Eighty-seven people were scheduled to speak, but on a day when the region was digging out from heavy snow, only about 50 did. Each was limited to a strictly enforced three minutes, with their remaining time counting down on a giant screen that everyone could see. There was a lot of fast-talking. No questions were allowed.
Afterwards, Mackereth said she would take all of the comments into account. "I took a ton of notes," she said.
She said the state had no choice but to make changes to Medicaid, the federal and state medical insurance program for the poor. One in six of Pennsylvania's residents gets Medicaid, and it eats up 27 percent of the state's budget.
The Affordable Care Act, popularly (and unpopularly) known as Obamacare, included a provision expanding the number of people eligible for Medicaid, beginning Jan. 1. The Supreme Court said that states could opt out of the expansion.
Twenty-three states, including New Jersey, accepted the original plan.
Pennsylvania has proposed a "private-coverage option" that would not take effect until next year. It would insure an estimated 500,000 people and calls for changes in the current Medicaid program as well. Among its controversial rules is a requirement that some recipients register at an online job-matching website.
Mackereth said the state wanted to keep Medicaid for its most "vulnerable" residents while creating a different plan that required more personal responsibility.
Among the first to speak was Curt Schroder of the Delaware Valley Healthcare Council of HAP, whose association of hospitals and systems has "long advocated" for Medicaid expansion.
"Not only will expanding Medicaid eligibility be important to improving the health of low-income working adults and their productivity, it will also benefit the state's economy," Schroder said. "For this reason DVHC urges DPW to submit a proposal that has the likelihood of being approved by the Centers for Medicare and Medicaid and can be implemented by July 1, 2014."
Athena Smith Ford of Cover the Commonwealth Campaign criticized the Healthy Pennsylvania plan as "complex and controversial." The plan, she said, delays health-care access for a year for hundreds of thousands, including seniors and people with disabilities.
Representing the other side of the political spectrum, Danielle Cyr, grassroots director for Americans for Prosperity, said the Corbett administration was embracing the same system it had rejected a year earlier even though it contends that Healthy Pennsylvania takes a "free market" and "private" approach.
"Despite what the Corbett administration claims, more individuals will become reliant on federal and state health care as a result," Cyr said.
Ignoring the three-minutes, no-questions-allowed rules, Philadelphia consumer advocate Lance S. Haver took the microphone and immediately began addressing Mackereth directly. He asked her why the state did not file its proposal in a timely fashion so people would not be without health insurance. When told that no questions were permitted so that more people could speak, Haver turned to the audience members and asked if they wanted to hear the secretary's answer. He got a rousing yes.
"Please answer the question," Haver said, turning back to the secretary.
"There is no time frame," she said. "We can file this when we are ready to do so. We are taking the time to make sure that whatever we do for Pennsylvania will work."
Former city Health Commissioner Stuart H. Shapiro said he supported the governor's plan, which he had reviewed and compared to other states' expansion efforts. "There is no doubt in my mind that Healthy PA is the right plan substantively, economically, and socially," said Shapiro, who is now president and CEO of the Pennsylvania Health Care Association, which represents long-term care providers.
The hearing came as the first wave of people who signed up for insurance on state or federal exchanges became eligible to use their new plans this week.
Area hospitals and hospital organizations reported no snafus or bumps in patient volume as the new policies took effect. Some said they are continuing to have employees available to help educate patients about the new law and how to apply for insurance.
Independence Blue Cross, which is offering plans through Pennsylvania's online exchange, said it had more than 200 customer service representatives working on New Year's Day, quadruple the normal number.
This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.