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Source: The Patriot-News, Harrisburg, Pa.迷你倉最平Sept. 17--Gov. Tom Corbett is pushing what can be described as a uniquely Pennsylvania approach to Obamacare.Here's one of the most unique things: it would require people covered by Medicaid, the state-federal health insurance program for people with low incomes, to get a job or least be trying to get one. No other state imposes such a requirement, and Corbett needs federal permission to do so in Pennsylvania.Here's are the basic facts of Corbett's plan, and on the status of the Affordable Care Act, or Obamacare, in Pennsylvania._Obamacare proposes two tactics for covering the uninsured. One is to expand Medicaid to cover people earning up to 138 of the federal poverty level, which is $15,856 for a single person and $32,499 for a family of four. Pennsylvania has an estimated 500,000 to 700,000 residents in that range. The second is for people earning more than that to obtain coverage through an "exchange," which is an online marketplace of government-approved health insurance plans. Many people will be eligible for subsidies to help them afford coverage on the exchange. Subsidies will be available for individuals earning up to $45,960 and families earning up to $94,200 for a family of four._In 2012, the U.S. Supreme Court ruled that the Affordable Care Act is legal. But it also ruled states can't be forced to expand Medicaid. That's why the decisions of Republican governors across the country, including Corbett, have been watched so closely. Regardless of politics, expanding Medicaid is an enticing proposition for states: the federal government promises to cover 100 percent of the cost through 2016, with the federal share then dropping to 90 percent by 2020 and thereafter. That's expected to bring $2 billion to $4 billion per year to Pennsylvania, depending on how many people are covered._So far, about half the states plan to expand Medicaid. That includes nine led by Republican governors._On Sept. 16, Gov. Corbett announced his long-awaited decision on whether to expand Medicaid. He offered a plan that would accept the Medicaid expansion funds, but use them to enable the uninsured to buy coverage on the Obamacare exchange, rather than add them to Pennsylvania's existing Medicaid program, which Corbett contends is already too big and too expensive._Corbett also said he wants additional changes to the existing Medicaid program, with many of the changes also applying to the new people who would receive coverage. For example, he wants cost-sharing and related changes he says would make the coverage similar to coverage of people who have private market health insurance. There would be monthly premiums of up to $25 for an individual and $35 for a family. But it would be based a sliding income scale, and people with the lowest incomes would pay nothing. At the same time, Corbett officials have said there would be fewer co-pays, making the coverage less confusing and possibly less expensive._Regarding the work requirements, Corbett officials say they would apply only to the healthy, non-elderly uninsured people. They suggested it won't impact a high percent迷你倉ge of people covered by Medicaid, but had no figures._In supporting his belief that Medicaid shouldn't be expanded, Corbett has stressed that the program already covers 2.2 million Pennsylvania residents. Corbett has said that amounts to 18 percent of the state's population, and expanding Medicaid per Obamacare would raise it to 25 percent._But it's worth keeping in mind that the Medicaid program Corbett refers to also pays for nursing home and other long-term care for many Pennsylvania seniors and people with disabilities. Here's a breakdown on the 2.2 million _ 2,198,861 to be exact _ covered by Medicaid: 1,072,723 are children from poor families; 320,410 are seniors and disabled adults receiving long-term care, such as in nursing homes. The remainder _ 805,728 _ are non-disabled, non-elderly adults receiving Medicaid to cover their medical needs. It's also worth noting that in Pennsylvania, and in most states, Medicaid is only available to poor adults who are raising children; poor single adults aren't eligible. The Obamacare expansion, however, would make them eligible._Everything that Corbett proposes regarding changing Medicaid and using federal expansion funds to enable people to buy coverage on the exchange requires federal approval. As of Sept. 16, neither Corbett nor federal officials were able to provide a firm timeline. Fabien Levy, a spokesman for the U.S. Department of Health and Human Services, said: "We are encouraged by Pennsylvania's commitment to helping cover more of the state's uninsured population. As we have done with other states, we are eager to work with Pennsylvania to provide the best options that work for Pennsylvanians ... HHS is committed to supporting state flexibility and working with states to design Medicaid programs that work for them, within the confines of the law. HHS stands ready to work with states to explore options that improve care and lower costs in the Medicaid program."_Corbett had previously decided that Pennsylvania won't run a health insurance exchange. About half the states are taking the same route. That's OK, because the federal government will run the exchange for states including Pennsylvania. Pennsylvania's exchange is scheduled to begin operating on Oct. 1, allowing people to begin shopping for coverage that would take effect Jan. 1._On a national level, the expanded Medicaid coverage also is scheduled to take effect Jan. 1. But given that Corbett submitted his complicated proposal to the federal government in mid-September, it seems highly unlikely coverage for people earning between 100 percent and 138 percent of the poverty level will be available on Jan. 1. In addition to leaving several hundred uninsured Pennsylvania residents with no Obamacare coverage option, Pennsylvania residents will know that their federal tax dollars are funding the care of uninsured people in other states, including New Jersey, where Republican Gov. Chris Christie has agreed to the expansion.Copyright: ___ (c)2013 The Patriot-News (Harrisburg, Pa.) Visit The Patriot-News (Harrisburg, Pa.) at .pennlive.com Distributed by MCT Information Services儲存