HARRISBURG -- Gov. Tom Wolf’s move to supplant Healthy PA with a more basic version of Medicaid promises an easier path for low-income people looking for health insurance, advocates say.
Others warn that a glut of Medicaid enrollees poses a problem since many doctors avoid taking patients in the program.
Wolf says his approach will "alleviate confusion, remove unnecessary red tape and streamline the system." But Republicans, including Senate Majority Leader Jake Corman, have sniffed that the new governor killed Healthy PA, designed by former Gov. Tom Corbett, before it had a chance to work.
Wolf is replacing it, they argue, with “one-size-fits-all Obamacare.”
Corbett, who spent months negotiating parameters of Healthy PA with the Obama administration, aimed to use money available under the Affordable Care Act to enroll as many Medicaid-eligible people in private health insurance as possible. Wolf’s plan simply rolls them all into a government-run program.
Before the changes, about 2.25 million Pennsylvanians were enrolled in Medicaid. More than half were adults - mostly elderly, disabled or low-income parents.
Under the Healthy PA expansion, childless adults can sign up for coverage if they make about $16,000 a year or less. The state estimates about 600,000 working adults now qualify.
About 135,000 people have already used the new guidelines to get health insurance since Jan. 1. They will move onto Medicaid rolls during the coming months, since Wolf's plan does not change the broader definitions of who is eligible.
Neal Bisno, president of SEIU Healthcare Pennsylvania and the United Home Care Workers of Pennsylvania, called Healthy PA too complex and inefficient. In a conference call with reporters, he and advocates for those with low-incomes said Healthy PA was hampered by glitches.
Kristen Dama, a Community Legal Services attorney, cited an "egregious" snafu in which dialysis patients were enrolled in Healthy PA insurance plans that didn’t actually cover dialysis treatments.
But it's unclear how seamless it will be to move people who signed up for Healthy PA onto Medicaid, increasing enrollment in the program by 27 percent. After the expansion, about 1 in 5 Pennsylvanians will use Medicaid.
Gone will be premiums of up to 2 percent of household income that were required by Healthy PA. Former Welfare Secretary Beverly Mackereth had said those premiums meant people enrolled in the program had “skin in the game" and made for more responsible consumers.
Many doctors are more likely to fill their practices with privately insured patients who can be easier to deal with, said Lisa Davis, director of the Office of Rural Health at Penn State.
Medicaid patients tend to be sicker, less compliant with doctors' orders and more likely to not show up for appointments, she said. The program also pays doctors less than private insurance.
That raises fears that new Medicaid patients may have trouble getting appointments. They may especially struggle to find dentists; Davis noted some counties lack a single dentist willing to see patients with Medicaid.
A University of Pennsylvania study released last summer found that doctors in the state are more likely to accept new patients with private insurance. In the study, callers tried to make appointments with doctors’ offices. Doctors took privately insured patients 77 percent of the time but only accepted new Medicaid patients 50.5 percent of the time.
The Pennsylvania Coalition of Nurse Practitioners also has cited data showing how difficult it could be for Medicaid patients to find doctors as a way of bolstering its case for giving nurse practitioners greater autonomy.
“Getting insurance is an important step toward better health, but it can only help patients who have access to a health care provider,” said Susan Schrand, the coalition's CEO. “Unfortunately patients have a harder time finding offices that accept new Medicaid patients. Those who do often face longer wait times to get an appointment.”
Pennsylvania’s delayed adoption of Medicaid expansion under the Affordable Care Act also means the state missed out on higher reimbursements included in the first years of Obamacare. That money was meant as an inducement to coax more doctors to accept Medicaid.
But Kathaleen Gillis, a spokeswoman for the Department of Human Services, said state officials believe they can expand Medicaid without creating problems for people trying to find doctors. The state is also planning steps to resolve any problems with access to dental care, she said.
"The department has not identified any access issues, nor have we had any complaints surrounding this matter," she said.
Dr. John Pagana, who runs a free clinic in Sunbury that helps people who work, said he supported Healthy PA's requirements that encouraged recipients to look for better jobs.
Government help “should be a crutch to get better,” he said. “There’s a fine line between helping and enabling.”
Pagana said he admires his patients because they choose to work. Welfare programs create a disincentive to some recipients who could collect almost as much in benefits as they earn in paychecks, he said.
Medical costs can tip the scale - for someone with a fast-food job who needs a chest X-ray, for example. “They don’t eat for two weeks,” if they don't have access to low-cost healthcare, he said.
One way or another, expanding health coverage will help make preventative care available to those who previously saw doctor only when they were sick, he said. And finding a doctor who accepts Medicaid, he added, is less likely to be a problem than coping with no medical insurance at all.