Doctor Writes Governor's Healthy PA Plan is 'Bad Medicine'

Governor Corbett's Healthy PA plan threatens to undermine the stability of community health centers and services for Pennsylvania's most vulnerable, according to Dr. Hilda Shirk, the chief executive officer of SouthEast Lancaster Health Services, writing in a recent op-ed for the Lancaster Sunday News.

On the face of it, Gov. Corbett's Healthy PA plan addresses some of the problems facing the 500,000 state residents who would have been covered by Medicaid expansion as designed in the Affordable Care Act. Healthy PA proposes that newly eligible Pennsylvanians could secure coverage through the new insurance marketplace, with the state picking up the tab for the bulk of the cost.

The people most likely to be covered under this expansion are many who have been uninsured patients at community health centers like SouthEast Lancaster Health Services that offer high-quality health and dental care to all, regardless of ability to pay. The problem is that Healthy PA will reduce access to and undermine the economic stability of community health centers, which have been the nation's primary means of providing affordable care that is culturally competent and clinically successful.

The waivers included as part of Healthy PA would allow commercial insurers to exclude community health centers from their networks so that many patients would need to find a new medical home or pay more for care. In addition, Healthy PA limits the number of primary care visits a patient could have each year, while allowing unlimited emergency room visits, with a nominal fee for non-emergency care. This flies in the face of best practices, which encourage patients to develop a relationship with their primary provider to keep people healthier at a lower cost rather than encouraging unnecessary emergency room services.

Healthy PA also includes a waiver that forces community health centers to negotiate rates with the insurance companies rather than use the federally mandated payment rates for these safety-net providers. The mandated rates take into consideration the unique access community health centers provide in that they must be open to all and offer mandated services. This bundled rate is intended to avoid an "order more and be paid more'' approach and instead supports a more cost-efficient approach to care that places the patient first. Without this bundled rate, inadequate payment would quickly cause health centers to lose viability and the ability to serve as health care homes for patients with the greatest needs.

Read Dr. Shirk's full commentary here.