Living on health care's fault line

MANSFIELD, Pa. - Rural Tioga County sprawls across more than 1,100 square miles along the New York border in the north-central section of Pennsylvania. Like many other depressed areas, it suffers from high unemployment, low income and high rates of chronic disease.

But it has far fewer employers than do most urban sections of the state, and most businesses are too small to offer health insurance to their employees.

The net result? Tioga has a higher percentage of uninsured (35.6 percent) residents than any other county in the state, according to the Pennsylvania Insurance Department.

While Gov. Rendell and the General Assembly are hashing out a compromise on competing health-care proposals to provide insurance coverage to more Pennsylvanians, many uninsured residents of Tioga County say they are living on the edge every day.

"We live with that question, 'What if?', every day," said Ann Lichty, 36, who runs a 154-acre dairy farm with her husband, Dave.

The Lichtys, who have three children, say that with the fluctuation in milk prices they cannot afford hundreds of dollars a month in private insurance and must pay for all health services out of pocket.

A bad fall from his tractor in April sent Dave Lichty, 39, to a chiropractor several times a week at a cost of $1,000 a month.

"We keep writing checks to the chiropractor," Ann Lichty said. "There's no money left at the end of the week."

As the budget year comes to an end, the governor and Senate Republicans are pushing competing approaches to make people such as the Lichtys eligible for health insurance.

Under a plan called Pennsylvania Access to Basic Care, Rendell wants to expand coverage to an additional 275,000 residents. The plan would be open to small businesses and individuals with premiums paid on a sliding scale, depending on income. Grants would be provided to help offset costs to businesses.

The cost of the program is expected to exceed $1 billion by the 2012-13 fiscal year, and would be paid for through the tobacco settlement fund and other state and federal funding sources.

A competing plan recently introduced by Senate Republicans would cover 500,000 uninsured at a cost of $100 million that would be financed annually by existing revenue from a 25 cents-a-pack cigarette tax and traffic ticket surcharges.

Mansfield coffee-shop owner Jessica Ricker was grateful she escaped from a car accident in January with only a mild concussion. A fellow passenger was hospitalized with a broken neck and needed $85,000 in treatment.

"Thank God that I wasn't in the condition of the other girls," said Ricker, 28, who is among the the 14,700 residents of the rural county without health insurance.

After Tioga County, the next three counties with the highest proportion of uninsured citizens - Forest, Warren and Crawford - are also rural, according to the state Insurance Department. (Philadelphia is fifth with 17.3 percent.)

The young woman who suffered the most serious injury had health insurance. Such a catastrophic injury would have been a huge financial blow to Ricker, who, even with her growing business and four part-time employees, still only clears about $20,000 a year.

Tioga County is about the size of Rhode Island, but it has only 41,000 residents, many of whom live in the postcard-quaint towns of Mansfield and Wellsboro. But the county draws thousands more to its natural beauty and the breathtaking views of what is known as Pennsylvania's Grand Canyon.

For those who live here, there are limited employment options and outside of the major employers - Mansfield University, Laurel Health System, and an iron foundry - most service-sector or tourist-industry jobs do not offer employees health coverage.

At the same time, many Tioga residents need more health services because the county has one of the highest rates of diabetes in the country, and a high percentage suffer from other chronic conditions often related to poor diet, smoking and alcohol consumption. That adds up to $1.8 million in uncompensated care bills paid by Laurel Health System, a nonprofit health and human-services organization that runs the county's only hospital, along with health clinics and nursing homes.

"It's a real challenge for the health-care system," said Peter Keller, acting dean of the faculty at Mansfield University and chairman of the board of Tioga County Partnership for Community Health. "It's harder to sustain programs and the hospital is seeing so many uninsured or underinsured."

During its 15-year existence, the partnership, which includes the university, the Laurel Health System, and an array of local agencies and groups, has launched countywide initiatives to address health issues from early-childhood immunizations to senior care.

But health problems are often compounded by limited access to health care, both for the insured and the uninsured.

There is no cardiologist or dermatologist in Tioga County and only handful of specialists in other areas. . It also has few primary-care physicians.

Last year, the county lost its low-cost dental clinic, which served hundreds of patients, when the dentist moved away.

"We run on a pretty tight margin," said Ron Butler, chief executive officer of Laurel Health System. "Our malpractice-insurance carrier went out of business, and our rates went up by $1 million. It's precarious."

With an estimated 875,000 uninsured Pennsylvanians, Rendell has focused on health care as a priority for the last two years, but the legislature has yet to approve his primary health-insurance initiative. Now the Republicans have a plan of their own. They tout it as costing less and covering more Pennsylvanians. Administration officials say the Rendell plan would provide full insurance coverage, and the GOP plan would provide health care through clinics and depends on charitable contributions from corporations.

Rendell said last week he expected a compromise could be reached by the end of the budget process later this month or the beginning of July.

If the general income limits for insurance coverage under the Rendell plan are contained in the final bill, the Lichtys, who earn less than $32,000 a year, would be eligible for free coverage.

As a single person, Jessica Ricker, proprietor of the Night and Day Cafe, would have to pay about $50 a month, two-thirds less than the cheapest plan offered to her by traveling insurance salesmen.

For now, Ricker is banking on her youth and good health.

"It's common knowledge that health insurance is so unaffordable," Ricker said. "People just take that risk."

Contact staff writer Amy Worden at 717-783-2584 or

» READ MORE: aworden@phillynews.com

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