing included Bruce Trego, state fire commissioner; Dylan Ferguson of the Department of Health’s Bureau of Emergency Medical Services; David Chiaramonte and Adam Perreault of the PA Professional Firefighters Association; Charles McGarvey Sr. and Jay Delaney of the PA Career Fire Chiefs Association; and Steve Bair of the PA Fire and Emergency Services Institute.

Last fall, as part of our “Helpers and Heroes” initiative, the House passed a series of bills designed to improve recruitment and retention of volunteers for fire and ambulance companies, boost access to training and increase funding options. Most of the measures are now awaiting action in the Senate. Late last year, Act 106 was signed into law, making online training more readily available to current and prospective first responders.
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