By Dennis Sadowski • Catholic News Service • Posted April 5, 2013

WASHINGTON (CNS) — Bishops and men and women religious are urging governors and state legislators in a handful of states, including Pennsylvania, to opt for Medicaid expansion under the Affordable Care Act.

The action comes in states where no final decision has been made on whether to expand Medicaid or let the federal government step in to set up federal exchanges to widen access to health care for the uninsured.

Individual bishops or state Catholic conferences in Indiana, Kansas, Tennessee, Utah, Virginia and West Virginia have called for the expansion in some form, advocating that it is a morally just action to take for the uninsured and working poor.

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In Pennsylvania, 1,300 sisters, brothers and priests petitioned Republican Gov. Tom Corbett, who is Catholic, to reverse his decision not to expand Medicaid.

“What we believe, not only as Catholics but as women religious, we need to look out for those who are most marginalized,” said Sister Donna Korba, director of the Office and Justice and Peace for her order, Sisters, Servants of the Immaculate Heart of Mary in Scranton, Pa.

“With something like health care, it seems almost logical that the federal government is offering an opportunity for those who are uninsured to become insured,” a board member of Network, the Catholic social justice lobby, told Catholic News Service in explaining why she and Sister Mary Beth Hamm, who is a Sister of St. Joseph, and Mercy Sister Diane Guerin, both of Philadelphia, organized the petition drive.

Last summer’s Supreme Court ruling on the Affordable Care Act allowed states to opt out of the law’s Medicaid expansion provision without penalty, essentially moving that decision from the federal government to governors and state legislatures.

The law calls for expanding Medicaid coverage to people whose income is 133 percent of the federal poverty level ($14,856 for an individual and $30,675 for a family of four in 2012). The Congressional Budget Office projects that as many as 11 million Americans will gain health care coverage by 2022.

Under the law, the federal government will cover the full cost of expansion for three years beginning in 2014. The federal share gradually will drop to 90 percent of the cost of expansion by 2020.

The end result is billions of federal dollars flowing into state coffers for health care.

Through March 31, 25 states and the District of Columbia had signed on to expand Medicaid and 16 states declined participation, reported the Advisory Board Co., a research, technology and consulting firm in health care and higher education. Two states were leaning toward expansion and three were leaning against it while four states — Indiana, Kansas, Utah and West Virginia — were undecided, the company reported.

In those four states, the Catholic voice supporting expansion has varied, but has largely been supportive of expanding health care for the uninsured.

Bishop John C. Wester of Salt Lake City thought the expansion was a good deal for Utah. In a column in The Salt Lake Tribune Jan. 19, Bishop Wester said he recognized that state officials were responsible for appropriating limited financial resources to provide services to Utahns, but that such decisions must be guided by principles that protect the dignity of people.

“Catholic support for expansion does not rest on dollars and cents calculations,” he wrote. “We support expansion because we believe that it is the role of government to foster the common good, which includes ensuring that all have access to what is needed to lead a truly human life.”

Citing two university studies, he also said between 14,000 and 24,000 new health care jobs would be created by the expansion.

Bishop Anthony B. Taylor of Little Rock, Ark., supported expansion in a Jan. 31 statement sent to Democratic Gov. Mike Beebe and state legislators. While Beebe has said he wants to expand Medicaid, the Republican-controlled Legislature has blocked the move thus far.

Bishop David R. Choby of Nashville, Tenn., urged Tennessee Gov. Bill Haslam to adopt Medicaid expansion in a March 7 letter. But Haslam announced March 28 that too many questions remained before the state could move forward with such a plan.

The Catholic Conference of West Virginia has supported the expansion. The Catholic conferences in Kansas and Indiana have supported increased access to health care for the uninsured, but are listening to alternatives on how that could be accomplished before coming out in favor of any one plan.

The Virginia Catholic Conference supported expansion as well. However, Virginia Gov. Robert F. McDonnell recently opted to let the federal government run the state’s health exchange.

Most of the opposition to the expansion has been in states with a Republican governor and/or a Republican-led legislature. However, some Republican officials are re-evaluating their opposition to the expansion as they review budget implications and face pressure from hospitals that treat the uninsured.

In a Feb. 5 letter to Health and Human Service Secretary Kathleen Sebelius, Pennsylvania’s Corbett, explained that the state could not afford the expansion. He said Medicaid costs were rising too rapidly and 30 percent of the state’s general fund spending covers health care for low-income people. He said he feared that any further growth in Medicaid roles would be unsustainable.

Republicans in some states instead have proposed using Medicaid expansion funds to buy vouchers to allow the uninsured to buy their own insurance even though that plan is projected to be as much as 15 percent more costly. Sebelius has been open to such arrangements and is negotiating the particulars in several states.