To illustrate his opposition to an expansion of Medicaid in Pennsylvania, Dr. Zane Gates - founder of two free clinics in the region that help the working poor - told a story from his childhood.
He was shopping at the A&P in Eldorado, near Evergreen Manors housing project where he grew up, when he saw a classmate.
Instead of checking out, Gates walked around the store until the classmate left, before handing over his food stamps for groceries.
Modern Medicaid is like food stamps because it generates embarrassment - "it takes a lot of people's dignity away" - largely because the program's low reimbursements cause providers to refuse service to cardholders, Gates said this week.
Like Gates, Gov. Tom Corbett has misgivings about the Medicaid program. In his budget address Tuesday, he said he wouldn't expand it here, as the federal government has invited states to do, until there are program reforms and clarifications.
Program advocates said it's crazy to refuse the invitation, which includes a federal promise to pay - temporarily - almost all the costs of expanding enrollment from 100 percent of federal poverty to 133 percent.
"It's a tragedy if the state doesn't," said Dr. Deborah Baceski, who runs a free medical clinic in Somerset.
"It would truly be an act of fiscal malpractice for the governor to reject Medicaid expansion," said Ron Pollack, executive director of Families USA, a Washington, D.C.-based advocacy group.
Not only would the expansion give hundreds of thousands more people health coverage, but it would improve the state's economy, Pollack said.
The federal government would pay 100 percent of the additional cost for three years, then 95 percent, then 94 percent - with the federal share not dipping below 90 percent, Pollack said.
And while a succeeding federal administration could back out of that plan, the states could back out of their expansions, as Arizona Gov. Jan Brewer has promised, Pollack said.
"It's a no-brainer," he said.
Corbett disagrees, for now.
"The administration intends to engage in an informed dialogue with the public and the Legislature on whether expansion of the Medicaid program is prudent, affordable and the right choice for the commonwealth," states the administration's budget-in-brief. "When a final decision is made, it will be done in consultation with the Legislature and it may require modifications to be made and accounted for in the budget."
The state worries that the expansion of Medicaid will encourage employers to drop coverage, which is an incentive in the wrong direction and which would increase the financial strain of taking care of the 2.2 million current recipients, said Department of Public Welfare spokeswoman Anne Bale Wednesday.
The state also worries about a lack of incentives like job training to get recipients off Medicaid, she said.
And it wants to create a targeted approach for Medicaid recipients with special medical problems, instead of the current "one-size-fits-all," she said.
For example, should the state need to pay the "full package" that reflects the possibility of diabetes and mental health issues for a healthy 25-year-old? Bale asked.
"We have to pay the full widespread package for everybody," she said.
"It's complicated," said state Sen. John H. Eichelberger Jr., R-Blair, of the Medicaid situation.
And federal officials haven't been forthcoming with answers so far, he said.
Medicaid is imperfect, but it isn't the dignity-robbing program Gates imagines, according to Pollack.
Surveys of Medicaid recipients in recent years - including a Harvard researcher's study of Oregon residents - show the program "makes a huge difference in giving people true access to care," Pollack said.
It also has a high satisfaction rating, he said.
"Things have changed," Pollack said, referring to Gates' experience with the food stamp program decades ago.
Moreover, the Affordable Care Act will boost payments to providers, albeit temporarily, Pollack said.
There's hope the boost could become permanent, he added.
Gates believes that a reasonable alternative to Medicaid expansion is expansion of the free clinic model he pioneered with Buffalo insurance broker Patrick Reilly.
Corbett's budget includes $5 million for clinics - including some for hospitals to reproduce the Gates-Reilly model.
Pollack thinks that's wishful thinking.
Clinics do good work, but they can only be "a drop in the bucket" compared to the comprehensive reach of Medicaid, said.
Mirror Staff Writer William Kibler is at 949-7038.