On Thursday, the Center for Medicare and Medicaid Services (CMS) announced approval of the Healthy PA waiver, including a new private coverage option. But the approved waiver severely limited the flexibility Governor Corbett sought. While the state was able to achieve rewards for work, rewards for healthy behaviors and some cost sharing, the federal government refused to allow fundamental changes that could truly improve access to quality care. Some of the key reforms granted are:
- Work requirements: The Governor fought tooth and nail to tie taxpayer-funded health care to work. In the end, enrollees can receive premium discounts for participating in work search activities.
- Healthy behaviors: Enrollees can also reduce their premiums by attending yearly checkups and other healthy behaviors.
- Cost sharing: It’s important for enrollees to contribute to their health care costs. The waiver charges enrollees monthly premiums based on income and family size.
- However, there are few consequences for not paying. There is no waiting period if one fails to pay. If an enrollee misses three months of payments, they will be disenrolled. While that is a deterrent, it may not be enough to keep individuals from not paying when they are healthy and then begin payments again when they become sick and need medical care.
- Providers can refuse service to enrollees above the poverty line who do not make co-pays.
These are good reforms. However, they do not justify the expansion of a system that’s still fundamentally broken.
There are much better ways to help low-income adults than placing them in a system that competes with our neediest citizens for limited taxpayer funding. The Governor can pursue state-based ways to improve low-income adults’ access quality and affordable care.
- State lawmakers can ease waiting times and improve the quality of care by encouraging more physicians to locate in Pennsylvania through House Bill 1760—which gives doctors liability protection if they volunteer to help the neediest among us at free clinics.
- State lawmakers can allow doctors licensed in other states to participate in temporary free clinics by organizations like Remote Area Medical (RAM), a volunteer corps that provides free quality health care. Currently, it is illegal for RAM to bring medical volunteers to Pennsylvania.
- Finally, Senate Bill 1063 would allow nurse practitioners to run their own practices, as they currently can in 17 other states, improving patient accessibility.
Pennsylvanians deserve real Medicaid reform that encourages work and provides patients with robust health care choices, no matter their income.