By Bill Toland

Pennsylvania is taking a pass on a major expansion to its Medicaid program, at least for now.

Republican Gov. Tom Corbett, in a letter sent Tuesday to U.S. Department of Health & Human Services Secretary Kathleen Sebelius, said "the Medicaid program in Pennsylvania is on an unsustainable path ... I firmly believe we can serve more of our citizens in Pennsylvania, but only if we are given the independence and flexibility to do so."

One of the major components of President Barack Obama's Affordable Care Act of 2010 is the relaxing of income eligibility requirements for enrollment in Medicaid, the state-operated health care program for the poor.

Relaxing the income standards would allow more people to join the program starting in 2014, but because of the 2012 U.S. Supreme Court ruling on "Obamacare," the Medicaid expansion is now optional, not mandatory, for the states.

That means governors and legislatures have discretion as to whether to expand their Medicaid rosters. Mr. Corbett, in his letter, says the expansion would cost too much and would require "a large tax increase on Pennsylvania families."

"At this time, without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion," said the letter, released as part of the governor's budget address.

Under the Affordable Care Act, the federal government will pay for 100 percent of the extra Medicaid costs for three years, and scale back to 90 percent thereafter. Mr. Corbett said the 10 percent state share will cost Pennsylvania an extra $4 billion through 2021, but for many governors -- including some Republican ones -- the 90-10 cost split was a good deal.

Last month, Arizona Gov. Jan Brewer said she would take the money to help accommodate Arizona's large uninsured population. And on Monday, Ohio Gov. John Kasich, also a Republican, said he would expand the Buckeye State's Medicaid eligibility, a move that will cover hundreds of thousands of uninsured Ohioans.

Democrats, who favor the expansion, were displeased with Tuesday's letter.

"Gov. Corbett chose to pander to the far right and willfully inflict damage on Pennsylvania's economy," said state Rep. Dan Frankel, D-Squirrel Hill, in a Tuesday afternoon press statement.

"The Republican governors of Arizona, Nevada, New Mexico, North Dakota and now neighboring Ohio have agreed to accept federal funds to improve health care in their states because they know it's vital for their states' economies, it's vital for keeping hospitals open and it's the right thing to do."

The governor's letter, Mr. Frankel said, essentially denies 600,000 Pennsylvanians the opportunity to access low-cost health care.

State Sen. Jim Ferlo, D-Highland Park, remarking on Tuesday's budget briefing, said the governor was guilty of "abandonment of those in Pennsylvania who need his leadership" in part because of his "obstruction" of the potential Medicaid expansion.

In his letter, Mr. Corbett also said that a successful, reformed version of Medicaid should "promote independence, not dependence," and should likewise promote "personal responsibility."

©2013 the Pittsburgh Post-Gazette