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The ACA at Penn Square

By on November 17, 2013

glassesAlthough the Affordable Care Act of 2010 ushered in a national change, its success or failure in Pennsylvania will occur at the state level where the responsibility for health care oversight and regulation rest. Following implementation, voters will assess the results of the change and vote their pocketbooks. The architects of the law in Washington may have had one thing in mind, but the way it plays out in each state has a lot to do with the politicians in power there.

The federal government under President Obama hoped to influence the states through its ability to award money to them. It believed the commerce clause in the Constitution gave them real clout. The Supreme Court ruling of 2012 complicated things. That decision allowed a state to decide not to expand its Medicaid program and still receive considerable federal money for their existing program.

Pennsylvania went through a change of governors in the year the law passed. The switch has had major consequences. In November of 2010, Republican Tom Corbett was elected to succeed termed-out Democrat Ed Rendell, an early supporter of the ACA. Corbett found himself running in a state that had voted for Obama in 2008, and would do so again in 2012. He spoke vaguely about the law on the campaign trail, sometimes supporting aspects, some times being critical. It helped that his opponent was a colorless non-starter.

Once elected he came out swinging against the new law, joining the failed multi-state suit that went to the Supreme Court. Thwarted there,  he tantalized the press and his constituents taking considerable time deciding what to do next. He passed the responsibility for a state exchange to the federal government. In February 2013, he announced he would not expand Medicaid.

Corbett-patientProviders and insurers in the state went on record urging the Corbett to reconsider the terms of the bill. They wanted the extra revenue. Five months later he was back with a proposal that would allow him to tap the extra dollars accompanying expansion of Medicaid, but doing it on his terms, using carrots for private insurance and sticks for new enrollees required to look for jobs.

These ‘common sense’ enhancements, as Corbett called them, need the OK of the state legislature and approval by the Obama Administration. Push back in Harrisburg to the new Corbett plan appeared right away, where the Senate has voted to renew the current Medicaid program and the Assembly balked. Observers feel Corbett’s job search requirement will be too much for Washington to stomach.

Time may be running out for Governor Corbett. His popularity numbers are at record lows. Eight Democrats have already lined up to challenge him in 2014. They will want something to run against and his handling of the Medicaid issue gives them something big to attack— not that there are not other juicy targets — starting with his slow-motion handling of the Penn State football scandal. Reports that Republicans are privately urging him not to seek re-election just add to his woes.

The upshot of all this is that Pennsylvania’s uninsured may have to wait until 2015 to find out how the ACA finally plays out for them in the keystone state.

About Tom Godfrey

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