Gov. Tom Wolf vetoes Medicaid reforms passed by Pa. Legislature

Gov. Tom Wolf has vetoed a series of proposed reforms to Pennsylvania's medical assistance programs. The measures were high priority items for House and Senate Republicans in the state Legislature. (James Robinson/PennLive) (James Robinson/PennLive, file)

Gov. Tom Wolf has vetoed a series of modest medical assistance reforms crafted and passed by the Republican-led General Assembly.

The veto kills, for now, the proposed addition of a work / work search / training requirement that supporters said would have applied to nearly 500,000 "able-bodied" adults receiving Medicaid.

Children, pregnant women, senior citizens and the disabled were all specifically exempted from the 20-hour-per-week requirement.

Other proposed changes in the bill included:

* A requirement obligating the Wolf Administration to match future single-year cost overruns in the medical assistance program with proposed program modifications, which would need separate federal government approval.

* Requirements for the administration to test-drive programs that identify fraud and abuse within the system.

* A request for the administration to test a data-driven care management program for participants in one region of the state, to see if it can eliminate treatment errors and otherwise wring costs out of the system.

But the work search requirement seemed to be the lightning rod.

Early estimates were the new requirement could capture nearly a half-million Pennsylvanians, including 350,000 who qualified for Medicaid through the Affordable Care Act, and another 140,000 pre-Obamacare medical assistance clients.

Supporters said the goal is to provide at least some of those people with a carrot to get a job, in the hopes that, for many, that will become an important first step to self-sufficiency and, ultimately, becoming taxpayers themselves.

Work requirements are already in place for food stamp and cash assistance programs. For food stamps, able-bodied adults without dependents are asked, for example, to get a job, enroll in a job training program or school, or volunteer.

Advocates for Medicaid recipients opposed the bill because they said it wasn't clear how the work requirements would apply to people with long-term diseases like cancer, those caring for children or older relatives, or people in treatment for drug and alcohol addictions.

Those folks might appear "physically and mentally able" to work, but in many cases cannot hold a job, said Antoinette Kraus, of the Philadelphia-based Pennsylvania Health Access Network.

They also contend the cost-overrun off-set provision is a veiled way to cut "non-essential" benefits like dental, vision, and mental health care.

While no one knows how much the proposed changes could save, Republicans see them as a key continuation of their efforts to try to contain growth in long-term cost drivers for state government.

In formally sending the bill to Wolf's desk this week, GOP lawmakers veered between characterizing the changes as no stricter than welfare reforms previously approved by Democrats like Bill Clinton and Bob Casey a generation ago, and cheering on the end of the welfare state.

"The free ride should be over," said Rep. Dan Moul, a Republican from Adams County, flanked by dozens of his colleagues in the Capitol Rotunda for a mid-day press conference to make a final case for the bill.

"If you are truly disabled and can't work, I give you that pass. But if you can work, we need to encourage people to get out there and be a productive member of society."

Wolf was unmoved.

In his veto message released Thursday afternoon, the governor wrote:

"This legislation does not promote health coverage, access and treatment for our seniors, individuals with disabilities and individuals suffering from a substance use disorder.

"Instead, this legislation increases costs, creates unnecessary delays and confusion, penalizes individuals who need healthcare, and terminates health coverage for those who need it the most."

Wolf's veto provoked predictable anger from the legislature.

"This just goes back to the governor just does not respect the taxpayers of this state," Steve Miskin, spokesman for House Majority Leader Dave Reed, R-Indiana County, said after the veto announcement.

"The main thrust of the bill was to help control the out-of-whack spending of the DHS (Department of Human Services) budget.

"We don't think there's anything wrong with asking able-bodied people to at a minimum look for work - a job search is not unreasonable, nor is volunteering. Why does the governor oppose people looking for work?" Miskin continued.

"We are just standing up for taxpayers... you know, the people who work hard for their money."

A veto override seems unlikely; House Bill 59 passed the House on a 116-78 vote on Oct. 4, a margin significantly less than the two-thirds majority needed to enact a law over a governor's veto.

An override attempt would need to start in that chamber since this is a House Bill.

What was murkier, at the moment, was whether any of the proposed Medicaid reforms will resurface as part of still-evolving efforts to close a $2.3 billion general fund deficit.

It seemed possible Republican leaders in the House and Senate could still try to push for at least some of the proposed reforms as part of a global package that could include authorization to borrow against future tobacco settlement payments, school reforms and, possibly, an expansion of legal gambling and a new severance tax on Marcellus Shale gas production.

Medicaid, the primary public medical assistance program for the poor, blind and disabled, is one of the biggest cost drivers in state government because of the runaway train nature of health care costs.

For many fiscally conservative Republicans, it is the next major state spending spigot to turn.

In Pennsylvania, state taxpayers pay about half the cost of Medicaid treatments, and in the 2015-16 budget year, the program accounted for 29 percent of all state general fund spending.

From 2004 through 2014, before federal Affordable Care Act changes took effect here, general fund dollars spent on medical assistance lines jumped from $3.9 billion to $6.0 billion, or nearly 54 percent.

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