What’s interesting about the Pennsylvania plan to expand Medicaid?

As expected, Gov. Corbett, Republican of Pennsylvania, has endorsed expanding Medicaid. This makes his state the 26th to do so. Now more than half of the states are committed to Medicaid expansion.

But it’s Corbett’s approach that makes Pennsylvania’s approach interesting.

Gov. Corbett proposes incentives for people to use doctors’ offices rather than emergency rooms. His plan explicitly recognizes that preventive care improves health and saves money.

As the document outlining the proposal states:

Healthy Pennsylvania  encourages  individuals  to visit  their family doctor rather than using the Emergency Room (ER) through elimination of co-payments, with the exception of a $10 dollar co-payment for inappropriate use of ER services. Encouraging the use of primary care practitioners and prevention services will lead to healthier lives.

Pennsylvanians on Medicaid will be required to pay a premium, with the cost varying on a sliding scale. And this policy element incorporates a provision incentivizing particular behaviors.

The  proposed cost sharing model allows individuals to reduce their monthly premium when they participate in health and wellness appointments and actively engage in job search and training programs. The Corbett administration believes that by reducing premiums for achieving healthy outcomes, individuals will be encouraged to work towards improving their health.To assist  Pennsylvanians in achieving independence, requires work search and linkages to job training for all unemployed, working-age Medicaid beneficiaries, with limited exceptions.

This job search requirement does not apply to all, but those to whom it does apply will get assistance from the state.

In addition, Pennsylvania will include a “private option,” enabling Medicaid-eligibles to purchase insurance on the health marketplace/exchange.

To put such a system in place, Pennsylvania would have to get a waiver from the federal government. And, of course, its state legislature would have to agree on such a plan.

Some of these elements may be unwise. Low income-working people may not be able to come up with money for doctor visits. Their jobs don’t tend to allow flexible schedules, so it would be hard for them to get to wellness appointments. And the job search requirement is legally questionable.

But this approach to expanding Medicaid shows policy creativity. And, although the devil most certainly is in the details, that’s certainly good to see.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.