July 01--HARRISBURG -- Republican lawmakers could urge action this fall on a constitutional mandate stating no Pennsylvanian can be compelled to buy insurance, as part of continuing challenges to provisions of the federal health care law.
At least 20 states have passed binding legislation opposing broad elements of health care reform, the National Conference of State Legislatures says, and several -- including Pennsylvania -- likely will not expand Medicaid since the U.S. Supreme Court removed the threat of federal penalties, analysts said.
That decision would be critical because of Pennsylvania's growing senior population and the high costs of skilled care for older people, said Linda Rhodes, a former secretary of the state Department of Aging and author of a book on caring for elderly parents.
"Medicaid has become a safety net for the middle class," Rhodes said.
As of the end of May, Pennsylvania administered Medicaid insurance to 2.2 million people and would add an estimated 800,000 if it expanded the program. The court upheld most of President Obama's signature law, dubbed Obamacare, but said the government cannot take away states' existing federal Medicaid dollars if they refuse to widen eligibility to include adults slightly above the poverty line.
Though lawmakers likely won't decide most issues until after the November election, states have the option of setting up the online, one-stop shops where people could buy insurance, but there's no indication what Pennsylvania will decide.
Pennsylvania'sInsurance Department surveyed people statewide about their needs but hasn't spent any of its $33 million federal grant to develop the marketplaces, department spokeswoman Roseanne Placey said.
Rep. Matthew Baker, R-Tioga County, who chairs a House committee on health care, said Pennsylvania can't afford the long-term Medicaid expansion the court declared optional.
"The court took away the big club when they said the government could not withhold Medicaid money for opting out," said Charlie Gerow, a GOP consultant and Harrisburg attorney.
Democratic Rep. Joe Markosek of Monroeville believes the cost of additional Medicaid coverage would be offset by savings the law provides through discounted prescription drugs, reduced costs for children's health care and lower costs for the state's prescription drug program for seniors.
"Using the opt-out doesn't make sense. Federal dollars pay for it," said Rep. Dan Frankel, D-Squirrel Hill.
Pennsylvania could join more than a dozen states with laws pertaining to the mandate that everyone must buy insurance.
"Many members would like to see us run this bill, but we need to thoughtfully consider this," Baker said.
Sen. Don White, R-Indana County, who chairs the Senate health panel, urged speedy action on the proposed constitutional amendment. White said his constituents like some parts of the law but "universally oppose the insurance mandate. They believe it to be an expensive intrusion by the federal government into their lives."
Lawmakers would need to reapprove the constitutional amendment in their 2013-14 session and then present it to voters. The federal mandate takes effect in 2014.
"For the (Republican) base, it's a powerful statement," said Steve Peterson, a political science professor at Penn State University'sHarrisburg campus.
"I don't think (Republicans) will back off at all," said Jack Treadway, retired chairman of the political science department at Kutztown University.
State action might not be necessary if the GOP assumes control of the U.S. Senate and Republican nominee Mitt Romney defeats Obama, Treadway said. Romney vowed to ensure that lawmakers in Washington dismantle Obamacare if he wins the White House.
In its 5-4 ruling largely upholding the health care law, the court said the mandate that people buy insurance equates to a tax that Congress can impose.
Some analysts, such as Joseph DiSarro, chairman of the political science department at Washington & Jefferson College, dismiss much of the posturing about continuing to challenge the law as "chest-pounding talk by politicians."
A state law banning mandatory coverage is "more of a symbolic thing," Gerow said. "What the court said was that Obamacare will be decided by the political process, not the judicial-legislative process."
Gov. Tom Corbett, as state attorney general, was among several who filed the lawsuit the court decided. He said after the ruling that he disagrees with the court's decision, and it would take time to decide the state's response.
"Those kinds of decisions will be made after we get the budget done," Corbett said.
Corbett pledged to "limit the law's negative impact on Pennsylvania" -- a statement his spokesman, Kevin Harley, said Corbett meant in general and not necessarily about Medicaid expansion.
Brad Bumsted is State Capitol reporter for the Tribune-Review. He can be reached at 717-787-1405 and email@example.com. Michael Macagnone is an intern for the Pennsylvania Legislative Correspondents Association. He can be reached firstname.lastname@example.org.
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