Corbett Medicaid meeting comes as Pa. revenue lags

HARRISBURG, Pa. (AP) -- Gov. Tom Corbett's meeting with U.S. Health and Human Secretary Kathleen Sebelius on whether he'll seek an expansion of Medicaid to provide health care to hundreds of thousands of low-income Pennsylvania adults comes as state revenues are lagging his projections.

The meeting is set for late Tuesday afternoon in Washington, D.C.

On Monday, Corbett's administration remained quiet about what kind of concessions he might seek from Sebelius to address his complaints about the need for flexibility in Medicaid and the potential cost to Pennsylvania taxpayers.

A spokeswoman would not discuss details of the matters the governor will raise in the meeting. Instead, she pointed to the governor's previous statements that his administration has unanswered questions about the Medicaid expansion, and he is seeking more flexibility to tailor benefits packages to different types of Medicaid enrollees as a way to save money.

Under the 2010 Affordable Care Act, states were required to expand Medicaid's eligibility rules, primarily to benefit low-income working adults. But a U.S. Supreme Court decision last summer ruled that the federal government could not force states into the expansion, and it thus became a decision for each state.

Thirty-seven House Republicans are co-sponsoring a bill that would prohibit a Medicaid expansion. However, many, if not all, Democratic lawmakers support an expansion, as do a growing number of Republican senators, the AARP, hospital executives and labor unions.

Corbett has three months left until he must join with lawmakers to approve a budget, and his financial flexibility is slimmer than he had anticipated just two months ago. A disappointing report Monday on March tax collections left state accounts about $200 million behind the expectations in Corbett's Feb. 5 budget proposal.

Corbett warns that he is worried about the cost of a Medicaid expansion to Pennsylvania taxpayers, even though the federal government will pick up the lion's share of the expansion's cost. But Corbett also warns the federal government can't always be trusted to deliver on its funding promises.

Senate Public Health and Welfare Committee Chairwoman Pat Vance, R-Cumberland, said she has not been briefed by the Corbett's aides on the topics they will raise with Sebelius.

Vance agrees with Corbett that more information is needed about how the Medicaid expansion would work, but she also thinks other states have secured valuable cost-saving concessions from the Health and Human Services Department.

"I think it's intriguing," Vance said. "If you could get enough concessions, it could be worthwhile."

Senate Minority Leader Jay Costa, D-Allegheny, said Democrats believe that a Medicaid expansion will be a net tax benefit to Pennsylvania. The federal government will pick up health care costs currently borne by the state and counties while infusing billions of dollars into the economy to ensure hospitals and doctors get paid for the care they provide to the poor, Costa said.

"We're concerned by three straight months of not meeting our revenue projections, but now more than ever it puts a lot of weight on the governor's conversation with Secretary Sebelius because we see a Medicaid expansion as a way to address any revenue shortfalls that we may experience," Costa said.

A Rand Corp. study sponsored by the Hospital & Healthsystem Association of Pennsylvania, which supports a Medicaid expansion, said Pennsylvania would save money, at least in the first three years when the federal government picks up the entire cost of newly eligible Medicaid enrollees.

If Corbett goes along with it, one motivating factor may be the taxes paid by Pennsylvanians and the loss of federal funding. Without a Medicaid expansion, Pennsylvania will get nearly $17 billion less from the federal government over eight years.