News Health Systems

Coalition Urges Pennsylvania Lawmakers to Expand Medicaid to Solve Budget Crisis

Tara Murtha

While Gov. Tom Corbett insists Pennsylvania can’t afford Medicaid expansion, advocates argue Pennsylvania can’t afford not to expand Medicaid.

On Monday, a coalition of 130 state organizations called Cover the Commonwealth kicked off a campaign demanding that state legislators help solve the state’s budget crisis by expanding Medicaid—even if only temporarily, until the federal government makes a decision on the governor’s alternate proposal.

Pennsylvania is one of 24 states whose leaders chose not to expand Medicaid. Gov. Tom Corbett has waged a battle against the Affordable Care Act (ACA) for years. In 2010, as attorney general, he filed an unsuccessful lawsuit challenging the constitutionality of the health-care reform law. Four years later, with Medicaid expansion considered “the final battle in the war over Obamacare,” he has refused to expand. Now, Pennsylvania is a geographic outlier; every state touching its borders has expanded.

Support for Medicaid expansion has generally fallen along partisan lines. But experts say politics has gotten in the way of governance. To wit, the number of people left in the coverage gap far exceeds the number of newly insured. Approximately half a million low-income Pennsylvanians who would have coverage under expansion are going without insurance.

Refusing Medicaid expansion has created an inverse situation where those who need the most financial help obtaining health insurance are the least qualified to obtain it. For example, a Pennsylvania family of four earning $45,000 a year qualifies for a tax subsidy toward health insurance, but a family of four earning $9,000 does not.

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Additional populations, such as childless, able-bodied adults in Pennsylvania earning less than $11,490, remain categorically disqualified from traditional Medicaid altogether.

State health-care organizations and advocates have been tirelessly advocating for Medicaid expansion in Pennsylvania since the Supreme Court decided the states could opt out in 2012, but now the campaign is heating up and shifting gears as the state’s General Assembly enters a tough budget season.

Pennsylvania is facing a $1.3 billion budget shortfall, and lawmakers need to pass a balanced budget by June 30.

Advocates are focused on advising lawmakers and raising awareness of the significant financial benefits of Medicaid expansion.

The tactical shift may get traction: There’s already evidence that the partisan split on the issue is beginning to crumble. Last week, three Republican house members cast a committee vote to force Medicaid expansion.

The defection caused dissent in the ranks. Republican Rep. Brad Roae (R-Crawford) declared that “Obamacare is ruining our health-care system.”

Meanwhile, Drew Crompton, chief of staff for Senate President Joe Scarnati (R-Jefferson), has said, “All options [for finding revenue] are truly on the table,” and Miriam Fox, executive director for Democrats on the House Appropriations Committee, called Medicaid expansion “key to helping solve this budget crisis.”

“I think it really shows that both Democrats and Republicans recognize the fact that expanding Medicaid is a huge revenue generator for our state. We’re facing a billion dollar budget crisis … and here is $600 million on the table that we can draw down,” Antoinette Kraus, director of the Pennsylvania Health Access Network and spokesperson for the Cover the Commonwealth campaign, told Rewire.

The coalition, which held a rally on the capitol steps Monday afternoon while flanked by a ticker tallying the real-time loss of revenue without expansion, are campaigning for Medicaid expansion on the same terms Gov. Corbett has consistently used to argue against it. While Corbett insists Pennsylvania can’t afford Medicaid expansion, advocates argue Pennsylvania can’t afford not to expand Medicaid.

“We are looking at being able to bring in $600 million in new revenue and savings if we decided to expand Medicaid as part of this year’s budget,” says Kraus. “At the same time, if we expand by June 30, we would be able to draw … on another $100 million for this year, the 2013-2014 budget.”

Kraus says that expanding Medicaid will also create some 35,000 jobs.

The Pennsylvania Health Law Project notes that new Medicaid costs will be incurred regardless of whether or not the state expands Medicaid, but the revenues and savings associated with expansion “more than offset” the marginal difference.

