Beyond Medicaid Expansion: Helping the Poor

Yesterday’s announcement that Healthy PA will be rolled back in favor of full-scale Medicaid expansion misses the point. Instead of unraveling the few positive reforms incoporated in the original Medicaid waiver, lawmakers should focus on fixing a program that reguarly provides subpar care for the most vulnerable.

The real problem is not a lack of insurance, but access to care. One in three doctors do not currently accept new Medicaid patients, which leads to long wait times for patients who need treatment. It takes 49 days to see a dermatologist in Philadelphia, according to a Merritt Hawkins survey. No wonder ER visits dramatically increased in Oregon and California after Medicaid expansions.

Note that Governor Wolf’s press release claims Medicaid expansion will increase access to insurance, not health care: “Today is the first step toward simplifying a complicated process and ensuring hundreds of thousands of Pennsylvanians have greater access to the health insurance.” Adding more Pennsylvanians to Medicaid increases competition for a limited pool of doctors who are already paid well below market rates. This guarantees worse health care access for those who need it most. 

What should Governor Wolf do to fix Medicaid and improve health care options for low-income Pennsylvanians? First, he should seek a reprieve from federal regulations that hamstring the state. For instance, the commonwealth should have more freedom to offer unique benefit packages for different types of patients. Plus, Medicaid recipients should have the freedom to use vouchers to purchase their own care.

Secondly, Pennsylvania can take steps to chip away at the supply-side of the access problem. Lawmakers can allow advanced providers, such as experienced certified nurse practitioners, to open their own practices without the oversight of a doctor. The state could also empower charity clinics to serve more people who fall through the cracks by reforming liability coverage for volunteer doctors.

Removing cost-sharing, health screenings and other noteable reforms in Healthy PA—while pressing forward with full-scale Medicaid expansion—will do nothing to ensure more Pennsylvanians gain access to the care they need.