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But Republicans like state Rep. In the meantime, double-digit insurance rate increases continue and are unaffordable and unsustainable for many, and will continue to lead some to not be able to afford insurance as a direct result of Obamacare. Nearly , Pennsylvanians are currently covered through the first major ACA provision, which took effect in The exchanges allow individuals and small businesses to choose from a selection of privately administered, competitively priced health plans regulated by the Pennsylvania Insurance Department. Roughly three-quarters of the , individual Pennsylvanians on the exchange qualify for federal subsidies, which are available to applicants earning up to percent of the federal poverty level.

Between lower net rates and the elimination of exclusions for pre-existing conditions, the exchange radically transformed the landscape of individual health insurance. Tom Wolf set the plan in motion. As of April , the Medicaid expansion had reached , newly eligible Pennsylvanians; nearly half are employed, and a similar percentage is younger than And within a year of the expansion, nearly 63, of the new Medicaid recipients had received addiction treatment — a priority of the Wolf administration, which has put the opioid crisis at the top of its public health agenda.

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But the fact that Pennsylvania waited a year later than many states to expand Medicaid speaks to the very issues that make the state a challenging environment for reform. Any decision you make, someone stands to win and someone stands to lose. People argue over turf. One very visible example: the short-lived experiment known as Healthy PA.

Tom Corbett. Similar plans were floated in other Republican-controlled states, noted Gillis, as a way to extend coverage without signing on to a key Obamacare provision. But more patients were able to enroll a year later when Healthy PA was replaced with expanded Medicaid, which simplified enrollment and extended eligibility requirements.

The Pennsylvania insurance market is also finding its footing more slowly than those in neighboring blue states, according to Katherine Hempstead, a senior advisor and health insurance expert at the Robert Wood Johnson Foundation in Princeton, N. One upside to the Pennsylvania marketplace: stability. Pennsylvania never had the kinds of experimental, nonprofit marketplace startups — co-ops, for example — that have failed in other states.

Nor has it thus far suffered from the overly restrictive provider networks that generate complaints elsewhere, said Grande of Penn. In addition, the high-profile marketplace exit of United HealthCare, the biggest player on the national scene, will have only a minor impact in the Keystone State, where it has only about 6 percent of the overall market, Ruman said. But even if rates somehow stabilize, experts say a long-term challenge will be to bring down spiraling health care costs — many of which are related to an overreliance on expensive hospital systems statewide, not just in Philadelphia.

Emanuel is certainly in a position to know.

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But she noted that the ACA — with its copious, expensive paperwork and technology requirements, including a shift to electronic medical records — has had the unintended effect of encouraging smaller providers to consolidate for efficiency within larger hospital networks. Third, Medicaid is big. The program has enrolled more than 74 million people who thus are already connected to a system that can determine eligibility based on income and other factors and has the systems in place to conduct program enrollment. Furthermore, the federal requirement to enroll in health insurance continuously brings people into contact with the Medicaid program, which can then connect them to social services.

Finally, state Medicaid programs already have experience serving diverse populations who may benefit from a range of social services — the young and the old, families and individuals, and those with complex health care and related social needs.


  • Two years on, assessing the Affordable Health Care Act's impact on PA;
  • The Pennsylvania Health Care Landscape | The Henry J. Kaiser Family Foundation?
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As leading states have been among the first to recognize, addressing social needs may result in positive health care outcomes for the populations Medicaid serves. Rather than emphasizing personal responsibility for health care expenditures, the social determinants of health model recognizes that social conditions affect health care utilization, costs, and outcomes. A social determinants model makes these factors visible and actionable. Health care costs will continue to rise until we address the underlying social conditions that affect health and wellbeing for everyone.

As a national conversation continues about the role of health care in our society, there is a real opportunity to support and build on the Medicaid platform to address the social determinants that can improve health for all Americans. Featured Blog topic. Learn more. Health Affairs Blog Health Equity.

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Katharine Witgert. September 7, Doi: Add to favorites. Where Medicaid Leads In Addressing Social Determinants Medicaid programs have long been leaders in addressing social determinants of health. There is evidence from a range of social programs that transaction costs—the difficulty of applying—significantly influence take-up rates. Single applications can facilitate access. Louisiana, meanwhile, has embedded permanent supportive housing into Medicaid home- and community-based services, allowing for better integrated care for individuals who are homeless or at risk of homelessness.

The Medicaid program and early learning systems share goals, staffing, and funding. Why Medicaid?


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