Democrats seized on New Jersey Gov. Chris Christie's decision to embrace the Medicaid expansion as an opportunity to paint Corbett and Pennsylvania as increasingly isolated from a growing group of states that will accept billions of federal health care dollars to help hospitals and doctors care for millions of uninsured people.
With Christie's decision Tuesday, all of Pennsylvania's neighbors are on board with the Medicaid expansion under President Barack Obama's signature health care law, except for West Virginia, where Democratic Gov. Earl Ray Tomblin is still deciding.
"Pennsylvania is now essentially surrounded," state Sen. Vincent Hughes, D-Philadelphia, told reporters on a conference call. "We are a deserted island in the health care oasis. ... We're standing out here by ourselves."
Corbett's insurance commissioner last week called Medicaid a "broken" system and Corbett did not sway from his public stance Tuesday.
"The governor remains concerned about the cost of expanding Medicaid in Pennsylvania without reform," spokeswoman Christine Cronkright said Tuesday.
The Corbett administration estimates that Pennsylvania's taxpayers will have to shoulder a $4 billion tab under the federal health care law over the next eight years. But that estimate includes costs that would occur anyway under the law and is much higher than an estimate from the Kaiser Commission on Medicaid and the Uninsured.
In addition, some governors calculated the tax benefit that would result from billions of federal health care dollars pumping into their state's economy. Corbett did not. Meanwhile, Democratic lawmakers maintain that the expansion would be a net tax benefit for Pennsylvania because federal money would relieve some of the state's existing health care costs.
Senate Majority Leader Dominic Pileggi, R-Delaware, said Tuesday that his fellow Republicans in the GOP-controlled Legislature and members of the Corbett administration are becoming better educated on the issues involved with the Medicaid expansion by the day, and he echoed a Corbett administration complaint that information from the federal government has been lacking.
Republicans in the Senate are very concerned about the long-term cost of an expansion, but they are also hearing from hospitals about what a Medicaid expansion would mean to them financially and the consequences of a failure to expand, Pileggi said.
Pileggi also acknowledged Christie's decision, along with that of other Republican governors in other heavily populated states—Florida, Michigan and Ohio—who support the expansion.
"I think it's very relevant that those governors have made the decision they've made," Pileggi said. "It shifts the argument to why is Pennsylvania situated differently and were there different considerations in those states that led to a decision that would not make sense in Pennsylvania."
Corbett and his top aides have listed a number of reasons not to join the expansion. At the top of Corbett's list is his insistence that the state have flexibility to shape Medicaid's coverage plans for different populations, a concept that the federal government has said for months that it is making available to states.
Hughes, during an Appropriations Committee hearing Tuesday, tried to reiterate that point to Corbett's top Health Department officials. U.S. Health and Human Services Secretary Kathleen Sebelius told him in a meeting last week that the Corbett administration has been told that the flexibility it wants is available, Hughes said.
The federal government offers a major incentive for states to join: It is promising to pay the full cost of the expansion for three years, after which the subsidy gradually shrinks to 90 percent of the cost. The money begins flowing Jan. 1. Along with other elements of the federal health care law, it is estimated that it would cover more than half of the 1.3 million people in Pennsylvania thought to be without insurance.
Uninsured adults would primarily benefit. For instance, the expansion would cover parents in a family of three earning up to $26,344 a year, up from the current income eligibility limit of $4,391, according to the Pennsylvania Health Law Project. Subsidized coverage is already more liberal for children.