The Limits of Medicaid Reform in Pennsylvania: Thinking Regionally about Access to Insurance and Health Care under the Affordable Care Act

Abstract

States’ varied decisions with respect to Medicaid expansion under the Affordable Care Act have drawn significant attention to questions about equity across states. Missing from the conversation is consideration of the varied impact that reform will have within states. This article considers how low-­income Pennsylvanians will fare under Medicaid expansion. Although Medicaid reform has already expanded access to insurance to significant numbers of low-­income residents in the state, improvements in access to health care are mediated by pre-­existing regional inequalities in social determinants of health and by Pennsylvania’s system of health governance. Drawing on lessons gleaned from the literature on regionalism, and examples of success in states that have adopted regional approaches to health delivery, we offer a theoretical approach for thinking regionally in Pennsylvania by building opportunities and capacities for cross-­jurisdictional approaches to health and health care access.