Medicaid is first a moral issue, not an economic one. The poorest and the sickest among us deserve better than a crass political debate over the potential economic windfall Pennsylvania may receive if our state takes federal dollars to expand Medicaid.

Instead, the debate should focus on the health and dignity of low-income individuals who are relying on Medicaid, or soon will, and how the system is failing to serve our most vulnerable.

The Medicaid system's failure is so broad that Forbes Magazine called it a "humanitarian crisis" and a scandal bigger than Bernie Madoff's investment schemes and the Wall Street bailouts. Gov. Corbett was right to say no to expanding it.

As the Corbett administration has pointed out, expansion could burden state taxpayers with billions of dollars in additional health-care costs in coming years, while denying the state the flexibility it needs to direct care where it's needed most.

Expanding an already overburdened and failing program with borrowed federal dollars that could eventually dry up is not compassion, it is irresponsible. Lower-income workers need real health-care solutions, not short-term illusory promises. This is a "profiles in courage" moment for the governor and our state legislators. Will they put the health and welfare of poor individuals, and the state's long-term fiscal health, over the demands of the political mob?

A recent poll shows that many in Pennsylvania support expansion of the program, and understandably so. It is the American way to want to help a neighbor in need. While some of us may not need Medicaid today, many understand that economic conditions change, and one day we might need government medical assistance. As a working mom, I certainly feel that way. But it is not enough for good people to focus only on good intentions without considering the results that their proposed solutions to a problem will have.

Those who currently support expanding Medicaid, and possibly adding up to a million new recipients to the rolls, know they are condemning those souls to a program that studies show will lead, in too many cases, to worse health outcomes than if they were uninsured.

A shocking study by the University of Virginia showed that Medicaid surgical patients are 13 percent more likely to die than those without insurance, and 97 percent more likely to die than those with private insurance. A study published in Cancer shows people over the age of 65 who are insured by Medicaid have a greater risk of late-stage diagnosis of various cancers, and therefore are at greater risk of death than even the uninsured.

The New York Times highlighted the problem in 2011, interviewing a woman unable to work because of severe health problems. She called her Medicaid card a "useless piece of plastic. I can't find an orthopedic surgeon . . . who will accept Medicaid." A 10-year study by the Annals of Emergency Medicine found that Medicaid patients have a harder time getting an appointment at a clinic and a longer wait for the appointment than those with private insurance.

Part of the reason for these statistics is the difficulty that Medicaid recipients have in finding care. Almost a third of doctors refuse new Medicaid patients. That's not surprising, as doctors are reimbursed at a rate of about 55 cents on the dollar for their services.

This doctor shortage is also leading many Medicaid patients to head to the emergency room for care - one of the problems the Affordable Care Act was supposed to solve. As one researcher rightly concludes, access to "insurance" does not guarantee access to care.

In light of this situation, it's an outrage that some state lawmakers, including State Rep. Gene DiGirolamo (R., Bucks), argue that taking the federal money to expand Medicaid would provide a "huge infusion" of cash to Pennsylvania, potentially for jobs and infrastructure improvements. But it is morally wrong to boost our economy on the backs of the poor and sick. Politicians arguing this point are either blind to the suffering of those stuck on Medicaid, or they blithely choose to ignore the suffering to promote other interests.

Worse, some hospitals and hospital groups are aggressively pushing for expansion so they can make up for other reimbursement cuts they have experienced. It would be better if these health-care providers demanded an improved system for suffering low-income patients, rather than trying to expand a system that doesn't work. Strong, vibrant, and sustainable economies are not built on crony capitalism at the expense of the poor.

The politicians and lobbyists trying to bully Corbett into expanding Medicaid should put people before politics and money. Those of us looking to help others should focus on results, not good intentions. And the governor would do well to stay on the right side of history and fight for real health-care solutions for low-income workers, rather than condemning one more person to Medicaid's sad plight.

Jennifer Stefano is the Pennsylvania state director of Americans for Prosperity. E-mail her at