New Pennsylvania plan offers health care hope for residents with preexisting conditions

Posted: August 05, 2010

Nearly 1,000 Pennsylvanians with preexisting medical conditions that have prevented them from getting health insurance filed applications for a high-risk plan the state launched Wednesday morning, two days after New Jersey opened its program.

Getting rid of insurers' longtime practice of refusing to write individual policies for people with conditions ranging from diabetes to cancer was among the most popular parts of federal health reform passed earlier this year.

That mandate, however, doesn't take effect until 2014. The states' health plans, funded by the federal government, are intended to serve as a bridge.

Pennsylvania and New Jersey are among 29 states that will offer such plans; residents of Delaware and 20 other states will be able to get coverage via plans run through the U.S. Department of Health and Human Services.

The federal government has allocated $5 billion to pay for the efforts, including $160 million in Pennsylvania, $141 million in New Jersey, and $13 million in Delaware.

"Full federal health reform is still three years away," Pennsylvania Insurance Commissioner Joel Ario said in a statement. "In the meantime, we are doing everything we can for Pennsylvanians to have access to affordable, quality health care."

On Wednesday morning, Matt Stetson, 50, of the Fairmount section of Philadelphia, was at his computer when the Pennsylvania plan began taking applications.

After being laid off from a financial firm two years ago, Stetson had used COBRA to keep his coverage. Shortly before that was about to run out, he was diagnosed with a bicuspid aortic valve, a birth defect that affects about 2 percent of Americans. It can lead to a range of cardiac problems, including congestive heart failure.

As a result, Stetson was turned down for an individual health insurance policy and has had no insurance for nearly a year.

On Wednesday, he was excited about the possibility of getting coverage at what he considers a reasonable monthly premium: $283 plus copayments and other fees.

Like many people, Stetson - a college graduate with a well-paying job for many years - never thought he would be uninsured or uninsurable.

"I lost a good job and then learned that I was born with this condition. It happened to me," he said. "This program will be a real lifesaver."

Pennsylvania initially plans to enroll 3,500 eligible residents in the program, dubbed PA Fair Care, on a first come, first served basis, with as many as 5,600 people by 2014.

The state Insurance Department had received 946 applications as of 3:30 p.m. Wednesday, the latest tally available.

The plan is administered by Highmark Blue Shield in Pittsburgh. The full range of benefits includes prescription-drug and mental-health coverage as well as standard preventive care and doctor, hospital, and laboratory services.

Pennsylvania officials encouraged people to apply online, saying it should take only 15 minutes.

New Jersey launched its program on Monday. That plan, called NJ Protect, is administered by Horizon Blue Cross Blue Shield.

A spokesman for that insurer said Wednesday applications had begun to trickle in by mail. Unlike Pennsylvania, applications cannot yet be made online, although the form can be downloaded and printed.

New Jersey estimated that about 21,000 residents could ultimately be covered under the plan, with premiums ranging from $213 to $660 a month, depending on age and benefits package.

"For too long, Americans with preexisting conditions have been locked out of our health-insurance market," U.S. Health and Human Services Secretary Kathleen Sebelius said in detailing the initiative last month. "This program will provide people the help they need as the nation transitions to a more competitive and fair marketplace in 2014."


New Health Insurance Plans

Pennsylvania and New Jersey began accepting applications this week for subsidized health insurance from people with preexisting medical conditions.

Eligibility

You must:

Be a U.S. citizen or legal alien.

Be a state resident.

Be uninsured for at least six months.

Have a preexisting medical condition.

More information

PA Fair Care: Call 1-888-767-7015 or go to www.pafaircare.com

NJ Protect: Call 1-888-551-2130 or go to www.state.nj.us/dobi

Full details: For lists of preexisting medical conditions and other details, go to www.healthcare.gov


Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.

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