|By Rep. Matt Baker (R-Tioga/Bradford/Potter)|
Congress could dismantle the exchanges altogether or ask states to take them over. Because of this, states will be keeping a close eye on the $509 billion Medicaid program, which is the single largest budget item for most states. The ACA included huge financial incentives for states to expand Medicaid programs to cover more people, and 31 states took advantage of the deal. Those expansions added some 16 million citizens to the Medicaid rolls.
Now, with Republicans in control of Congress and the White House, it is likely that some of the changes we could see might include work requirements, cost controls, more insurer competition both interstate and intrastate, greater portability, elimination of the Cadillac tax, and the individual and employer mandates to name a few. Far more sweeping changes could change the Medicaid program into a block grant program to the states. Rather than having states and the federal government share cost increases in the program, the feds could agree to pay a fixed and limited share and then give states more flexibility to spend the rest of their Medicaid dollars as they see fit. Although states could potentially keep their Medicaid expansions in place under that scenario, it’s more likely that they would limit access to control costs.
Here in Pennsylvania, the state budget for the Department of Human Services (DHS) is over $30 billion in both federal and state funds that are used to provide a multitude of services for over 3 million Pennsylvanians. Due to its size and complexity of issues for which DHS oversees, it is likely that substantive changes could result, given any changes made to the ACA.
In anticipation of some of these changes, I have introduced three bills in the House of Representatives.
One bill would let insurers sell health insurance plans across state lines, something that was technically allowed but never fully implemented under the ACA. I believe this free-market approach will spur competition and hopefully lead to insurance costs going down, thereby making insurance more affordable and consumer participation go up. I believe this approach may also be part of the federal reform to the ACA repeal.
Another bill would require the commissioner of the Department of Insurance to review state laws to determine how best to go about allowing Pennsylvania residents to purchase health insurance sold in other states by carriers not subject to Pennsylvania laws. This is an important component to the successful implementation of the bill I mention above.
The last bill in the package would provide a tax credit for the purchase of more affordable Health Savings Account policies. This would target segments of the population that are uninsured and need and can afford insurance but choose not to purchase coverage. My plan would permit greater flexibility and offer rewards for healthy lifestyles while eliminating unnecessary state and local premium taxes.
In the end, if we can open up the health insurance markets, greater choice for consumers will ultimately result in more customized plans and better pricing.
This year promises to be a year of change both at the federal and state levels that will have an impact all across our nation. As a Pennsylvania state representative and chairman of the House Health Committee, I look forward to working with my colleagues on these and many other important issues to best serve our great state.