It's not unusual for part of a political narrative to be over-simplified to better fit the whole, but when a Republican governor proposes using federal funds from Medicaid expansion under Obamacare for private health insurance instead only if the federal government agrees to restrictions they want to put on the Medicaid program, reporting that as proposing Medicaid expansion under Obamacare is not an over-simplification, it's a falsehood. But that is Pennsylvania Governor Tom Corbett's Medicaid proposal, and MSNBC has nonetheless reported it as Medicaid expansion under Obamacare on multiple occasions.
Governor Corbett's Medicaid restriction proposal is the most conservative alternative to Medicaid expansion under the Affordable Care Act (AKA Obamacare) in the United States. Arkansas recently became the first state to get approval from the federal government to spend Medicaid expansion funds from Obamacare on private health insurance, allowing those who would have been newly eligible for Medicaid to shop for private health insurance on the new state-based insurance exchanges. Of course that's better than a state completely refusing the Medicaid expansion funds for any kind of health insurance for its uninsured people, but it's not the same as Medicaid expansion under Obamacare.
The amount of money a state receives for Medicaid expansion or an alternative to it doesn't change depending on the particular plan. Since private health insurance is more expensive than Medicaid, using the funds on private plans rather than the public Medicaid program means you can't give as many people health insurance. The Pennsylvania Budget and Policy Center has estimated that Medicaid expansion under Obamacare would allow 600,000 - 800,000 currently uninsured people to get on the program.
According to Corbett's own estimates, his Medicaid expansion alternative would cover up to 520,000 people. So there would be at least 80,000 and as many as 280,000 people who would get public health insurance if Corbett went with Medicaid expansion but will remain uninsured even if Corbett's alternative is approved. That number could be even higher if Corbett's plan doesn't enroll the maximum of 520,000 people.
And that's just the part of Corbett's plan that's similar to the Arkansas plan. Corbett has the most conservative alternative to Medicaid expansion in the country because in addition to insisting on insuring fewer people to avoid having the government be the insurer (gasp!), he is only willing to do even that much if the federal government allows him to add restrictions to the state's current Medicaid program, kicking some people off of it.
I think the hostage-taking comparison is way over-done in political discourse, but since health insurance is a life-or-death issue for so many people, I'm okay with using it here. Corbett is holding the 520,000 uninsured people who would be eligible for his plan hostage, insisting that they remain uninsured unless he's allowed to take Medicaid away from an as-yet-unknown number of Pennsylvanians. Sorry, you have to lose your government-run public health insurance or hundreds of thousands of others like you will remain uninsured.
According to Mary Wilson of WITF:
The proposal includes replacing Medicaid co-pays with monthly premiums that will range from zero to 25 dollars a month per person based on a recipient's income. The governor also wants to require working-age Medicaid recipients, with some undefined exceptions, to show they're looking for work or getting job training.If you can't afford a co-pay, you can't use your insurance to go get health care right away, but you're still insured, so you can go as soon as you can afford the co-pay. If you can't afford a premium, you lose your health insurance altogether. For people living paycheck-to-paycheck, that means the constant threat of losing their health insurance looming over them if they can't pay their Medicaid premium. As if that's not bad enough, the more frightening thing to me here are the "undefined exceptions" for the work-search requirements.A separate program extending private health insurance to low-income Pennsylvanians will hinge on federal approval of such reforms.
First, it says the work-search requirements will be for working-age Medicaid recipients, but it doesn't define exactly what that means. People can take smaller Social Security benefits at a younger age or larger Social Security benefits at an older age, so how exactly is working-age defined according to Corbett? How far into your golden years do you have to be for Governor Corbett to not force you to hit the streets looking for work to qualify for Medicaid under his restrictions of it? 60? 62? 65? That's undefined right now.
Another thing that's undefined is what the exceptions for people with mental and physical disabilities will be. How severely disabled will a person need to be to not be forced to hit the streets looking for work to qualify for Medicaid under Corbett's restrictions? What kind of documentation will they need to prove their mental and physical disabilities? These are restrictions that would undoubtedly reduce the number of people on Medicaid in Pennsylvania.
But even for people old and disabled enough for Governor Corbett to abide them getting health insurance without a work-search requirement, this is not Medicaid expansion under Obamacare, this is the most extreme anti-government alternative to it in the country. It is a Medicaid restriction plan, and that's what it should be called. And yet, MSNBC has used Corbett's new proposal as an example of a Republican governor finally accepting Medicaid expansion under Obamacare as part of a narrative suggesting the policy is inevitable even in the states controlled by Republicans.
The September 24th edition of MSNBC's Politics Nation with Al Sharpton featured a map titled "Republican Governors Cave on Medicaid Expansion":
Last month, Pennsylvania Governor Tom Corbett became the tenth Republican governor to back the expansion of his state's Medicaid program under the Affordable Care Act.No. No, he did not. Corbett does not support expanding Medicaid in Pennsylvania as part of Obamacare. Everybody in with me one more time: His plan would restrict Medicaid, not expand it.
I'd like as much as anyone to be able to say Governor Corbett's finally on board with expanding Medicaid under Obamacare in Pennsylvania. But that's simply not the case. Pretending that any Medicaid plan counts as expansion even when it literally does the opposite just to fit a convenient narrative defeats the purpose of advocating for it, because then you're really not. You're kind of advocating against it. If Corbett's Medicaid restriction plan was accepted by the federal government and became a normalized alternative to real Medicaid expansion, it would reduce Medicaid access, replace some of it with private insurance, and leave the rest of the people uninsured. That's not momentum making Medicaid expansion seem inevitable for even the most conservative governors, that's an attack on Medicaid to shrink its roles.
Full credit goes to MSNBC's Melissa Harris-Perry and Comedy Central's The Daily Show with Jon Stewart for accurately including Pennsylvania on maps of states that are still rejecting Medicaid expansion in the past couple weeks. You can go here for more wonky details about Corbett's Medicaid restriction plan. And next time you hear someone refer to it as Medicaid expansion, please, refer them to this blog.