WASHINGTON — The governor of Pennsylvania, Tom Corbett, released details on Friday of his proposal to use federal Medicaid funds to buy private health insurance for low-income people — a plan similar to one being carried out by Arkansas and considered by other Republican governors who oppose expanding Medicaid under President Obama's health care law.
Like the Arkansas plan, which the Obama administration formally approved in September, Mr. Corbett's proposal would use federal funds available for expanding Medicaid under the Affordable Care Act to instead buy private coverage for an expanded Medicaid population, using the new online insurance marketplace.
But Mr. Corbett's proposal veers more sharply from traditional Medicaid and thus may have a harder time winning federal approval than the Arkansas plan. Under his plan, people whose incomes are greater than 50 percent of the federal poverty level — currently $15,415 for a household of one — would have to pay a "nominal" monthly premium, according to a draft of Mr. Corbett's application for a federal waiver.
The premium requirement would encourage beneficiaries "to make healthier choices, both in their daily lives and when making decisions about their health care," according to the draft application. People could see their premiums reduced if they paid their premiums on time and got an annual physical exam.
"The idea here is to encourage people to seek preventive care and develop a relationship with a primary care provider," said Christine Cronkright, a spokeswoman for Mr. Corbett, adding that those who worked at least 20 hours a week on average would qualify for additional reductions.
In addition, most adults ages 21 to 64 who are unemployed or work fewer than 20 hours a week would also have to search for jobs as a condition of eligibility for the insurance program.
Mr. Corbett also wants to restructure Medicaid for current beneficiaries, who, under his plan, would stay in the traditional program instead of getting private coverage through the exchange. Under his plan, most working-age adults in the traditional program would be enrolled in a "low-risk" health plan with basic benefits, but people with complex health problems would qualify for a "high-risk" plan with more benefits.
Mr. Corbett announced the broad outlines of his plan in September but provided more details on Friday. In a news release, he said the plan would cover more than 500,000 uninsured residents "in a fiscally sustainable manner." Ms. Cronkright said the state would formally submit its application early next year after holding public hearings on the proposal around the state.
The president's health care law allows states to expand Medicaid to include people who earn up to 138 percent of the federal poverty level. About half the states have decided to do so, with the federal government paying the entire cost through 2016 and no less than 90 percent in later years. Many states with Republican governors or Republican-dominated legislatures have flatly rejected the expansion funds. Arizona, Michigan and Ohio are among the handful of states with Republican governors who are expanding the program, often despite stiff resistance from Republican legislators.
Antoinette Kraus, director of the Pennsylvania Health Access Network, an advocacy group, said she was pleased that Mr. Corbett was moving to expand Medicaid but worried that his proposal would face lengthy vetting by the federal government.
"We're looking at a process of probably about a year," she said, "when we could have just done what our neighbors in other states have done and expanded our traditional Medicaid program."
As for the additional requirements that Mr. Corbett is seeking, Ms. Kraus said, "it's kind of an administrative nightmare and added expense to require work searches and premiums for folks that really just need to be able to access health care."
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