Poor Pennsylvanians need access to care

The Morning Call

April 29, 2008

More than a year ago, Gov. Ed Rendell made access to health care a major issue in this state with his ''Cover All Pennsylvanians'' proposal. Since then, the fact that tens of millions of Americans lack health insurance has become a major issue in the presidential race, too.

However, little has changed either in the state or the nation. Hundreds of thousands of Pennsylvanians live day-to-day without health insurance, hoping to stay healthy because they can't afford to get sick. Meanwhile, state lawmakers can't agree on either the scope of health care reform, its cost, or how to pay for it.

Earlier this year, the state House drastically scaled back Gov. Rendell's plan, reducing the number of uninsured it would cover from 800,000 to 220,000. The House did this by gutting and amending the already passed Senate Bill 1137. That was returned to the Senate and is awaiting action. But, the House action stripped out two of the main funding mechanisms of Gov. Rendell's ''Cover All Pennsylvanians'' proposal -- a 3 percent payroll tax and higher tobacco taxes (10 cents more in cigarette taxes and new state taxes on cigars and smokeless tobacco). Pennsylvania is the only state that doesn't tax cigars and smokeless tobacco.

There never is much enthusiasm in Harrisburg for raising any sort of taxes but especially not in an election year. However, the $225 million that the new tobacco taxes would raise are significant in this case. That's because there's a $120 million funding shortfall in the new Access to Basic Care program that threatens its passage.

It's important to note that of the current $1.35 the state collects on each pack of cigarettes, 25 cents goes to subsidize the malpractice insurance system (MCare) for Pennsylvania physicians. Stabilizing the high cost of malpractice insurance has been crucial to stem the tide of physicians leaving the state. But Gov. Rendell wants to tap the growing MCare surplus to help pay for extending coverage to uninsured Pennsylvanians. There is some irony is a proposal to help extend health insurance to uninsured Pennsylvanians would target a program designed to make sure there are enough doctors in the state to provide that care. But Gov. Rendell has turned that around by asking why lawmakers were able justifying taxing tobacco users to help doctors but can't find the political will to do the same to help uninsured Pennsylvanians.

This shouldn't be about political posturing. It should be about figuring out how best to provide for the least fortunate and most vulnerable and working class Pennsylvanians who can't afford health insurance. It should be figuring out practical and fair funding solutions to keep Pennsylvania healthy.

But, as S.B. 1137 awaits action in the Republican-controlled Senate, the Republican caucus is trying to line up arguments to shoot it down. That process starts tomorrow in a hearing of the Senate Policy Committee. So far, only members of the business community, hospitals and medical community and the insurance industry have been invited to testify. What these groups have to say about the costs and consequences of extending health coverage to the uninsured certainly is relevant. But it's not all that needs to be considered. There's another group of shareholders in this debate that need to be heard from -- Pennsylvanians who need health care and can't afford to get it. Unfortunately for them, they can't afford to hire lobbyists to argue on their behalf.

Pennsylvanians have come to expect leading-edge innovation from their state lawmakers when it comes to health care issues. The state was among the national leaders with its Children's Health Insurance Program and prescription subsidies for the elderly. Maybe Gov. Rendell's ''Cover All Pennsylvanians'' proposal sounded too much like statewide universal health care for some lawmakers. But, it's not fair to uninsured Pennsylvanians, nor wise public policy, for state lawmakers to wait and see what happens on the national stage regarding universal health care. The legislators were elected to be leaders and the Senate should lead by extending health insurance coverage to as many Pennsylvanians as they can.