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Pennsylvania health insurance

Keystone State moves from waiver to straight Medicaid expansion

Public health and access to affordable healthcare 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

In 2014, America’s Health Rankings placed Pennsylvania 28th out of the 50 states in terms of overall health. The state’s rating is helped by a low percentage of uninsured, a strong high school graduation rate, and high immunization coverage among children and adolescents. Pennsylvania’s challenges include high rates of drug deaths and air pollution, and relatively low per capita public health funding. In the past several years, the state has seen improved immunization coverage, fewer preventable hospitalizations and a decrease in smoking.

Pennsylvania fared slightly better in The Commonwealth Fund’s 2014 Scorecard on State Health System Performance. 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.

Trust for America’s Health has summarized a variety of public health data pertaining to Pennsylvania in their 2015 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 Republicans hold a majority in the state’s House and Senate. Former Gov. Tom Corbett was also a Republican and not an ACA supporter. As such, the state defaulted to a federally facilitated health insurance exchange.

But unlike many Republican governors, Corbett pursued the possibility of Medicaid expansion under the ACA. Corbett submitted his proposal for a modified version of Medicaid expansion – dubbed Healthy Pennsylvania – to HHS in February 2014.  It took half a year of negotiations, but on August 28, 2014, Corbett and HHS announced that they had reached an agreement, and Pennsylvania became the 28th state, including DC, to accept federal funding to expand Medicaid and thereby cover residents with incomes up to 138 percent of poverty.

Corbett lost the 2014 gubernatorial election to Tom Wolf, a democrat. Gov. Wolf was sworn into office January 20, 2015. Shortly after he assumed office, Wolf began to do away with Healthy PA in favor of traditional Medicaid expansion, which had been a campaign promise.

How did Obamacare help PA 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 10.3 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.

By mid-2015, Pennsylvania’s percentage of uninsured dropped to 7.7. The number of people that obtained 2015 coverage through the exchange, including Medicaid/CHIP and private plans, was 539,023.

Nonetheless, Pennsylvania still has 994,000 uninsured residents, according to the Kaiser Family Foundation. Forty-eight percent of them are eligible for Medicaid and 18 percent are eligible for tax credits if they buy private health plans through Pennsylvania’s exchange.

In September 2015, Pennsylvania was awarded more than $3.1 million in Navigator grants to help six organizations provide outreach and enrollment assistance through 2018.

Pennsylvania enrollment in qualified health plans

In the fall of 2013, the Kaiser Family Foundation estimated that 1,276,000 Pennsylvania residents could potentially buy qualified health plans (QHPs) 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.

During 2015 open enrollment, 472,697 Pennsylvanians selected private plans through the state’s exchange. By June 30, however, some had dropped their coverage and total effectuated enrollment was 397,967 with 80.4 percent of enrollees in plans with premium tax credits and 55.3 percent receiving cost-sharing subsidies.

Pennsylvania’s final 2016 rates have a 12 percent weighted average increase, and there will be 15 carriers offering individual health plans through the state’s exchange.

PA Medicaid/CHIP

By July 27, 2015, about 439,000 Pennsylvanians had enrolled in the state’s expanded Medicaid program – expanded coverage did not take effect until January 2015. The state saw a 12 percent increase in its average monthly Medicaid enrollment from 2013 to 2015, a number that is sure to keep changing now that Pennsylvania has expanded Medicaid coverage and Medicaid enrollment lasts year-round.

State-based health reform legislation

Here’s a summary of recent Pennsylvania legislation related to public health and healthcare reform:

If the Supreme Court would have ruled that the federally facilitated exchange could not provide Obamacare subsidies, Pennsylvania had a contingency plan to create a state-run exchange. However, following the King v. Burwell verdict, which upheld subsidies in the federal exchange, the state withdrew its proposal.

Medicare in the Keystone State

Pennsylvania Medicare enrollment reached 2.5 million in 2015, which is about 19.6 percent of the state’s population. About 17 percent of the U.S. population is enrolled in Medicare. In the Keystone State, 82 percent of Medicare beneficiaries qualify based on age alone and 18 percent qualify due to a disability.

Medicare spends about $10,555 annually per Pennsylvania enrollee, and the state ranks fifth in overall Medicare spending with $23.7 billion per year.

Pennsylvanians that qualify for Medicare can select a Medicare Advantage plan instead of Original Medicare, and about 40 percent do so. About 41 percent of Pennsylvania’s Medicare beneficiaries are enrolled in stand-alone prescription drug benefits through a Medicare Part D plan. Nationally, about 32 percent of Medicare beneficiaries choose a Medicare Advantage plan and 43 percent select a Rx plan.