"We carry a vision of what the world would look like if it were as God intended it to be," the Rev. Sally Jo Snyder told the two dozen people attending a candlelight vigil Dec. 8. Which was just as well, because the world as it is looked especially unforgiving. Candles quickly died in the frigid wind blowing down West North Avenue ... and the huddled attendees worried that a critical state health-insurance program might flicker out as well.
Since 2002, the state has provided a no-frills, low-cost insurance -- called adultBasic -- to low-income workers. It covers roughly 45,000 people, using tobacco-tax revenue and contributions from Pittsburgh-based Highmark and other big Blue Cross plans. Due to shifting state priorities and a drop-off in support from insurers, however, the program's future is uncertain.
A crisis could come as soon as next month: If the state can't find $54 million to keep adultBasic running through June, subscribers could receive cancellation letters in a few weeks. But that seems unlikely: Incoming governor Tom Corbett has said he would continue supporting adultBasic, and Highmark spokesman Michael Weinstein says the Pittsburgh insurer, for one, is prepared to cut a check for $32 million.
"There's an understanding that we will provide the money, I imagine by the end of the year," he says.
Still, even if adultBasic is maintained at current levels, that leaves more than 450,000 people on the waiting list, hoping to enroll. And insurers have agreed to provide funding only through June. After that, all bets are off.
"We've made a voluntary payment, and we've fulfilled the terms of our agreement" with the state, Weinstein says flatly. That agreement, forged by outgoing Gov. Ed Rendell in 2005, "was always viewed as temporary," says Weinstein. "We've been saying for quite awhile that what is needed is a much more diverse funding source."
What form that will take remains to be seen ... though any plan Corbett comes up with will likely have Highmark's blue-tinted fingerprints all over it. Corbett's "transition team" includes a team of 17 people who will help shape state insurance policy; by my count, all but three have direct ties to the insurance industry. None belong to advocacy groups like those who staged the Dec. 8 vigil.
Those advocates worry Corbett's ascension is "an opportunity that the Blues might try to take advantage of," says Sharon Ward, who heads the Pennsylvania Budget and Policy Center.
And while activists appreciate the insurance industry's previous support -- "Highmark has funded over $300 million to adultBasic; we know they are committed," says Beth Heeb, of the Consumer Health Coalition -- they suspect insurers haven't acted entirely out of altruism.
The Blues, after all, began their payments under duress. The Rendell administration was raising questions about why big insurers were sitting on $3 billion in surplus funds -- far more than they needed -- while Pennsylvanians struggled with rising premiums.
"People were angry about the surpluses," says Ward. So the big insurers "made voluntary contributions rather than having [Harrisburg] pass a law. And they got off pretty easily." Since adultBasic was founded, Ward's liberal-tilting think tank has found that big insurers nearly doubled the size of their surplus, to $5.6 billion.
For his part, Corbett has helped jeopardize what may be the best hope for a more lasting solution.
In March, the Obama administration passed a landmark overhaul of the insurance industry: Come 2014, a slew of reforms will help the uninsured pay for coverage, making adultBasic obsolete. But Obama's reforms have been challenged in court by Republican attorneys general all over the nation ... including Corbett.
Advocates hope that's not an omen. "It's one thing to file a lawsuit," says Ward, "but it's another to look people in the eye as governor and be responsible for losing their insurance." And while Corbett fought the reforms as the attorney general, he's pledged to implement them as governor.
The Democratic reforms aren't perfect: Many Democrats wish Obama had bypassed big insurers altogether, providing a government-managed insurance plan instead. As for adultBasic, even after Rendell expanded it, the program gives help to only one out of 10 people who ask for it.
Still, there's no Democratic initiative so half-hearted that Republicans can't make things worse. And no matter what happens in the next few weeks, advocates may be back in the streets next June.
At least the weather will be nicer. Too bad the climate will probably be so much worse.