So there’s considerable satisfaction among supporters of health care reform today at the news that embattled PA Governor Tom Corbett is reversing field and preparing to announce next week a plan to expand Medicaid coverage under the options offered by the Affordable Care Act, making the Keystone State the 27th to go along with this key provision of Obamacare. Most chronicles of this development note that Corbett’s not just caving and expanding Medicaid, but is instead following a number of other states (including next-door Ohio) in seeking HHS approval for a plan that moves both new and existing Medicaid beneficiaries into private health insurance plans via the new Obamacare “exchanges.” Though details are lacking for what Corbett has up his sleeve, it’s probably some version of the so-called “Arkansas Plan” HHS has already approved.
Like other Republican governors who have gone in this direction, Corbett is at pains to deny he’s “expanding Medicaid.” Oh no: he’s engaged in “entitlement reform,” at the expense of the feds, of course.
It’s important for progressives to understand that this claim isn’t entirely BS. Prominent conservative health care writers Douglas Holtz-Eakin and Avik Roy argued back in February that Republicans should come to grips with the existence of Obamacare and focus on using it to expand the coverage arena of private health insurance, most especially for those in the public health insurance programs of Medicaid and Medicare. Indeed, the ultimate conservative health policy fantasy, reflected in Paul Ryan’s Medicare “voucher” proposal, is a transition to universal private health insurance via a uniform system of public subsidies that wither away over time.
So it’s a perfect solution for someone like Corbett, whose back is against the wall politically and who is undoubtedly being battered by complaints from hospitals and providers about leaving all that federal money on the table, to cut a deal that will indeed expand insurance coverage but that will also “reform” Medicaid. It’s richly ironic that any Republicans will treat the system of mandates, exchanges and subsidies called Obamacare as monstrous slavery when applied to one element of the population but “reform” when applied to another. But it also reflects how many of them think about poor people.