Health

"Since becoming law in 2010, the Affordable Care Act has been subject to a barrage of revisions and lawsuits designed to amend, improve or topple the controversial legislation -- depending on your point of view. During the past four years, more than 42 significant changes have been made to the ACA, according to the Galen Institute, a nonprofit health and tax policy research group. They include 24 changes made by President Obama, 16 passed by Congress and two by the U.S. Supreme Court. Hundreds of additional lawsuits are working their way through the courts, challenging key provisions of the law."

"Now let's look to the future of Healthy Pennsylvania. Unfortunately, that's where its bad "side effects" can be found. It creates a third health care delivery system, in addition to the Medicaid Managed Care system and the federally facilitated exchanges. Small changes in income will send people from one system to the other, creating many opportunities for bureaucratic mischief that could interrupt their coverage. Starting in 2016, the Welfare Department will be able to charge Pennsylvanians living from 100 percent to 138 percent of the poverty level (for an individual that's an annual income of up to $16,105, and for a family of four that's an annual income of up to $32,913) 2 percent of their monthly income for coverage. That's a higher premium than any other state has sought to charge its low-income residents."

"Twenty-nine of 50 eligible schools in Vermont have chosen to participate in this program, according to the governor's office. The program is part of the federal Healthy Hunger-Free Kids Act of 2010, Concannon said. The 'Community Eligibility Provision' of that law has already been introduced in several states but this year opened to all 50 states. Schools qualify if they have a high number of children whose family income is 185 percent or less of the federal poverty level (for a family of four that means $23,850) and if they have a high percentage of children whose family income has been verified through another state or federal program, such as ReachUp or food stamps, Concannon said."

"This is a big deal because the Arkansas approach has been seen as the most likely model under which GOP-friendly states might eventually expand Medicaid. But the GAO report is a reminder that the economics of the Arkansas model might not work and that the private-option waiver might not be funded after three years. But the big challenges facing the Medicaid expansion don't only involve the private variation. The public version of the Medicaid expansion is about to hit its own funding wall starting in January when the Affordable Care Act's boost in funding for Medicaid primary care doctors expires."

"Rather than simply expanding Medicaid - a program that sometimes essentially denies care to the poor because doctors avoid its low reimbursement rates - Corbett sought to reform it. Corbett's program seeks to provide coverage to an estimated 600,000 additional Pennsylvanians by offering them federal subsidies to purchase private insurance. This will reduce disruption for those whose incomes rise enough to no longer qualify for the program and likely provide better coverage overall."

"The relentless economics of the U.S. health care system have sapped resources in poor areas for decades as hospitals and doctors follow the money in the form of well-insured patients. Doctors and medical care facilities serving large numbers of poor patients have trouble staying afloat because uninsured patients and those on Medicaid are expensive."

"If the 23 states that have rejected expanding Medicaid under the 2010 health-care law continue to do so for the next eight years, they'll pay $152 billion to extend the program in other states -- while receiving nothing in return. This exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time. Most of the money, nearly $88 billion, would come from taxpayers in just five non-expansion states: Texas, Florida, North Carolina, Georgia and Virginia."

"Some Missouri Republicans say they're willing to expand Medicaid - provided that new recipients look for jobs as a condition of eligibility. But a new agreement between the federal government and Pennsylvania suggests that strategy probably won't work. Pennsylvania's plan to provide coverage to as many as 600,000 low-income residents was approved last week, but only after its work-search requirement was dropped after stiff resistance from the federal government"

"Georgia has opted out of expanding Medicaid under Obamacare, aiming to avoid increased costs. On top of that, at the close of this year's legislative session Gov. Nathan Deal signed a bill making sure Medicaid cannot be expanded in Georgia without approval by the legislature. HB 990 bars any expansion of Medicaid eligibility 'through an increase in the income threshold without prior legislative approval.' The law specifies the approval must be by a legislative act or joint resolution of the General Assembly. Maybe this is a hedge against the possibility of pro-Medicaid expansion Democratic nominee for governor Jason Carter winning in November? Carter, trailing Deal, is trying to make Medicaid a key issue in the race."