Political roundup: Health and environmental policy after the midterms

The Pulse prognosticates on a few of this election’s hottest policy topics. 

Tom Wolf easily defeated incumbent Pennsylvania Governor Tom Corbett in Tuesday’s election while Republicans won control of the U.S. Senate. That means key changes in health insurance and environmental policy at both the state and national levels. The Pulse prognosticates on a few of this election’s hottest policy topics: 

Medicaid expansion vs. Healthy PA

Governor Tom Corbett has spent much of the past year developing Healthy PA, an expanded insurance program for the poor that he billed as an alternative to Medicaid expansion.

Corbett got around technically expanding Medicaid by using federal subsidies to pay for private insurance plans for poor Pennsylvanians who earn incomes just above the poverty line.

During his campaign, Wolf said he would scrap Corbett’s plan and opt instead for straight Medicaid expansion. He has yet to provide details on how he may do that, but it seems as though Corbett’s program is likely to disappear.

The potential problem is timing: Wolf won’t take office until mid-January, while coverage starts at the beginning of January for the expected hundreds of thousands of new enrollees. Enrollment opens on Dec. 1. As a result, any changes to the program would have to happen while people are already covered by Healthy PA insurance.

Changing the program mid-year does seem to be possible. Federal authorities, who look kindly on full Medicaid expansion, would be likely to work with the state to transform Healthy PA into Medicaid or a program that looks very much like it, provided enrollees don’t lose coverage.

And the programs are not drastically different: of the 24 changes to traditional Medicaid that Governor Corbett applied for when negotiating with federal authorities over Healthy PA, he got only four. 

One change, which would be nixed if traditional Medicaid replaced Corbett’s program, are premiums for Healthy PA enrollees that would kick in in 2016.

It’s unclear how Wolf’s election may impact larger changes to the entire Medicaid program Corbett instituted along with Healthy PA, including winnowing down the number of different coverage options and introducing high-risk and low-risk plans for all Medicaid enrollees. In the coming years, Wolf may have a fight if he has to get necessary regulations for expanded insurance programs through the Republican General Assembly. 

Natural gas drilling in the Keystone State

Wolf’s election left many environmentalists cheering and natural gas companies warning of lost jobs this week.

Wolf campaigned on a five percent tax on natural gas production in Pennsylvania to replace Corbett’s local impact fee, saying under current production levels it would bring in $1 billion, about $800,000 more than current fee revenues. Wolf pledged to funnel that money toward the state’s school system.

However, Wolf would have to get a severance tax past a Republican legislature, and the gas industry is already gearing up for a fight.

Wolf also supports moratoriums on new oil and gas leasing in state parks and forests and a moratorium on hydraulic fracturing in the Delaware River Basin.

Ongoing squabbling in Washington over the Affordable Care Act

Many Republicans campaigned on repealing or defunding President Obama’s Affordable Care Act. Congress is likely to pass a symbolic repeal law when they take office, but even presumed Senate Majority Leader Mitch McConnell is now acknowledging the President would spike such a measure. Now, many members of the GOP are focusing on whittling away some pieces of the law.

“I would say this for sure,” McConnell said Wednesday in a post-election press briefing. “There are pieces of it that are deeply, deeply unpopular with the American people. The medical device tax, which has exported an enormous number of jobs, the loss of the forty-hour work week, big, big mistake, that ought to be restored, the individual mandate, people hate it.”

The loss of the forty-hour work-week comment refers to the rule that requires full-time workers to be covered by their employers, and defines “full –time” as 30 hours a week.

The medical device tax is low-hanging fruit, deeply unpopular with the industry and lawmakers in biotech-heavy states. The President on Wednesday didn’t give a flat-out “no” when he was asked about rolling back that provision. Many analysts also think changes to the employer mandate are possible. However, the individual mandate, the requirement that everyone has insurance, is seen as key to making the health law economically feasible and is unlikely to go away.

Clean Power Plan Rule

The new Republican-controlled Senate headed by Senator Mitch McConnell is less likely than its predecessor to pass climate legislation, and will probably try to weaken the Obama administration’s Clean Power Plan rule. That rule requires states to cut carbon emissions from power plants by a nationwide average of 30 percent. Senator McConnell, who is from Kentucky, successfully campaigned on the ‘war on coal’ he said Obama is waging.

Congress may try to overturn the carbon-reducing law, or de-fund the Environmental Protection Agency through the appropriations process, but both would at some point require presidential approval.

“So instead what’s likely to happen is that the EPA will continue to get funded based on continuing resolutions and the like, and there will be a bit of a standstill,” said Bill Antholis, managing director of the Brookings Institution.

Ultimately Congress will likely try to slow down environmental proceedings with lengthy questioning, hearings and document requests.

“It will definitely continue to add to the stalemate in Washington, or at least to the hostility between the administration and Congress,” Antholis said.

The Pulse will be watching other key issues as elected officials take office this winter, including how key committee appointments may impact science policy, and how National Institutes of Health other science funding will fare in the age of austerity and government stalemate.