The Medicaid program took a few hard shots to the gut -- mostly from the right — Thursday during a Pennsylvania House Health Committee hearing on the proposal to expand the program in Pennsylvania.

 

Medicaid is the state's public insurance program for low-income and disabled residents. Under the federal health law, states can choose whether to expand the program.

The federal government wants Pennsylvania to opt into an expansion because it would provide health coverage to hundreds of thousands of uninsured low-income childless adults and others.

The U.S. Department of Health and Human Services estimates the expansion would create tens of thousands of jobs and generate revenue for the state. One estimate from RAND, an independent research group, found that Pennsylvania could draw down about $2 billion in federal funding.

According to HHS, roughly half of states have plans to expand Medicaid.

So far Gov. Tom Corbett says he's undecided.

Via Skype and other Web technology, speakers from across the country presented state lawmakers with lots of reasons to say "no."

Sounding a warning

Congressman Joe Pitts of Pennsylvania started with a warning about his colleagues in Washington.

"Congress will not keep its promise to you," Pitts said. "We broke our promise on special education funding. More recently, we broke our promise to pay for your program for people with pre-existing conditions — PA Fair Care."

Under the Affordable Care Act, the federal government pledges to match the cost of covering the newly eligible people. The match is 100 percent in early years, a little less in later years.

In a conference call with reporters, Paul Dioguardi, director of external affairs with HHS, addressed concerns that the federal government would "renege" on its end of the deal.

Dioguardi said an expansion is completely paid for under the Affordable Care Act.

"If you look at the president's budget, it very clearly does not touch Medicaid," Dioguardi said.

Dioguardi said states can opt out of an expansion at any time.

Back at the House Health Committee meeting, several speakers said Medicaid is already "under incredible strain" and an unpopular program because it underpays doctors.

Jonathan Ingram, director of research for the Foundation for Government Accountability, said the uninsured who would become eligible will be sicker — and more costly to Pennsylvania than the estimates from expansion advocates suggest.

Michael Cannon, director of health-policy studies at the libertarian think tank, the Cato Institute, urged Pennsylvania to follow the lead of several other states and get litigious over the Affordable Care Act.

And a call to litigation

"It should join the state of Maine in challenging the federal government's attempt to force Pennsylvania and other states, to implement parts of the Medicaid expansion that the Supreme Court has made optional," Cannon said. "Pennsylvania should join Oklahoma is challenging the IRS's attempt to impose illegal taxes on Pennsylvania employers."

Cannon also questioned whether Medicaid delivers on one of its core missions.

"A lot of people are surprised to learn that we have very little evidence about whether Medicaid is even improving the health of enrollees," Cannon said.

On the call with reporters, Dioguardi said the bottom line is that Medicaid is a valuable source of health care.

"Having better health insurance period leads to better health outcomes," he said. "I would just argue plain logic that having health insurance is better for you than not having it."

Dioguardi said he's seen several studies that show that having Medicaid leads to better health, on several measures.