True access: Health care works only if one gets to the doctor

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The best health insurance is worthless if patients can’t get to the doctor’s office. That’s the problem with part of Gov. Tom Corbett’s Healthy Pennsylvania, his alternative to a state expansion of Medicaid under the Affordable Care Act.

Healthy PA would let 520,000 low-income Pennsylvanians become eligible for subsidies to help pay for coverage, but before that can happen, the U.S. Department of Health and Human Services must approve the governor’s proposal. The plan includes a request for waivers from some regulations, including the requirement for funding non-emergency medical transportation.

Every state offers some kind of transportation assistance under Medicaid, the coverage plan for poor and disabled people that is funded jointly by the federal and state governments. 

The practice of subsidizing transportation is far less common with private insurance policies, and that’s what Pennsylvanians would be buying under the Corbett plan.

The rationale for the transportation subsidy is simple: Poor people may not have cars or access to other transportation they need to get their medical care. In a large number of cases, the recipients have chronic conditions, and almost half of all the trips acquired through Medicaid are for dialysis patients and those who require treatment for behavioral health problems and substance abuse.

Pennsylvania already learned how cutting the transportation money can backfire. Two years ago, it cut the Medical Assistance Transportation Program block fund budget by 18 percent, or $26 million, and put a cap on mileage reimbursements for drivers using private vehicles. In response, some counties reduced service and were on the brink of shutting it down.

A simple expansion of Medicaid always has seemed more straightforward and the best way to get care for more Pennsylvanians, but Mr. Corbett’s plan is not without positive features.

However, it should not win federal approval unless it has guarantees that recipients who will gain access to health insurance also will have access to their doctors.


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