Eight years ago, then-candidate Tom Wolf ran for, and won, Pennsylvania’s top spot, in part by promising to expand Pennsylvania’s Medicaid rolls under the Affordable Care Act, scrapping a controversial private coverage plan offered by his Republican opponent, then-Gov. Tom Corbett.
In the years since, hundreds of thousands of uninsured Pennsylvanians have been added to the joint state-federal program, a move that provided critical access to care during the COVID-19 pandemic.
According to the investigative news site Spotlight PA, total enrollment now exceeds 3.5 million people statewide, more than 1 million of whom were covered through the expansion, at a cost of more than $38 billion in state and federal funds in a recent fiscal year.
But Democratic Gov. Tom Wolf will leave office in January 2023 after serving the constitutional maximum of two, four-year terms.
One of the men angling to succeed him, Republican Doug Mastriano, is on record as hostile to the current administration’s healthcare policies, and once said “Obama Care must go.”
Democratic nominee Josh Shapiro, the current attorney general, has defended the law, both in court and in public statements.
So with Pennsylvania’s next chief executive in a position to wield extensive power over healthcare policy, where does that leave the expansion?
Here’s what we know so far.
Mastriano’s campaign did not return the Capital-Star’s request for comment for this story. And his official gubernatorial campaign website is silent on these matters. But the Republican nominee’s past public statements and proposals do provide some insight.
During a failed congressional bid in 2018, Mastriano announced his opposition to the Affordable Care Act on his campaign website, arguing that “health care and benefits for the American people should be by our choice and based on our needs. There should be no penalties nor astronomical costs for individuals or families.
“Obama Care must go,” Mastriano said at the time.
In 2019, Mastriano, now a state senator from Franklin County, was among the co-sponsors of legislation that would have imposed a community engagement or work requirement for Medicaid beneficiaries. The bill died in a Senate committee without receiving a vote, according to the Legislature’s website.
Democratic opponents of such proposals have pointed out that such bills usually end up depriving people of coverage without measurably increasing employment.
An analysis of Arkansas’ work requirements law by the Center on Budget Policy and Priorities, for example, found that more than 18,000 people — nearly 1 in 4 of those subject to work requirements — lost coverage over the course of just seven months.
“A survey of people with low incomes in Arkansas and neighboring states showed that the people who lost coverage because of Arkansas’ work requirements experienced adverse consequences, including having problems paying off medical debt and delaying care or forgoing medications because of cost,” analysts wrote.
As Pennsylvania’s top prosecutor, Shapiro has taken legal steps to defend the signature Obama-era health care law against Republican attacks.
In 2018, Shapiro joined with attorneys general in 10 states and the District of Columbia in a lawsuit challenging the Trump administration’s U.S. Labor Department’s “Association Health Care” rule, which they argued evaded consumer protections and undermined the Affordable Care Act.
In a statement at the time, Shapiro said the “Affordable Care Act is the law, and I’m acting to enforce the law and ensure that Pennsylvanians and Americans can continue relying on it for safe, affordable health care for themselves and their families. Just because the Trump administration doesn’t like Obamacare does not give them the right to undermine the law.”
Shapiro later joined with other states to file a friend of the court brief in connection with a Texas case attacking the health care law, arguing that “Americans have a right to accessible healthcare—that’s the law of the land … I won’t let [the Trump administration] destroy the ACA benefits that are guaranteed under law.”
In a statement provided to the Capital-Star, Shapiro said he believes “that every Pennsylvanian should have access to affordable healthcare, and as attorney general, I protected health care access for nearly 1.9 million Western Pennsylvanians after two health care giants’ dispute threatened access to their doctors.”
If elected, Shapiro said. he “will continue to protect healthcare access for all Pennsylvanians and fight to keep Medicaid expansion in place. Doug Mastriano wants to take away healthcare from nearly 1 million hardworking Pennsylvanians, proving once again he is too dangerous to be governor of the commonwealth.”
As Spotlight PA reports, because of likely White House and legal resistance, it’s not clear that Pennsylvania’s next governor could easily disentangle the state from the Medicaid expansion even if they chose to do so.
However, starting as early as next year, states must begin removing ineligible people from the rolls when protections extended under the pandemic public health emergency lapse. The federal government has urged states to move slowly on that front, according to Spotlight PA.
Neither campaign responded to Spotlight PA’s inquiries about that eventuality, which could impact hundreds of thousands of Pennsylvanians.