Pennsylvania subsidized health insurance for low-income people to end

Posted: January 12, 2011

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 outgoing Gov. Rendell, a Democrat.

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 - would 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 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 normal restriction on people with preexisting conditions who move from adultBasic to the Blues' current 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's office visits a year for most issues, including both primary care and specialists, for example.

"Special care is horrible insurance," said Gene Bishop, an internal medicine doctor at Pennsylvania Hospital and a physician consultant to the Pennsylvania Health Law Project, one of several advocacy groups that condemned the move.

"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?" said Bishop. A doctor should see someone with diabetes at least that often, she said, just to meet medical guidelines for managing the person's condition, not counting anything else that might happen, such as contracting the flu.

Kathy Dabanian, a 52-year-old house cleaner who lives in Sellersville, Bucks County, has been enrolled in adultBasic almost since the beginning, when doctors at Doylestown Hospital suspected she had Lyme disease.

Since then, she has been diagnosed with fibromyalgia, a chronic condition involving pain and fatigue, and osteoporosis, a thinning of the bones. The state plan has been a lifesaver, she said, covering doctor's visits and providing discounts on antibiotics and medications that relieve joint pain.

"I realized that I was really lucky with adultBasic," she said.

When she heard recently that the program might be discontinued, "I got panicked," she said.

She visited her doctor Monday in hope of squeezing in appointments for any follow-up she needs.

PennACTION, an advocacy group, announced protests across the state for Friday, including one outside Independence Blue Cross headquarters in Philadelphia.

Health advocates have been hoping for an agreement that would somehow continue adultBasic until 2014, when key provisions of the federal health-care overhaul would kick in, replacing programs such as this one.

They have been regular critics of Corbett, who was among a group of state attorneys general who sued to overturn that aspect of the law that requires people to have health-insurance coverage or face penalties. Corbett and others believe the mandate is unconstitutional.

Without that provision, supporters of the law say, much of the bill would fall apart because people would avoid applying for insurance until they needed it, raising costs beyond what the market could bear.

Pennsylvania's adultBasic is among the more generous plans offered by states for low-income working people, with premiums of just $36 a month.

It was originally funded entirely by tobacco-settlement money. As that money was diverted to pay for other things, however, Rendell reached an agreement with the Blues in 2005 to pay a percentage of their revenues into a fund that would support and expand the program.

That agreement ran out in December and was replaced by a temporary agreement, negotiated by Senate Republicans last summer, for the Blues to contribute an additional $51 million to keep the program afloat through June. Rendell administration officials maintain that they said both then and later that the money was not enough, and that when the Blues' payments from the previous agreement also came in short, the shortfall recently became even clearer.

The Corbett team insists that the Rendell administration should have found a way to fund the program; Rendell officials say they suggested alternatives to the transition team.

"We told everybody that the money was going to run out. If I was staying on as governor I would be asking for a supplemental appropriation," Rendell said Tuesday in response to a question during a news conference about education. The incoming administration, he said, "should find a way to renegotiate with the Blues."

But Simon, the Corbett transition's insurance chair, said the Blues would not be open to giving additional money.

The Blues have not been officially informed that the program will end, a spokeswoman said. They are obligated to send a letter to subscribers 30 days in advance.

Rendell administration officials said they had been hoping a solution would be reached and that the letters would not need to go out. Corbett transition officials said they had been pushing the administration to send them.

"It would say we regret to inform you that funding for the adultBasic program will be exhausted as of February 2011. We urge you to explore any alternatives," Simon said.

Ruth Stoolman, a spokeswoman for Independence Blue Cross, which provided the subsidized adultBasic coverage in Southeastern Pennsylvania, said, "We are disappointed that the state wasn't able to secure additional funding. It leaves 12,000 of our members without coverage.

"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," Stoolman said.


Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.

Inquirer staff writer Chelsea Conaboy contributed to this article.

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