Even before Gov. Corbett formally seeks a federal Obamacare waiver to allow the state to levy monthly health-care premiums on hundreds of thousands of the state's uninsured working poor, he should know the answer. And knowing that his request is likely to be refused - as a similar one from Iowa officials was last week - why would Corbett continue to move ahead with his complex, makeshift proposal to use billions of federal Medicaid dollars to subsidize private insurance for some 520,000 Pennsylvanians?
Many governors - including Corbett's counterpart and fellow Republican in New Jersey - long ago agreed to the Affordable Care Act's straightforward expansion of Medicaid to those earning up to a third more than the federal poverty level. Even as Corbett fleshes out the details of his alternative and prepares to seek Washington's OK, Medicaid expansion remains the best strategy.
After a hurry-up schedule of hearings around the holidays, the state presumably will take its proposal to the feds. But after the Iowa ruling, it seems clear that Pennsylvania's suggested monthly premiums for people with incomes at 50 percent of the poverty level will be a nonstarter. So why pursue it?
Imposing premiums on the working poor, whose strained household budgets prevent them from affording health coverage in the first place, is wrongheaded. Combine that with other requirements proposed by Corbett - principally a vague job-search mandate for those who are unemployed or underemployed - and the governor's scheme looks even less workable. Washington officials have frowned on the idea of a work-search requirement for health coverage eligibility.
Health-care analysts also see pitfalls in Corbett's expectation that many patients will turn to federally certified health clinics for care. Those clinics may not be able to operate at the unsubsidized commercial-insurance rates the Corbett administration plans to pay if the feds approve its plan.
Then there is the cost to the state's health-care economy and budget resulting from the governor's convoluted approach to plugging holes in the health-care safety net. Federal aid due to start flowing next month will cover 100 percent of costs for New Jersey and other states implementing the Medicaid expansion. Not in Pennsylvania, though.
The state wouldn't see a dime until 2015 at the earliest under Corbett's plan - losing out on an astounding $10 million a day in direct aid and related economic activity, according to estimates in three credible studies. Nor would the 40,000 new jobs expected to be driven by that spending materialize.
In coming hearings on the governor's plan, including one scheduled for Jan. 3 at the National Constitution Center in Philadelphia, it's vital that Corbett's aides hear these and other concerns aired fully. Then they can go back to their boss and argue for the only assured means of expanding access to quality health-care coverage for the state's working poor - a no-loopholes expansion of the Medicaid rolls.