Healthy PA or nothing until 2016

Atrios raises an interesting question concerning Healthy PA.  Healthy PA is the proposal by Gov. Corbett (R-PA) to expand Medicaid by using a combination of the Arkansas private option and the Michigan style health incentive/HSA program plus some gratuitous poor shaming.

 

I’m not sure if it’s better to just pay it and get people enrolled, or gamble on the reasonable possibility that after November a new governor will have a better plan.

I’m not a Pennsylvania political junkie, but from my understanding of Pennsylvania politics, it is extremely likely that Corbett loses this fall to any of the fairly generic/standard issue Democrats running but the Republicans are extremely likely to continue to hold one if not both chambers of the state legislature.

The biggest downside to this political gamble that the Democrats could get something better is timing.  Right now, the Corbett administration has put out a request for interest/application to Pennsylvania insurance companies.  If the goal is to have Healthy Pennsylvania running on January 1st, the health insurance companies have six months to do the prep work.  Speaking as a plumber, six months to build a brand new product with a whole lot of strange and odd business rules is an extremely aggressive timeline.  It is achievable if the Pennsylvania companies are able to keep most of their plumbers on a single task.

Now, as I understand it, the Pennsylvania governor’s term starts in mid-January.  Getting anything better than Healthy PA past at least one Republican controlled chamber will take several weeks/months.  At that point, the plumbing for expansion is several more months.  Realistically, if anything better than Healthy PA can get passed, it probably could not be implemented until at least September 2015, more likely the start date would be January, 2016.

There is a non-zero probability that a failed Healthy PA (shot down by Dems holding most of their votes away) leading to a failed straight up Medicaid expansion.

The trade-off is Healthy PA effective January 1, 2015 OR the probability of something better on either September 1, 2015 or January 1, 2016 plus the probability  of nothing.  If Healthy PA is implemented, it can be tweaked, modified and improved.  My moral sense says it is better to get a significant improvement in wellbeing for the most disadvantaged in society than to hold out for the possibility of something better but later with the chance of nothing. I’m mini-maxing here.

24 replies
  1. 1
    OzarkHillbilly says:

    Do not let the perfect be the enemy of the good. Or, if one likes, a bird in the hand is worth 2 in the bush.

  2. 2
    Baud says:

    The big risk is that, if it’s approved, it’ll become a model for red states to try something even more aggressive. It sucks to play games with people’s lives, but that’s what happens when the GOP is given power.

  3. 3
    geg6 says:

    As a resident of PA, I say let’s go with Healthy PA for now. No way are we going to get anything better past the troglodytes in the PA Leg, which is GOP-controlled and likely to stay that way thanks to the idiots who populate the T of the state that we call Pennsyltucky. We’ll get a whole raft of statewide offices filled by Dems, thanks to the civilized state bookends (The Burgh and Philly), but the Legislature will continue to be filled with dummies catering to their Teahadist and KKK-loving constituents from places like Coudersport and Somerset.

  4. 4
    Richard Mayhew says:

    @Baud: I don’t think that risk is particularly high as the reactionaries and sadists will be reactionaries and sadists with or without examples or evidence.

  5. 5
    Baud says:

    @Richard Mayhew:

    True. I meant there has to be some limit in how much flexibility HHS will give. They have to approve, right?

  6. 6
    Chyron HR says:

    If you were a true progressive, you’d know that nothing is better than something.

  7. 7
    Patricia Kayden says:

    “My moral sense says it is better to get a significant improvement in wellbeing for the most disadvantaged in society than to hold out for the possibility of something better but later with the chance of nothing.”

    Or get the significant improvement until the “something better” can be implemented.

  8. 8
    Richard Mayhew says:

    @Baud: From what I’ve read, HHS has already nixed a couple of draft versions that were nasty and vindictive. HHS wants to approve, but there are limits to what they are willing to approve.

