Jeff Gelles: Corbett, Christie's approach to Medicaid plan is wrong

I've had a persistent cough recently. Nothing serious, I'm sure. But if I need to consult a doctor, I know I can. I've got good health insurance.

A couple years back, my wife faced a more serious concern: the Big C. She caught it quickly, thanks to regular mammograms, and got top-notch care. With luck, she'll be around for a long, long time.

My wife and I are part of the privileged masses in America - the large majority whose access to health care comes through work or, eventually, Medicare. We get affordable insurance through my paper and union. It's covered our daughters' births, their childhood immunizations, ear infections, and sports injuries, and the occasional more serious concern.

Based on their biographies, I'd guess that Gov. Corbett and Gov. Christie are in the same category: people who've never much had to worry that a major illness or accident would also mean financial catastrophe, leaving them unable to buy food, fix the car, or pay the gas or electric bill.

Right now, Corbett and Christie are suddenly key players in our nation's long-running psychodrama over health care. You might hope we could call this latest episode "Obamacare: Beyond Political Thunder." But so far, unlike some key counterparts, both governors appear to be sticking to pointlessly hard-hearted scripts.

The debate over 2010's Patient Protection and Affordable Care Act stoked a deafening and often irrational fight in America. Silly charges such as "Death panels!" and "government takeover!" were among its uglier symptoms. Oddly, some came from people defending Medicare, the national health plan for the elderly that was also denounced in the '60s by that GOP star, Ronald Reagan.

The truth is that "Obamacare" was always a compromise. Liberals traded away a decades-old goal - universal health care - in favor of a middle-of-the-road plan with a pedigree traceable to the Heritage Foundation and Mitt Romney. It aims to achieve universal access to coverage while leaving the private insurance market intact.

The law is often described as a "three-legged stool" that rests partly on a personal mandate to buy coverage and partly on new market rules that require insurers to cover anyone, regardless of medical history. Today's fight is over the third leg, which offers premium subsidies for those making up to four times the federal poverty level and an expansion of Medicaid, the federal-state health plan for the poor, to cover all those at the bottom end of the income spectrum.

Last summer, in a ruling that otherwise upheld "Obamacare," the Supreme Court kicked out half that third leg, saying it was up to each state to decide what to do with Medicaid.

Some Republican governors, such as Texas' Rick Perry, have been adamant that they won't participate. But others, such as Ohio's John Kasich and Arizona's Jan Brewer, have come around, mostly justifying their decisions on finances. "Obamacare" includes a commitment to pay the entire cost of each state's expansion of the program for the first three years, and at least 90 percent thereafter.

It's a powerful argument, and Pennsylvania advocates are making it, too. According to Valerie Arkoosh, an obstetric anesthesiologist at the University of Pennsylvania and a leader in the National Physicians Alliance, the expansion would add more than 600,000 Pennsylvanians to the Medicaid roles, bringing the state an estimated $38 billion in extra federal money in the next decade. The money would help cushion a blow to Pennsylvania hospitals that's coming regardless of whether the state goes along with Medicaid's expansion: the loss over the next decade of about $9 billion in "disproportionate share payments" - compensation for unpaid care that "Obamacare" was supposed to make unnecessary.

What should guide Corbett and Christie's decisions? I asked Arkoosh last week about the strange dearth of moral arguments in this last stage of a fight that, at least for those of us who supported universal care, was always about doing the right thing. Nor has there always been a plain partisan divide, despite the GOP's recent lurch to the libertarian right. Under a law Reagan himself signed, hospitals can't turn away those needing emergency care.

Arkoosh says one factor is that people don't always identify with the uninsured, even if they should realize they may be a layoff away from joining them. Another is a common failure to realize that, without the Medicaid expansion, many full-time low-wage workers simply can't afford health insurance.

"You'd have to be made of stone not to understand the human impact of this law," she says.

Can this script be rewritten? Florida Gov. Rick Scott offered a glint of hope last week, embracing the expansion with a statement centering on people as much as on finances and recalling his mother's struggles getting care for an ailing brother.

Scott says he learned that our greatness as a nation depends in large part on "how we value the weakest among us."

"Quality health care should be accessible and affordable for all Floridians," he said. "It shouldn't depend on your ZIP code or your tax bracket."

Against the odds and his party's fringe, Scott turned on a dime, calling it simply the right thing to do.

It is here, too, Governors?