UPDATE: This story was updated Monday to reflect a change in the federal deadline.
By Melissa Daniels | PA Independent
HARRISBURG — Pennsylvania lawmakers asked the federal government several questions in August about implementing two major features of the Patient Protection and Affordable Care Act.
And they are still waiting for answers, particularly related to the costs for the health insurance exchange and Medicaid expansion.
“We’re looking into all of the options at this point in time,” said Christine Cronkright, a spokeswoman from Gov. Tom Corbett’s office.
Whichever route the state takes, the exchange must be operational by the start of 2014. However, whether the state pursues the optional Medicaid expansion by January 2014 is less certain.
The state will have to tell the federal government of its plans to set up an exchange by Nov. 16, but they’ll have some time to hammer out the details. U.S. Secretary of Health and Human Services Kathleen Sebelius on Friday notified states that the deadline to send in blueprints for the exchanges was extended to Dec. 14.
The Insurance Department has said it won’t decide on how to plan for the exchange until it has more information.
“Given the extent and nature of the questions that remain open, we have determined that at this time it would be imprudent for us to continue extensive planning efforts until we receive answers to these items,” wrote Insurance Department Commissioner Michael Consedine in an August letter to Sebelius.
The 26 questions focused on the cost, scope and deadlines associated with the exchange, which is similar to a marketplace for individuals to purchase health insurance by comparing plans. A state could operate the exchange by itself, abdicate to the federal government or enter into a partnership, according to ACA.
Still, when the time comes, the state has the funds for at least a preliminary rollout. Pennsylvania held onto a $33 million federal grant for implementation of the exchange.
The new national eligibility limits for Medicaid will expand to 133 percent of the poverty level, or an annual income of $14,404 for a single person or $33,657 for a family of four.
In Pennsylvania, the expansion would provide Medicaid coverage to 750,000 residents by 2014, according to estimates from the Department of Public Welfare provided this summer.
The federal government would pay for 100 percent of the expansion costs until 2016, slowly decreasing its share to 90 percent by 2020 and thereafter.
Yet the state had questions — 21 of them, in fact. In his letter to Sebelius, Department of Public Welfare Secretary Gary Alexander asked about funding, eligibility requirements for recipients, the type of plan expected and extending the expansion to a later date.
“Pennsylvania’s focus remains on getting health care reform done right, not just done quickly,” Alexander wrote.
In the letter, Alexander expressed concern about the pressure the law would place on the state budget. Medicaid spending is “crowding out” other expenditures like transportation and education.
Existing federal policy research backs up Alexander’s concerns.
A March 2011 joint congressional report from U.S. Sen. Orrin Hatch, R-Utah and U.S. Rep. Fred Upton, R-Michigan, concluded that the Medicaid expansion would cost states a total of $118 billion — around $2 billion alone in Pennsylvania from 2014 through 2019.
Contact Melissa Daniels at firstname.lastname@example.org.