More were expected, but several dozen people braved the snow Friday, turning out at the Constitution Center, for the third of seven hearings on Pennsylvania Gov. Tom Corbett's Medicaid plan, known as Healthy Pennsylvania.

After months of staunchly opposing a Medicaid expansion, even with Washington offering to pay the extra costs, Corbett is seeking permission to use the money in another way, subsidizing people buying private coverage.

The proposal is a hard sell as far as 48-year-old Andre Butler, an uninsured banquet server who showed up in his tux and tails to testify, is concerned. He told fellow advocates outside before the hearing that he and many other blue-collar workers could have coverage, effective this week, had the governor opted for an expansion.

'Out in the cold'

"If these people would get sick tomorrow, what would happen to Pennsylvania's economy? So for Corbett to be keeping us out in the cold, literally out in the cold like we are here today, makes absolutely no sense at all," Butler said.

Inside the Constitution Center, Department of Public Welfare Secretary Beverly Mackereth kicked off the hearing with a presentation about Corbett's plan. She said Medicaid, which represents a  third of the state's budget, is growing too much as is. The state lacks the resources to keep up and needs a better alternative to an expansion.

"We do not need a program that works just today or tomorrow," Mackereth said. "We need a program that each and every one of us in here can say will be here next year, in 20 years, 30 years and will continue to help the most vulnerable citizens in Pennsylvania."

Mackereth went over some of the plan's key elements and goals, offering coverage to upward of 500,000 Pennsylvanians, adding more personal responsibility through income-based premiums, focusing on better health outcomes, to name a few.

Critics outline fears

Many of those who spoke at the hearing were critical of the plan.

"We are deeply troubled by many aspects of this proposal," testified Kristen Dama of Community Legal Services. Dama worried components such as new premiums, even if only $13 a month, will make it harder for low-income individuals, who may not even have a bank account, to get and maintain coverage.

Dr. Arthur Evans, Philadelphia's commissioner of behavioral health services, focused his testimony on two concerns: first, the proposal's basis on the shaky notion that putting people in the private market for coverage will cost the state less; and, second, that changes to current Medicaid coverage could get in the way of needed care and physician decisions.

"I'm very concerned about an arbitrary limit on benefits, whether for high-risk or low-risk beneficiaries," he said, referring to how the plan would break current Medicaid into two benefit level tiers, one for relatively healthy individuals and one for those with greater needs.

And some offer support

Not everyone testified against the plan.

"We appreciate the opportunity to express our support of several key components," said David Simon with Jefferson Health System, who commended the plan's "creative approaches" to improving care and trying to limit an influx of Medicaid patients to any one provider.

"The plan will also enhance physician and hospital choice for the newly eligible and reduce financial hardship on those providers that honor their social mission by seeing Medicaid patients," he testified.

The morning session alone lasted more than two hours, resuming again in the afternoon. Next, the state will review all comments and resubmit their proposal for federal review.