Pennsylvania health insurance
Keystone State 29th in ranking of state healthiness; is health reform helping?
By Louise Norris
August 20, 2014
Public health and access to affordable health care are important factors in long term health outcomes and quality of life. Here’s a summary of Pennsylvania residents’ overall health, access to health insurance, and state leadership’s approach to healthcare reform:
Pennsylvania health ratings
Pennsylvania ranked a little above average on The Commonwealth Fund’s Scorecard on State Health System Performance in 2014. The state came in 22nd out of the 50 states and DC, down from 14th place in 2009. The Pennsylvania Scorecard provides details showing how the rating was determined; the state scored better than average for prevention and treatment metrics, but lower than average on the “healthy lives” section, which includes factors such a specific disease incidence, tobacco use, and obesity.
In 2013, America’s Health Rankings placed Pennsylvania slightly lower than the Commonwealth Fund, giving the state a ranking of 29th out of the 50 states in terms of overall health. The state’s rating is helped by a strong high school graduation rate, high immunization coverage among adolescents, and a low percentage of the population without health insurance (11 percent in 2013).
Pennsylvania’s challenges include high rates of drug deaths and air pollution, and relatively low per capita public health funding. Just over 29 percent of the state’s adult population is obese, and although tobacco use decreased by 5 percent between 2012 and 2013, more than 2.1 million adults in Pennsylvania still smoke.
Trust for America’s Health has summarized a variety of public health data pertaining to Pennsylvania in their 2014 edition of Key Health Data, which contains information on specific diseases, health factors, and outcomes.
The Robert Wood Johnson Foundation also analyzed public health data at the county level, ranking Pennsylvania’s counties on this interactive map. The southeast part of the state has some of the highest ranking counties for both health factors and outcomes.
Pennsylvania and the Affordable Care Act
In 2010, both of Pennsylvania’s U.S. Senators, Democrats Robert Casey and Arlen Specter, voted in favor of the ACA. In the U.S. House, eleven Democrat Representatives voted yes, while seven Republicans voted no. Specter has since been replaced in the Senate by Republican Pat Toomey, and the U.S. House now includes just five Pennsylvania Democrats, and 13 Republicans.
At the state level, the overall population in Pennsylvania has a Democratic majority, but the Governor is a Republican and Republicans also hold a majority in the state’s House and Senate. Governor Tom Corbett is not an ACA supporter, and HHS is running the exchange in Pennsylvania.
But unlike many Republican governors, he has not entirely dismissed the possibility of Medicaid expansion under the ACA. Corbett has not yet expanded Medicaid, which means that hundreds of thousands of residents are currently in the coverage gap in Pennsylvania. But for the past several months, Corbett has been involved in negotiations with HHS, trying to win approval for his proposal for modified Medicaid expansion.
Corbett’s plan, which tends to be more popular with Conservative lawmakers than straight Medicaid expansion, would use federal funds to subsidize private health insurance for low-income residents. It would also charge some of those residents a “modest monthly premium.”
Lawmakers in Pennsylvania have also offered another alternative, which would involve expanding Medicaid as written in the ACA, but would give the state an out if the federal government were to back away from its promise to fully fund expansion through the end of 2016.
How did the ACA help Pennsylvania Residents?
Before the ACA was implemented, the uninsured rate in Pennsylvania was 11 percent, the seventh-lowest rate in the nation. Despite the fact that Pennsylvania has not yet expanded Medicaid, the uninsured rate had fallen slightly – to 10.1 percent – by the middle of 2014. About 360,000 people obtained coverage, including Medicaid/CHIP and private plans, through the Pennsylvania exchange during the first open enrollment.
Pennsylvania enrollment in QHPs
In the fall of 2013, the Kaiser Family Foundation estimated that 1,276,000 Pennsylvania residents could potentially buy coverage through the exchange, and that 715,000 of them would qualify for premium subsidies. By the end of the first open enrollment period, 318,077 people purchased private plans in the Pennsylvania exchange, and 81 percent received premium subsidies.
Nine carriers are offering plans in the Pennsylvania exchange: Aetna, Capital Blue Cross, Blue Cross of Northeastern Pennsylvania, Geisinger Health System, HealthAmerica PA, Highmark Health Services, Independence Blue Cross, Keystone Health Plan (a subsidiary of Independence Blue Cross), and the University of Pittsburgh Medical Center Health Plan.
Pennsylvania Medicaid/CHIP enrollment
Pennsylvania is currently one of 2 states waiting for approval from HHS to offer a modified version of Medicaid expansion. Rather than simply expand the existing Medicaid program to cover all legal residents with incomes up to 138 percent of poverty, Governor Corbett has proposed using federal Medicaid funds to subsidize private coverage, and would require small premium contributions from some insureds. Corbett also wants unemployed enrollees to be actively searching for work.
Although Corbett is still working with HHS to reach a solution, the delay means that there are currently 281,290 people – about a quarter of the state’s uninsured population – in the Pennsylvania coverage gap, and the exchange only enrolled 42,335 people in the existing Medicaid program by mid-April.
Because the state has not expanded Medicaid under the ACA, enrollment in 2014 still utilizes Pennsylvania’s existing strict eligibility guidelines: Non-disabled adults with no dependent children cannot receive Medicaid coverage regardless of income, and parents with dependent children are only eligible if their household earnings doesn’t exceed 33 percent of poverty (about $656 a month for a family of four – certainly not a liveable income).
State-based health reform legislation
Here’s a summary of recent Pennsylvania legislation related to public health and healthcare reform: