Legislation to potentially expand Medicaid eligibility to hundreds of thousands of adult Pennsylvanians under the 2010 federal health care law won approval from a Pennsylvania state Senate committee on Friday night, even though support for it is uncertain from Gov. Tom Corbett and the more conservative state House.
With lawmakers scrambling to wrap up a mountain for work for the fiscal year by Sunday night, the Senate's Republican majority are cooperating with Democrats to pass the legislation in an eleventh-hour effort to force the hand of Corbett, a Republican, and potentially hostile House Republican leaders.
The Public Health and Welfare Committee voted 9-2 to send the bill to the full Senate. Two Republicans from western Pennsylvania opposed it, while five Republicans and all four Democrats supported it.
Sen. Vincent Hughes, D-Philadelphia, called the bill a compromise between Republicans and Democrats that allows Corbett, who opposed the federal health care law and has thus far refused to join a Medicaid expansion, to negotiate a fair Medicaid expansion with President Barack Obama's administration.
"I think it represents a huge step forward for the commonwealth of Pennsylvania in terms of getting health care services to at least a half million Pennsylvania residents who are working every day," Hughes said. "They're making a contribution every day. They only thing they're lacking is health insurance. They make too much money to get into the Medicaid program, but not enough money to purchase their own insurance."
A full Senate vote is expected Saturday or Sunday.
Friday was also the anniversary of the U.S. Supreme Court's decision that upheld the federal health care law, Corbett was one of the state officials who challenged it in court as unconstitutional, but effectively made the Medicaid expansion provision a state-to-state decision instead of a federal mandate.
Senate Republican and Democratic leaders said they negotiated it with input from Corbett's office, and wrote certain conditions into it to make it more amenable to Republicans who may otherwise oppose it. Democrats are solidly in support of it.
Those 14 conditions include "reasonable" employment and job search requirements, cost-sharing by enrollees and maximized use of private insurance plans instead of the traditional Medicaid plan. It also would revoke an expansion if the federal government backtracks on its pledge to pay for the lion's share of the cost to enroll adults up to 138 percent of the federal poverty level, or about $15,000 for one person.
Corbett's office, while aware of the bill's contents, has not necessarily pledged his support.
"There's no agreement, there's no understanding," spokeswoman Jennifer Branstetter said Friday evening before the vote.
Also, House Republican leaders have not pledged support for it, but the Senate is inserting the provision into crucial budget-related legislation in an effort to force House approval.
Ultimately, the governor's office would need to submit a plan that wins federal approval for the expansion. The bill requires Corbett to submit a plan by Oct. 1 in an effort to compel expanded Medicaid eligibility in Pennsylvania by July 1, 2014.
In the House, 33 Republicans threatened in a Thursday letter to other House members to oppose any budget bill if it helps enable a Medicaid expansion.
The threat is significant if minority House Democrats choose to oppose a Republican-penned budget bill _ which was awaiting changes in the Senate _ that delivers hundreds of millions of dollars in tax cuts for businesses, instead of the hundreds of millions of new dollars for public schools that Democrats want.
Meanwhile, about a dozen people who would benefit from the Medicaid expansion were in their third day of staking out a Capitol hallway outside Senate offices, with organizing help from labor unions and other groups that support a Medicaid expansion.
One man, Andre Butler of Philadelphia, said he is forgoing days of work as a banquet server to spend his days in the Capitol appealing to lawmakers to agree to an expansion. Neither Butler, 47, nor most of his co-workers in the banquet and restaurant business are able to afford health insurance, he said.
"Cooks, servers, bussers, line cooks, concierge people, stewards, dishwashers. None of them," Butler said. "When you see us at the banquet, most of us don't have health insurance."