Medicaid expansion repeal worries Pennsylvania patients

Jan. 31--Going without health insurance meant living with bouts of sharp pain for Todd Whiting.

Flare-ups of kidney stones, which he said felt like claws piercing his back, threatened to drop him to his knees at any time, said Whiting, 54, of Green Tree.

The owner of a singing telegram business inherited from his mother, Whiting couldn't afford health insurance when symptoms appeared in 2013, he said. He lived with the pain until early 2015, when he learned Pennsylvania had expanded its Medicaid program. He signed up, qualifying under new eligibility guidelines, and underwent surgery to remove the stones.

He is one of nearly 700,000 Pennsylvanians who have enrolled since the state expanded the program to include people who make up to 138 percent of the federal poverty level -- about $16,000 for an individual or $33,000 for a family of four. As President Donald Trump and a Republican-controlled Congress pursue repealing the federal Affordable Care Act -- which could include undoing the Medicaid expansion -- Whiting faces going without insurance.

"There's nothing I could afford. I just wouldn't have (insurance) if it wasn't for this," he said of Medicaid, the state-federal insurance program for low-income people.

Congressional Republicans have offered few details about how they might replace the health law or change Medicaid. The Trump administration has expressed support for giving states set amounts of money in the form of block grants to spend on Medicaid instead of paying a share of patients' medical bills as the federal government does now. States could spend the money more flexibly but might get less of it.

The Pennsylvania Department of Human Services and other organizations have published data that help show who might be affected by changes.

By the end of December, 697,300 newly eligible people had signed up, according to the department. They make up about 23 percent of Medicaid's approximately 2.8 million members and account for about 8 percent of the program's spending, according to the department. Gov. Tom Wolf fully expanded the program in January 2015.

In April, when about 625,000 people were enrolled, the department released more extensive details on the expansion population.

Like Whiting, about 297,000 were employed. About 109,000 had children, according to the data. Sixty-one percent were white, 24 percent were black, and 4 percent were Asian. Forty-six percent were under 35 years old.

People have enrolled in each of the state's 67 counties. The 10 counties with the highest enrollment were Philadelphia, Fayette, Erie, Clearfield, Luzerne, Blair, Dauphin, Lackawanna, Lawrence and Cameron counties.

About 63,000 had received treatment for addiction-related conditions, according to the data, and 1,112 women were pregnant.

Consumer Health Coalition, a Pittsburgh-based nonprofit, has helped people -- including Whiting -- enroll in Medicaid and individual insurance plans sold on the federal insurance marketplace at healthcare.gov.

Sally Jo Snyder, the organization's director of advocacy and consumer engagement, said Whiting's situation is common. Many people breathe a sigh of relief after signing up, Snyder said.

"It's a huge exhale for them finally to be able to have coverage," she said.

Hotel and restaurant staff, home health care workers and hair stylists are some of the professions she has seen sign up in the biggest numbers, she said.

Theresa Jenks, 47, of Westwood, signed up after the expansion. She was diagnosed with gestational diabetes when she gave birth to a son in 1999 and now has type 2 diabetes. She stubbed her toe in November and developed an infection but did not know how serious it was because she had little feeling in her feet, she said.

In March, doctors had to amputate part of her foot to prevent the infection from spreading, she said. She stayed in a hospital for eight days, then in a nursing facility for about a month. She received daily nursing care at home for another month, including treatment with a wound pump and intravenous antibiotics, and then traveled each day for a month for hyperbaric oxygen treatments her doctor recommended.

She doubts she would have received the same level of care after hospital discharge had she not had Medicaid.

"I wouldn't be here without health care," she said.

She was an assistant teacher and worked at a nonprofit employment center before the infection, she said, but is now unemployed. She doesn't know whether she would be eligible for Medicare or traditional Medicaid because of a disability if the expansion went away.

The federal government paid 100 percent of treatment costs for Whiting, Jenks and the rest of the Medicaid expansion population through the end of 2016. The federal reimbursement rate dropped to 95 percent in 2017 and will decrease incrementally to 90 percent in 2020 under the Affordable Care Act.

The government pays about 58 percent of treatment costs for people with traditional Medicaid, with the state paying the rest. Before the expansion, the state paid several hundred million dollars per year in a program called General Assistance to treat some 80,000 poor people who didn't qualify for Medicaid, according to the state's Independent Fiscal Office.

The office estimates the state's share of the Medicaid expansion for fiscal year 2017-18 will be about $240 million, increasing to about $680 million for fiscal year 2021-22.

Estimates before the expansion predicted around 500,000 people would enroll. As sign-ups increase, so do costs. The state has not released data on how treatment costs for newly insured in the program compare to people who were enrolled before.

The office estimates that savings from eliminating the General Assistance program would be roughly equivalent to the state's annual spending by the 2021-22 fiscal year.

State legislators, who convened for a new session last week, face a projected $1.7 billion budget shortfall for the coming fiscal year. State fiscal officials have said eliminating the Medicaid expansion would worsen deficits, but no one knows what a replacement would look like. The General Assistance fund that existed before the expansion is not a mandatory program for states.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or [email protected].

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