Medicaid Expansion Failure: Win for PA

Member Group : Commonwealth Foundation

Editor’s note: A version of this commentary previously appeared on

When is the most humane decision the one that seems just the opposite? In refusing to expand the state’s Medicaid program, Gov. Corbett and the General Assembly have been vilified as cold and uncaring. But despite the critics, both the economic and moral arguments are on the side of those seeking to reform Medicaid, not those pushing the expansion of a broken program.

President Obama’s government health insurance overhaul, the Affordable Care Act, calls for states to expand their Medicaid programs to those up to 133 percent of the poverty line—about $15,000 for an individual or $31,000 for a family of four. But even without expansion, Pennsylvania’s program already consumes 30 percent of the state budget and is one of the most generous in the nation.

Expanding Medicaid would add close to a million new beneficiaries, resulting in fully one-quarter of the state’s population being eligible for coverage. The cost to Pennsylvania’s taxpayers through 2022 could reach $5 billion. That’s enough to give any governor or state legislature pause. It’s no surprise, then, that Pennsylvania isn’t alone in its opposition to Medicaid expansion.

So far, twenty other states agree that expansion is not a good solution for their most vulnerable citizens, despite the federal government’s offer to pay all associated costs for the first two years. What makes turning down "free" federal money so popular? Look no further than the strings attached: the results of the Medicaid program themselves.

Decades of academic research show the program has consistently failed the working poor. From greater chances of cancer recurrence, to higher in-hospital mortality rates for strokes, heart attacks, and pneumonia, to limited options for many medical procedures, Medicaid has proven unable to provide patients the care that they desperately need and deserve.

One in three doctors won’t even accept new Medicaid patients at all—that’s the difference between what Medicaid does provide, a health insurance card, and what it doesn’t, quality health care.

Unfortunately, such a harsh indictment of Medicaid hasn’t stopped politicians on both sides of the aisle from pushing for expansion instead of pursuing reforms that will better serve the working and non-working poor. What’s luring them is that promise of "free" federal money.

This same promise has broken the wills of politicians in other states who at one time opposed either Medicaid expansion or the Affordable Care Act as a whole. This list includes Florida’s Governor Rick Scott as well as Ohio’s John Kasich, who have both gone to great lengths to push expansion in their states.
But once state lawmakers saw the plan’s costs and failures, as they have in Pennsylvania, they strongly resisted the push to expand the broken program.
Accepting this bribery is a short-sighted move, at best. States should have learned from experience that Washington doesn’t exactly set its promises in stone. President Obama has already proposed cutting the federal reimbursement of state Medicaid costs—twice. That was the very promise that enticed several states to jump on the expansion bandwagon in the first place.

If reimbursement rates are cut, state taxpayers will be footing the bill. Compounded with the ACA’s $500 billion price tag–a cost equal to $6,300 per family–the funding shortfall would hit every Pennsylvanian’s wallet.

But by refusing to expand Medicaid, states like Pennsylvania have helped reduce the federal deficit by an estimated $459 billion. To some, the promise of free federal funding may seem too good to pass up, but the suffering that people will endure from an expansion of Medicaid should not be so easily forgotten.

Thankfully, Pennsylvania lawmakers’ steadfast refusal to trade our neediest citizens and taxpayers for temporary political gain and uncertain federal cash is a sign that other difficult reforms may yet be on the horizon.

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Matthew J. Brouillette is president and CEO of the Commonwealth Foundation (

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