No compromise on Pa. health coverage expansion

HARRISBURG, Pa. - The prospect of expanding subsidized health coverage to thousands of uninsured Pennsylvanians before the end of the year died Wednesday, as Gov. Ed Rendell and Senate Republicans failed to reach a compromise on the plan's price tag.

After the Legislature ended what was expected to be its final working day, Rendell expressed disappointment over the lack of an agreement. He called the Senate GOP's resistance to his efforts at a compromise "inexplicable."

"We bent many times to reduce the number of people (covered) to meet their concerns," Rendell said. "This was mean-spirited conduct by people who did not want to see action taken on what is the most fundamental challenge for most people."

But Senate Republican leader Dominic Pileggi said the administration's most recent proposal did nothing to assuage his caucus' concerns that the state could not afford to fund the insurance expansion in the long term without a tax increase , particularly in light of a faltering economy.

"I think ... and I don't believe it's just in our caucus, that it would be irresponsible for us to announce a new program when the state is now facing a 2-to-3 billion-dollar deficit in this year alone," said Pileggi, R-Delaware.

Wednesday was the final scheduled working day of the current Legislature. With the Senate not scheduled to reconvene before the Legislature goes out of business at the end of November, progress appeared unlikely before a new Legislature is sworn in in January.

Rendell said he would revive his effort next year and continue his push until he finishes his term in 2011.

Expanded health care coverage was the centerpiece of a broader initiative Rendell announced in January 2007 to improve health care affordability, access and quality in Pennsylvania.

On Tuesday, the administration proposed a compromise that would extend coverage to more than 118,000 adults on a waiting list for the state's adultBasic insurance program for uninsured adults whose incomes are too high to qualify for Medicaid. Roughly 49,000 people are currently enrolled in adultBasic.

The administration's proposal would cost more than $2 billion over five years, to be covered by a combination of existing state revenue and federal money that would become available under a Medicaid waiver that would require federal approval.

The proposal would also add coverage for prescription drugs and certain mental-health services, which is currently unavailable through adultBasic.

Amy Kelchner, a spokeswoman for the Governor's Office of Health Care Reform, said the proposal was the administration's "final best offer" to the Senate.

Senate Republicans countered with a plan to spend an additional $50 million annually on adultBasic, using existing state money only, Erickson said. Rendell said that plan would have covered only 15,000 people on the program's waiting list.

Both proposals called for the state to spend $30 million a year on health clinics that serve the poor, a measure championed by the Senate GOP.

Both sides also clashed over how to handle the reauthorization of a state program that helps doctors pay for malpractice insurance coverage. The administration proposed phasing out the program known as MCare over five years; Senate Republicans have proposed extending it to 2011 without necessarily ending it.

Rendell originally sought to extend coverage to roughly 767,000 uninsured adults. He quickly ran into trouble when state lawmakers balked at a business payroll tax, a new tax on smokeless tobacco, and a cigarette tax increase the governor proposed to help finance the plan.

This year, Rendell linked the expansion of subsidized health insurance to the reauthorization of MCare and of the Pennsylvania Health Care Cost Containment Council, a research agency that examines the financial performance and quality of Pennsylvania hospitals.

The council was briefly shuttered this summer amid the ongoing insurance debate, but was revived temporarily under an executive order that expires Nov. 30. Rendell said Wednesday he would have to examine whether he has the authority to extend the council's operations beyond that date.