Nearly 42,000 Pennsylvanians could be without the affordable health-insurance plan known as adultBasic by Feb. 28, thanks to the first major policy decision of the Tom Corbett era.
AdultBasic provided modest, low-cost health coverage to working people -- those earning up to 200 percent of the federal poverty level -- who couldn't afford coverage on their own. It was paid for with tobacco-tax revenue and contributions from large insurers like Highmark under an agreement secured by Gov. Ed Rendell.
But that agreement has expired. And rather than renew the program, as many advocates sought, Corbett's "transition team" announced that adultBasic will be replaced by a pricier, less comprehensive program called "Special Care."
Corbett's decision shouldn't come as a surprise, however. Last year, as Pennsylvnia attorney general, he sued to block President Obama's health-care plan.
Under Special Care, participants could pay as much as $160 monthly -- up from $36 a month under adultBasic. And Special Care offers less coverage for the money: The program covers four doctor visits a year, $1,000 in diagnostic tests and limited hospital stays of 21 days. The program doesn't cover vital expenses like diabetes testing supplies, says Erin Gill, a spokesperson for the Pennsylvania Health Access Network.
"This program is unbelievably inadequate," says Gill. "We're going to charge people five times more than they're paying now and severely limit their health care."
Even adultBasic fell short of its need, say Gill and other advocates: The waiting list for the program numbers more than 400,000 people. But for the lucky few, adultBasic provided critical aid.
Among them is Denise Lohr. The 56-year-old Greenfield resident has required hip replacement and spinal fusion surgery, among other services. Lohr, who owns a pet-sitting and dog-walking business, sees the doctor at least six times a year.
Without adultBasic or a similar program, says Lohr, "I would probably have to go on Social Security disability, which my doctor tells me that I qualify for." But that would mean giving up her job to qualify. "I'm trying to be a productive member of society, but with my medical issues, there's no way I could continue to pay for that level of insurance and continue working."
Officials with the incoming Corbett administration could not be reached for comment. But they have previously said that without money from insurers, the state simply can't pay for adultBasic. For its part, Highmark has previously stressed to City Paper that funding adultBasic was always a temporary measure. (It was hatched when Rendell's administration was threatening to investigate the large cash surpluses that insurers were sitting on.) The state needed "a more diverse funding source," Highmark spokesman Michael Weinstein said in December.
Some cuts to adultBasic may be unavoidable, given predictions that the state faces a $4 billion budget deficit. But state Sen. Jay Costa (D-Forest Hills), who leads Senate Democrats in Harrisburg, says cuts need not be as drastic as those Corbett is proposing. "There's a lot of room ... to work toward a sustainable solution," he says.
That solution need only be sustained until 2014, when President Barack Obama's health-care reforms will address the needs of the working uninsured. And Costa says he's not ready to write off adultBasic just yet. Leaders in both parties will be discussing the issue in the days ahead, he says.
"This is one of the most important issues facing this Commonwealth," Costa says. "We have to sincerely work together to get it solved."
