Last year's spike in Pennsylvania Medicaid enrollment exceeded single-year increases seen during the Great Recession, a Spotlight PA analysis found, demonstrating how uniquely challenging and far-reaching the coronavirus crisis has been.

Enrollment rose by nearly 13% statewide or more than 366,000 people. That's a higher rate of growth than seen in 15 of the 16 years prior. Sizable jumps were also seen in historically wealthier counties. 

Expanded eligibility rules are part of the reason why. But experts say the pandemic has only highlighted an existing need, long-running access hurdles, and a partisan urge to rein in Medicaid enrollments and related costs. 

THE CONTEXT: Medicaid costs are shared by states and the federal government — and those costs were going up before the pandemic accelerated the trend. Pennsylvania's Department of Human Services, which oversees the program here, pointed to the state's ballooning Medicaid tab in requesting an extra $941 million from the legislature earlier this month.

In the long term, many state Republicans who support lowering what Pennsylvania spends on Medicaid also support the addition of work requirements for adults in the health-care program — something the Biden and Wolf administrations both oppose. 

Republicans say the move would help people earn their way out of poverty and reduce costs, calling the program's current growth financially unsustainable. Critics say the move will actually raise administrative costs and open holes in a crucial safety net. The U.S. Supreme Court was expected to hear arguments on Medicaid work requirements later this month but ultimately decided against it, leaving states to continue the debate as pandemic-shuttered economies slowly begin to reopen. 

“I realize in the last year everything’s been turned upside down with this terrible pandemic,” said state Sen. David Argall (R., Schuylkill). “But someday this pandemic will end. And I still believe it’s an issue that we need to address.”