Philly.com
January 11, 2011
New Pennsylvania governor likely to end low-cost health insurance for the poor
By Don Sapatkin / Inquirer Staff Writer
Pennsylvania’s subsidized health insurance for low-income working people will likely end next month, officials on Gov.-elect Tom Corbett’s transition team said Tuesday, leaving more than 40,000 people with less palatable options and dashing the hopes of more than 400,000 on the waiting list.
“AdultBasic is not sustainable,” said Kevin Harley, a spokesman for the transition, referring to the insurance program that began eight years ago under Gov. Tom Ridge, a Republican, and was expanded by Gov. Rendell.
Staff for the incoming and outgoing governors traded accusations Tuesday about who was responsible for the program’s demise but both agreed that the money — a combination of tobacco settlement revenues and donations from the state’s four Blue Cross plans — will run out around Feb. 28 and that no good alternative was in place.
“There is no apparent source of funds,” said David F. Simon, chairman of the transition team for insurance matters and chief legal counsel of the Jefferson Health System.
To provide “as soft a landing as possible,” Simon said, the team had negotiated an agreement with the Blue Cross companies to waive their restriction on people with pre-existing conditions who move from adultBasic to the Blues' Special Care plans for low-income people.
Those plans cost several times as much as adultBasic and provide far fewer benefits — a maximum of four doctor office visits a year for most issues, including both primary care and specialists, for example.
“Special care is horrible insurance,” said Philadelphia physician Gene Bishop. "When I was in practice and I first saw someone with that insurance, I thought they were mistaken. Who would sell someone insurance that you can only go four times a year" to the doctor.
“We are disappointed that the state wasn't able to secure additional funding. It leaves 12,000 of our members without coverage,” said Ruth Stoolman, a spokeswoman for Independence Blue Cross, which provides the subsidized adultBasic coverage for people in the southeastern part of the state. “Unfortunately, people are going to have to find other options. Special Care is an option. It is not a perfect option but it is an option.”
Alternatives to adultBasic
By Don Sapatkin / Inquirer Staff Writer
People who currently are enrolled in adultBasic might have a few options if the program ends, according to those who have been following the issue, but many will not be eligible and most alternatives are unlikely to match the benefits or costs of the state-subsidized program.
Besides the possibility of Medicaid, Medicare or employer-sponsored insurance - mainly for people whose situation may have changed between the time they enrolled in adultBasic and now - the two most likely possibilities are:
"Special Care" plans for low-income people are offered by all four Blue Cross plans in Pennsylvania. Eligible income ranges from a maxium of $21,660 for a single adult to $74,020 for a family of eight, according to the plan description at Independence Blue Cross, which currently covers adultBasic members in Southeastern Pennsylvania. Premiums range from $140 for one adult to $341 for two adults and children. Coverage is minimal, especially for doctor visits.
If adultBasic ends, the Blues have agreed to waive two rules for people currently on that program, according to a spokeswoman (the web site has not been updated): the exclusion for people with pre-existing conditions (if they apply within two months of the program's end) and the income verification requirement (income numbers would be taken from the adultBasic account).
"PA Fair Care" is the state's version of federally subsidized programs for people with pre-existing conditions that came out of the federal healthcare overhaul. There is no income requirement and premiums are a flat $283 a month; applicants must be able to prove that they were ineligible for commercial insurance because of a pre-existing condition.
The program, which could fill up in the coming months, is currently limited to people who have had no insurance coverage for at least six months.