While the heads of local Jewish service agencies breathed a collective sigh of relief last Thursday when the U.S. Supreme Court upheld the bulk of the Obama administration’s health care overhaul, some remained concerned that many of the poorest in the community might still be left without health insurance.
At issue is the expanded Medicaid provision, which the Supreme Court affectively held is optional for states.
Under the original Affordable Care Act, which was challenged by 26 states including Pennsylvania, states would get additional federal money if they expanded Medicaid to include more people. The federal government would pay all of the cost of expanded coverage for three years, and then gradually reduce the federal share to 90 percent in 2020. States choosing not to expand would lose all of their federal Medicaid funding. The Supreme Court struck down that provision, allowing states to opt out of the Medicaid expansion without suffering a penalty.
But the ruling could leave many people whose family income is between 100 percent and 133 percent of the poverty level without health care coverage. If a state opts not to expand its Medicaid program, these families will make too much to qualify for Medicaid, but not enough to qualify for subsidized coverage through health exchanges.
“I have some concern about how the Medicaid provisions will roll out,” said Susan Friedberg Kalson, CEO of the Squirrel Hill Health Center, which provides affordable health care to the community at large and is funded, in part, by several Jewish foundations. “We’ll have to see what happens in Pennsylvania. Medicaid coverage is important for the patients we serve, and important for us as an organization. We depend on the reimbursements. But because the federal government picks up the tab (under the ACA) for the first three years, we hope the benefits of the expansion will be self-evident so there is an incentive to keep going.”
Although the National Council of Jewish Women is “thrilled about the high court’s decision,” according to Christine Stone, NCJW’s state policy advocacy chair, the group still has work to do to ensure that most states implement the Medicaid expansion.
Still, Stone sees last Thursday’s decision as a “huge victory for women and families across the country.”
The ACA is “essential for their well-being and security,” Stone said, noting an array of services to which women are now entitled without having a co-pay, including domestic violence screenings and mammograms.
Friedberg Kalson also heralded the ACA for its provisions that “strengthen health care centers and our patients.”
Since the ACA passed in 2010, “we see young adults who are covered [by insurance] who wouldn’t have been covered before,” she said, adding that the act reinforces the importance of community health centers.
The ACA has increased the funding available to community health centers in all 50 states, including the 241 existing community health centers in Pennsylvania. Health centers in Pennsylvania have received $48.2 million to create new health center sites in medically underserved areas, enabling them to increase the number of patients served, expand preventive and primary health care services, and/or support major construction and renovation projects.
“The work we do saves huge dollars to the system overall,” Friedberg Kalson said. “Expansion of the coverage that allows people to get preventative services is going to save money. We need to focus on that. It’s about quality, it’s about fairness, and it’s about finances. And there’s a lot of room for improvement in American health care.”
Although Americans are evenly split as to the Supreme Court’s decision on the ACA — a June 29 Gallup poll shows 46 percent agreeing and 46 percent disagreeing with the high court’s ruling that the law is constitutional — several national Jewish groups were quick to issue statements in support of last Thursday’s decision. Those groups include the Rabbinical Assembly, the umbrella arm of the Conservative rabbinate; the Jewish Council for Public Affairs; Hadassah; NCJW and the Religious Action Center of Reform Judaism.
Pennsylvanians have already seen many benefits of the ACA, although many of its provisions have not yet been rolled out.
As of December 2011, 91,000 young adults in Pennsylvania gained insurance coverage because of the health care law’s requirement that health plans must now allow parents to keep their children under age 26 and without job-based coverage on their family coverage, according to the U.S Department of Health and Human Services. Since the law was passed, 247,686 people with Medicare in Pennsylvania each received a $250 rebate to help cover the cost of their prescription drugs. In 2011, more than 1.5 million people with Medicare in Pennsylvania received free preventative services — such as mammograms and colonoscopies — or a free annual wellness visit with their doctor. And in the first five months of 2012, 573,472 people with Medicare received free preventive services.
Whether or not Pennsylvania opts in or out of the Medicaid expansion remains to be seen, as those in Harrisburg have been focused on passing the state budget before taking a closer look at the ACA.
“This summer, there will be a lot of discussion about what the state needs to do to implement the insurance exchanges,” said Hank Butler, director of the Pennsylvania Jewish Coalition. “After the state budget is passed, we will re-assess. The big question is whether Pennsylvania will go to the state exchanges, or whether the federal government will come in and run it.”
Although some changes have already been implemented by the state, Butler said officials were in a wait-and-see mode until the Supreme Court’s ruling.
“Now that it’s official,” he said, “we [the PJC] will see what we can do to help the Jewish community.”
Aryeh Sherman, president and CEO of Jewish Family & Children’s Service, said his agency also is in “wait, watch and see” mode in relation to the health care law.
“Anything that increases accessibility, anything that increases the quality of care, and anything that reduces costs and makes the process simpler is good news for our clients,” he said. “But time will tell.”
Sherman said that he is trying to obtain information about how the new provisions will be implemented.
“As it rolls out, we will have to evaluate it step by step,” he said, noting questions such as whether Pennsylvania will opt in to the Medicaid expansion as just one current unknown.
“With the election coming up, who knows what’s going to happen in November,” Sherman said. “The political process might re-examine the law. There is a lot of uncertainty among the providers. That is not healthy when we’re talking about health care. There is a lot of concern. We’ll just have to see how it plays out.”
(Toby Tabachnick can be reached at firstname.lastname@example.org.)