Personal stake a must in health care

Luis Fábregas
| Saturday, Sept. 21, 2013, 12:01 a.m.

If all the talk about Medicaid is giving you a headache, pass me the Advil. I'm right there with you.

Gov. Tom Corbett this week introduced his long-delayed alternative to the Medicaid expansion pushed by President Obama's Affordable Care Act. Corbett waited until the last possible minute, after resisting for months to expand the program for low-income Americans. You'll recall the Supreme Court ruled last summer the expansion would be optional and Corbett, never a fan of the federal health care law, happily seized the opportunity.

Details of Corbett's “Healthy Pennsylvania” plan are sketchy, but his solution seems intriguing at best. The governor believes Medicaid, which provides coverage for more than 2 million Pennsylvanians, is an unsustainable entitlement. Instead of using federal subsidies to expand it, he wants to use the money to pay premiums for newly eligible people who'd buy coverage in online markets opening Oct. 1.

Here's the kicker: Recipients would have to share some of the cost. In other words, this is no free ride. People would have to pay premiums based on income, capped at $25 for a single person and $35 for a family. There would be low premiums for people who participate in wellness programs. Corbett also wants working-age people who aren't disabled to show they've tried to look for a job in order to qualify.

“There is something to be said for patients having skin in the game, so they certainly feel they have some responsibility and ownership of their health care responsibility,” said Dr. Richard Schott, a cardiologist from suburban Philadelphia and president of the Pennsylvania Medical Society.

Indeed, demanding accountability is a perfectly acceptable way to address the elephant in the room: the soaring cost of health care. One can only hope that people with health insurance will be pro-active about their health, getting regular checkups and not just waiting until they are deathly sick to show up in the emergency room.

Critics of the premiums plan say low-income Americans reach out to Medicaid because they're already strapped. Even a $25 charge could be significant enough to stop them from going to the doctor, they argue, and the online marketplace they will have to rely on to buy coverage may come with additional co-pays.

No one knows whether the federal government will green-light Corbett's plan. Like Obamacare, Corbettcare is drawing mixed reactions. And like Obamacare, it would be impossible for the governor to suddenly develop an option that pleases detractors and supporters alike.

Once a decision is made, the ideal solution would include a way to educate consumers about their choices.

At a hearing this week sponsored by Rep. Erin Molchany, a Democrat from Pittsburgh's Mt. Washington neighborhood, I heard comments from Bill McKendree, who directs the Allegheny County office of a state health insurance assistance program called APPRISE. He said many people often are unaware of existing programs that can get them access to care.

“If it's hard now, imagine what it's going to be like to process another half a million individuals,” Mc-Kendree said, referring to the number of new people added to the Medicaid rolls. “Without effective guidance, how do we know they're going to make the right choices?”

Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or

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