It's been an uncertain ride for language outlining an expansion of Medicaid in Pennsylvania in the last few weeks.
First, the Pennsylvania House of Representatives passed a public welfare code bill.
Then, the Pennsylvania Senate passed it but added language outlining Medicaid expansion under the federal Patient Protection and Affordable Care Act and setting a deadline for passing an expansion plan. When it returned to the House, it stripped the amendment and sent it back to the Senate.
Finally, just before leaving for summer recess on July 3, the Senate passed the bill without the Medicaid expansion provision.
"We have grave concerns about the welfare expansion in Pennsylvania," state Rep. Kathy Rapp, R-Warren, said. "We have a history in Pennsylvania of the federal government not following through with their promises."
As an example, Rapp cited special education funding.
"The federal government promised way back when that they would always pay 40 percent," she pointed out. "They currently give us about 17 percent. The federal government doesn't have a good track record when they say they want us to expand Medicaid."
On June 10, the Pennsylvania House of Representatives passed House Bill 1075 by a 198-0 vote, a measure which handled a number of budgetary and program-related issues under the public welfare code including, among other things, expansion of the state's human services block grant program and reauthorization of funding to some elderly care facilities and hospitals.
A similar bill goes before the legislature each year as a means of implementing the appropriations made in the state budget.
After approval by the House, the bill moved to the Pennsylvania Senate, which added language to the bill outlining assurances, concessions and reforms the state would require to expand Medicaid as called for under the Patient Protection and Affordable Care Act.
The Affordable Care Act had slated the Medicaid expansion for 2014, but a 2012 U.S. Supreme Court decision ruled states did not have to participate in the expansion to continue to receive current Medicaid funding.
The Senate passed the measure with the added language in a 40-10 vote on June 30.
The bill returned to the House for concurrence, which stripped the Medicaid provision and re-approved the bill in an almost entirely party-line vote on July 1. Only two Republicans voted against the measure and no Democrats voted for it.
The bill once again returned to the Senate for approval, again absent the expansion language. On July 3, the Senate passed the bill without the expansion in a 27-22 vote.
"Failure of the general assembly to pass a welfare code bill in a timely manner will put millions of Pennsylvanians at risk," Pennsylvania Secretary of Public Welfare Beverly Mackareth said prior to Senate passage, outlining why passing a bill with or without an expansion was necessary. "It would mean the loss of hundreds of millions of dollars to fund Pennsylvania's healthcare system, including funding for hospitals and nursing homes."
A statement from the Pennsylvania Hospital Association agreed, but expressed disappointment with the lack of expansion language.
"From day one, Pennsylvania hospitals have unequivocally and forcefully supported Medicaid expansion, and our support for expansion is unwavering," Andy Carter, president and CEO of the Pennsylvania Hospital Association, said. "Pennsylvania hospitals, like the bipartisan group of senators who supported expansion, are disappointed that a bill that would provide eligibility for Medicaid health insurance coverage for low-income working Pennsylvanians has not yet passed both chambers.
"House Bill 1075 also included provisions that affected Medicaid funding and payment for hospitals, nursing homes, and facilities that serve individual with intellectual disabilities. Jeopardizing that funding by postponing action to the fall would have created access to care problems for Pennsylvania's most vulnerable citizens."
Rapp, meanwhile, pointed out concerns about increasing the number of people using government services.
"It would put one in four people on Medicaid," Rapp said. "Eleven states have more people on welfare than working. We don't want to put hard-working people in a position where more people are on welfare than are working."
If eventually approved, the expansion of Medicaid to cover those making less than 138 percent of the federal poverty guideline as outlined in the Affordable Care Act would extend coverage to approximately 350,000 Pennsylvanians, according to a non-profit Rand Corporation study. The study estimates the expansion would increase federal funds to the state by $2.5 billion and produce a secondary growth of approximately $3 billion in the state's GDP and sustainment of approximately 35,000 jobs. Other studies have estimated the number of uninsured Pennsylvanians covered by the expansion could reach as high as 600,000.