Will Medicaid 'permission' meet same fate as I-80 tolls?
HARRISBURG - For the second time in a half-dozen years, a governor is seeking approval from Washington to put major policy changes into effect.
The circumstances involving Gov. Tom Corbett's plan to revamp the state-run Medicaid program and expand health care coverage to the working poor and former Gov. Ed Rendell's plan to toll Interstate 80 are different, but in both cases, Pennsylvania can't go ahead with either plan without approval from a federal agency.
All states are under the gun to make some response to the mandates in the federal Affordable Health Care Act - the major domestic initiative of President Obama - that all Americans have access to health insurance coverage.
When Corbett presented his health care proposal last week, he framed it as a take it or leave it offer to the federal Department of Health and Human Services. Only if HHS approves his plan to revamp Medicaid would Pennsylvania seek available federal aid to enroll some 500,000 low-income adult Pennsylvanians who are currently uninsured under the federal health insurances exchanges being set up under the Affordable Care Act, the governor said.
He wants to scale back some existing Medicaid benefits for able-bodied adult recipients to correspond to the private sector and require them to pay a monthly premium based on income while dropping some current co-payments. He would also require able-bodied Medicaid recipients to participate in state work-search programs.
For someone seeking a green light, Corbett was very critical of Washington as he announced this proposal. He called the Affordable Care Act an unprecedented tax on Americans. He said Pennsylvania can't afford to expand the current Medicaid program because of a mandate from Washington.
The early word is that the governor's proposals for the work-search requirement and to continue the state-run Children's Health Insurance Program rather than fold it into Medicaid coverage won't fly with HHS. The Corbett administration has been negotiating health coverage issues with HHS since last winter, and a new round is set to begin this week.
When Pennsylvania enacted a transportation funding law in 2007 that relied on toll revenues from I-80 to help pay for road and bridge projects, the move was undertaken on a wing and prayer that it would meet with approval from the Federal Highway Administration.
Since federal dollars paid for 90 percent of the interstate's construction costs, any move to impose tolls on motorists needed FHWA approval.
The FHWA rejected the state's application to toll I-80 in 2010, thereby creating a $470 million annual hole in the state Transportation Department's budget.
The absence of the anticipated toll revenue is one reason why transportation funding remains a major issue facing state lawmakers this week as they start the fall session.
(Robert Swift is Harrisburg bureau chief for Times-Shamrock Communications newspapers. Email: email@example.com.)