  9. 9
    Richard Mayhew says:

    @Chyron HR: McLaren are you nym hijacking :)

  10. 10
    WereBear says:

    @Richard Mayhew: From what I’ve read, HHS has already nixed a couple of draft versions that were nasty and vindictive.

    Oh, we liberals will sure pay now for wanting things like civil rights and fed children. This is exactly the same as those thrillers who kill the pet first, isn’t it?

  11. 11
    biff diggerence says:

    definately

    Wow. there Is this squiggly, red underline when I typed this in.

  12. 12
    Snarki, child of Loki says:

    What’s not so obvious (to me, at least) is how much “legislation” is needed, versus “executive action”.

    Crafting an entirely new “Healthy PA” plan, with all kinds of new (& obnoxious) features, okay, that requires legislation.

    But just saying “YES” to the standard Medicaid expansion plan on offer from the feds? Does that require actual legislation, or can it be done by executive order?

    The extent the that Pennsyltucky morons in the PA legislature can be bypassed changes the calculus of “Healthy PA, yes or no?” considerably.

  13. 13
    MomSense says:

    The Republicans were so dearly upset that people couldn’t buy health insurance fast enough because of the problems with healthcare.gov. in the first two months. Meanwhile the Republicans in Pennsylvania are playing politics with the lives of their poorest citizens (how else do you explain refusing such an infusion of federal dollars?!) and will be lucky to fully implement the ACA in their state a year behind schedule.

    If only we had a media willing to point out Republican incompetence, negligence, and hypocrisy.

  14. 14
    HelloRochester says:

    I live here (FSM help me). Corbett sucks balls and is clearly just lining up his job at Heritage or whatever right wing grift factory will take him after November. I think there’s enough rural poor here who want the Medicaid expansion enough that the state GOP could get a pass if Governor Wolf wants to do it.

  15. 15
    RaflW says:

    My question is, how much does the Corbett plan encourage for-profit skimming of Medicaid dollars? Every damn GOP privatization is another long-term rent-seeking entitlement for the rich.

    Plus they usually f*k up the thing in the process of privatizing it.

    I hate that poor people in GOP-led states are being forced to go w/o insurance because of a failing Repub electoral strategy, but I also really dislike the overall push by them to create state-level privatizations of Medicaid. It just builds even more corporate profit-center bulkheads invested in blocking eventual reform (single payer, I’d hope…)

  16. 16
    smintheus says:

    Corbett’s proposal to HHS is just monstrous. Hard to believe it would be approved.

  17. 17
    Richard Mayhew says:

    @RaflW: Pennsylvania is already a Medicaid Managed Care state ( private insurance companies get a capitated payment per current Medicaid member, and then they pay out whatever to providers. So the skim is already in for either traditional Medicaid expansion or Corbettcare and has been in for 20 years. The big question is what the baseline reimbursement rate will be. If traditional MA expansion, the rate is probably based on Fee for Service MA rates plus a kicker; if Corbett Care, the providers will see commercial or near commercial rates.

  18. 18
    Mnemosyne says:

    @Snarki, child of Loki:

    But just saying “YES” to the standard Medicaid expansion plan on offer from the feds? Does that require actual legislation, or can it be done by executive order?

    I’m not sure about whether accepting it would require actual legislation, but I suspect that implementing it — setting up a website, hiring state employees to administer it, publicity, etc. — would require legislation.

  19. 19
    JGabriel says:

    Richard Mayhew @ Top:

    If Healthy PA is implemented, it can be tweaked, modified and improved.

    Don’t know whether this would be a good idea or not, but: How about accepting Healthy PA, then slow-walking the implementation through till November? If Corbett wins, accelerate the implementation at that time. If a Democrat wins, replace it, or if that’s infeasible, improve it while starting with a stronger hand than we currently have.

  20. 20
    JGabriel says:

    @geg6:

    … the Legislature will continue to be filled with dummies catering to their Teahadist and KKK-loving constituents from places like Coudersport and Somerset.

