PITTSBURGH The protesters had pretty good singing voices, Beverly Mackereth had to admit. And with all the grace she could muster, Pennsylvania's secretary of public welfare gamely tried to include them as she swung through Pittsburgh to pitch Gov. Corbett's controversial Medicaid-makeover proposal.
"Their theme was, 'We need better coverage,' " she said Friday morning at the Allegheny County Courthouse. "And that's our goal."
Mackereth visited Pittsburgh for the second of six hearings across the state - she'll be in Philadelphia on Jan. 3 - to collect public comments on Corbett's "Healthy Pennsylvania" plan, whose centerpiece is a private-market alternative to the Medicaid expansion offered by the Affordable Care Act.
Both versions would cover hundreds of thousands of uninsured people. Most of them are working but earning too little to qualify for subsidized insurance sold on the exchange, the website that is intended to provide coverage for people with slightly higher incomes and was plagued with technical problems early on. (Monday is the extended deadline to sign up at www.HealthCare.gov for coverage that would start Jan. 1.)
From the courthouse lobby Friday, Mackereth was serenaded by a few dozen protesters from the Cover the Commonwealth Coalition, who say the Republican governor's plan slashes benefits for the far-poorer population currently on Medicaid, and makes it harder to apply. In a musical twist on "Jingle Bells," they asked Corbett to "Do the right thing."
"This is not Medicaid expansion - this is something different," said Neal Bisno, president of SEIU Healthcare PA, who spoke at both the rally and the more-sedate public comment session upstairs.
Under the Affordable Care Act, an estimated half-million Pennsylvanians would have become eligible Jan. 1 for Medicaid, the government-run health insurance system for the poor and disabled. Empowered by a Supreme Court ruling that made the expansion optional, Corbett turned it down and is instead looking to use federal funds to pay for private plans.
This month, he introduced a larger Medicaid-revision proposal, one that would eliminate most co-pays, but require monthly premiums for participants making more than 50 percent of the federal poverty rate, or $5,745 in 2013. He also wants to enact a work-search requirement, which would give coverage to the unemployed, with some exceptions, only if they register on a career site and move toward finding a job.
Critics say the governor's plan will put the health of poor Pennsylvanians at risk, comparing his work requirement to denying poor children free lunches at school if they don't get A's in class.
In the three-hour session, about 30 advocates, opponents, and residents had their say on the proposal, which is still in draft form. Several disability-rights activists were disappointed about cuts in benefits; other speakers complained that the new sign-up requirements could put some people on the wrong plans.
Susan Kalson, CEO of the Squirrel Hill Health Center in Pittsburgh, told Mackereth that she fears that changes to reimbursement rates and other reforms could make her clinic unaffordable for its poorest clients.
"Access to insurance does not equal access to care," she said. "We're very concerned this is going to turn evidence-based best practice on its head."
Most agreed that the proposal, which must be approved by the federal government, is not easy to digest. With the document weighing in at more than 200 pages, health-care advocates say they're still combing through it to find changes.
Not everyone was against Corbett's plan. Amanda LaPorte, regional director of operations for HCR-ManorCare, a provider of posthospital services and long-term care, said the proposal rightly kept Medicaid centered on the state's hardest-luck cases.
"The governor's Healthy PA ensures the frail elderly remain a priority by keeping limited Medicaid dollars for older Pennsylvanians and tapping into the private-insurance marketplace for the expansion of health care to those who are uninsured," LaPorte testified in a prepared statement. "That's good for Pennsylvania's seniors."
The Corbett administration's struggles with Medicaid comes down to dollars: The governor does not believe the plan advanced by the federal law is fiscally sustainable. Medicaid already covers one in six Pennsylvanians; its annual $20 billion price tag grows $300 million to $400 million each year, Mackereth said.
Enter her focus on the private-insurance market, which she believes is in a better position to take care of Pennsylvania's indigent. If Corbett's plan is approved, federal dollars slated to expand those covered by Medicaid will instead help poorer residents receive private insurance.
Some health-care advocates said that was a step in the right direction: Corbett had originally appeared ready to turn down extra funding altogether. But multiple speakers said the governor was delaying relief for more than 500,000 residents, who they say would get insurance in January if the governor accepted Medicaid expansion instead of plowing his own way.
Mackereth doubts that, saying any action on Medicaid would require thousands of new hires and take time to ramp up.
And she doubts the state - or the caroling protesters - would like the bill that she says would eventually come due.
"We want to keep Medicaid for our most vulnerable," she said, "so we don't blow it up."
Details of Gov. Corbett's "Healthy Pennsylvania" proposal, including Medicaid expansion and hearings scheduled around the state,
are posted at www.dpw.state.pa.us/
To submit comments
Postal mail: Department
of Public Welfare ("Attention: Healthy Pennsylvania Waiver"),
Box 2675, Harrisburg, Pa. 17105-2675.
When: From 10 a.m.
to 1 p.m. Jan. 3.
Where: National Constitution Center,
525 Arch St.
Registration: At website above. Deadline Dec. 30.
Webinar public hearing
When: From 9 to 11 a.m. Jan. 8.