DN Editorial: ILL WILL

LAST WEEK, Gov. Corbett sent an official application to the federal government explaining why he thinks that his plan for offering health coverage to low-income Pennsylvanians is better than the feds' plan. A draft of Corbett's proposal was made public in December and was the subject of hearings in January. Unfortunately, the official application hasn't improved with time.

To review: As part of the Affordable Care Act, the feds have given states the option to expand Medicaid in order to make sure that as many people as possible will have health coverage. For the first three years, the feds will pick up 100 percent of the cost, and 90 percent thereafter. Corbett, who fought to overturn ACA, has declined the expansion, saying that it would be too costly for the state. (His math: Expanding Medicaid would lead to a swell of new enrollments, so even if the federal government starts picking up only 90 percent of costs, it will still be too much.) By turning down the Medicaid expansion, Corbett turned down $522 million this year alone.

What he's proposing is a plan that would use Medicaid money to allow low-income people to buy private health coverage on the open exchange.

Medicaid expansion is designed to ensure health coverage to many; Corbett's plan is designed to instill "personal responsibility" by requiring low-income people to pay a premium for their coverage, and engage in "healthier choices," including looking for work. The component that ties coverage to work/job-seeking is almost guaranteed to be scuttled by the feds.

There is nothing wrong with encouraging personal responsibility, but the implication is that ill health is a direct result of irresponsibility. That's offensive. So is the requirement that being able to access medical care should be tied to job-seeking; those working less than 20 hours a week will be required to enter job training and engage in job searches as a condition of their coverage. And there's more: According to Corbett, "Reducing the cost of health-care coverage needs to be the responsibility of both the provider and the individuals receiving care."

Really? So, in addition to paying a premium for health coverage - which is likely to be difficult for a great many low-income recipients - the state's poorest citizens will be busy making sure that they never get sick, and in their spare time, making sure that they're doing their bit to keep down health-care costs . . . which, the last time we looked, were driven primarily by high drug and physician costs, expensive technology and profound systemic problems. All of which, by the way, the Affordable Care Act was designed to address.

That's not encouraging personal responsibility; that's scapegoating our most vulnerable citizens.

Medicaid is a big expense to the state; one in six people receives benefits, and it accounts for 27 percent of the state's general-fund budget. But there are factors that drive these costs. According to the Pennsylvania Budget and Policy Center, they include a higher percentage of seniors and disabled individuals than most states, as well as a reliance on expensive nursing-home care.

The waiver application will be posted for 30 days, followed by a 15-day public comment period. Check out cmsideas.uservoice. com.