    I spent about two-thirds of my formative years growing up in Pennsyltucky (with the other third in Brooklyn). And the KKK thing has always puzzled me. PA was a union state. And yet, less than ten miles from where I lived, there was a KKK chapter.

    Even today, I still don’t get the Confederacy love from people whose ancestors probably fought against our southern traitors during the Slave Owner’s Rebellion. It’s weird.

  21. 21
    JGabriel says:

    Richard Mayhew @ Top:

    If Healthy PA is implemented, it can be tweaked, modified and improved. My moral sense says it is better to get a significant improvement in wellbeing for the most disadvantaged in society than to hold out for the possibility of something better but later with the chance of nothing. I’m mini-maxing here.

    Actually, the more I think about it, the more I think, “Don’t do it.”

    Politically, it’s probably designed to fail so Obamacare be blamed. And it gives Republicans the opportunity to say, “Hey, we tried. But government just doesn’t work.” The GOP will take credit if it works at all (which, again, it probably won’t), and blame Democrats if it doesn’t.

    But even more importantly, it’s an ethical shithole. Given the excuse to keep costs down, Corbett’s grifter pals will turn down just about every claim, only acceding to pay those that win on appeal (not unlike disability). It’ll force our most vulnerable to wade through reams of paperwork – which, knowing PA, will be so complicated it’ll require a lawyer (at the claimant’s expense) to get through the process – at which point they’ll either be denied again or charged with perjury for making a mistake while filling out the forms.

    Seriously, I suspect only a small percentage of claims will ever get approved in the Healthy PA system – because that’s how the privatized Medicaid insurers will make their money – with the cost of suffering, hassle, and anxiety accruing to most of the other people filing claims.

  22. 22
    mclaren says:

    Sound the trumpets!

    Roll out the ticker tape parades!

    It’s time to celebrate the great triumph that is the ACA:

    CBO and JCT now estimate that the ACA, in comparison with prior law before the enactment of the ACA, will reduce the number of nonelderly people without health insurance coverage by 14 million in 2014 and by 29 million or 30 million in the latter part of the coming decade, leaving 30 million nonelderly residents uninsured by the end of the period (see Table 3, at the end of this report). Before the Supreme Court’s decision, the latter number had been 27 million.

    Source: CBO budget office, 2012.

    Magnificent! Sublime! What a great leap forward!

    The number of uninsured people has gone…up by 3 million compared to pre-ACA levels.

    Two percent less of the American population is insured today than prior to the global financial meltdown in 2008-2009. (The ACA is not to blame for that, obviously: the Great Recession is. That doesn’t change the hard cold provable fact that more people in America are uninsured today than were in 2008, which adds up to a trendline that’s moving in the wrong direction.)

    Yes, at this rate, we can all count on living in caves and banging rocks and eating dirt someday soon, and our Democratic oligarch masters will assure us “things are getting better and better every day!”

  23. 23
    Richard Mayhew says:

    @mclaren: What is the counterfactual — how many people would have been uninsured in 2020 if no PPACA passed

    If you can’t answer that question, you’re beating off in public again.

  24. 24
    Richard Mayhew says:

    @mclaren: The CBO update was not a comparison of projections of uninsured rates from 2009 projections (pre-PPACA) to 2012 PPACA projections.

    It was a technical analysis of what the impact of the Supreme Court decision to make Medicaid expansion optional from the rest of PPACA. If you actually want to argue in good faith (which you don’t), you would note that the CBO projected the Supreme Court decision would take 6 million people off of Medicaid expansion and move 3 million more people to the Exchanges (100% to 138% FPLers in expansion states). So the net effect of the Supreme Court decision was a net decline in coverage of 3 million people compared to full PPACA implementation as passed in March 2010.

    Taking a look at table 3, the CBO projected a net decline of 20+ million in uninsured and a 10 point fall in the aggregate unemployment rate even accounting for the Supreme Court making Medicaid expansion voluntary.

    But since you won’t argue in good faith, you cherry pick your data and don’t identify context or counterfactuals.

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