Senate Majority Leader Dominic Pileggi (R-Delaware) has said essentially that he does want to reconsider Medicaid expansion while Gov. Corbett’s alternate plan, Healthy PA, is under review by the federal government.

Healthy PA is Corbett’s proposed alternative to expansion. The plan would cut benefits of current enrollees, and use expansion funds to assist un- and underinsured low-income residents to purchase privatized Medicaid insurance plans.

Healthy PA has had a bumpy road. It stipulated qualification requirements that experts said had little chance of being approved by the federal government, such as a system for proving beneficiaries were seeking full-time employment; no state has ever tethered Medicaid eligibility to searching for employment. In March, Corbett announced he was easing up on the job-search requirement.

The state is currently in negotiation with the federal government over the plan, and it is unclear when a decision will be made. Advocates say Pennsylvania lawmakers can choose to expand Medicaid without disrupting the approval process for Healthy PA.

“We could temporarily expand Medicaid and draw down the funds, while [Gov. Corbett] continues to negotiate Healthy PA. So it wouldn’t interrupt. … It would simply provide a bridge until [Healthy PA] is approved, amended, or redone,” Kraus explained to Rewire.

A statement issued by the Cover the Commonwealth coalition this afternoon noted that “specific language could be added to affirm the General Assembly’s intent that these funds are provided only as a bridge, as Pennsylvania awaits a decision on a waiver.”

Advocates point to similar circumstances in New Hampshire. Like Pennsylvania, New Hampshire submitted an alternate proposal requesting that federal funds earmarked for Medicaid expansion be used instead to subsidize private plans.

In March, the New Hampshire Senate passed a proposal establishing a “voluntary bridge to marketplace premium assistance program in order to provide medical assistance for newly eligible adults and their spouse and dependents.”

A recent poll revealed that the majority of Pennsylvanians want Gov. Tom Corbett to expand Medicaid. Corbett is considered one of the country’s most vulnerable governors in the forthcoming election. Tom Wolf, his Democratic challenger, has stated he’d expand Medicaid, if elected.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions


Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.


But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.


The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.


In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

News Abortion

Pennsylvania’s TRAP Law Could Be the Next to Go Down

Teddy Wilson

The Democrats' bill would repeal language from a measure that targets abortion clinics, forcing them to meet the standards of ambulatory surgical facilities.

A Pennsylvania lawmaker on Wednesday introduced a bill that would repeal a state law requiring abortion clinics to meet the standards of ambulatory surgical facilities (ASF). The bill comes in response to the U.S. Supreme Court’s ruling striking down a similar provision in Texas’ anti-choice omnibus law known as HB 2.

A similar so-called targeted regulation of abortion providers (TRAP) law was passed in Pennsylvania in 2011 with bipartisan majorities in both the house and state senate, and was signed into law by former Gov. Tom Corbett (R).

SB 1350, sponsored by Sen. Daylin Leach (D-Montgomery) would repeal language from Act 122 that requires abortion clinics to meet ASF regulations. The text of the bill has not yet been posted on the state’s legislative website.

The bill is co-sponsored by state Sens. Art Haywood (D-Philadelphia), Larry Farnese (D-Philadelphia), and Judy Schwank (D-Berks).

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Leach said in a statement that there has been a “nationwide attack on patients and their doctors,” but that the Supreme Court’s ruling upholds the constitutionally protected right to terminate a pregnancy.

“Abortion is a legal, Constitutionally-protected right that should be available to all women,” Leach said. “Every member of the Pennsylvania General Assembly swore an oath to support, obey and defend the Constitution of the United States, so we must act swiftly to repeal this unconstitutional requirement.”

TRAP laws, which single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to medical clinics, have been passed in several states in recent years.

However, the Supreme Court’s ruling in Whole Woman’s Health v. Hellerstedt that struck down two of the provisions in HB 2 has already had ramifications on similar laws passed in other states with GOP-held legislatures.

The Supreme Court blocked similar anti-choice laws in Wisconsin and Mississippi, and Alabama’s attorney general announced he would drop an appeal to a legal challenge of a similar law.