States Cutting Back Special Programs For Uninsured

Feb 02, 2010

Sherie Brace fears the coming of summer when a special insurance program for low-income adults in Washington state is set to end. (Robert Sumner/KHN)

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Sherie Brace fears the coming of summer. That’s when a special health insurance program for low-income adults in Washington state is set to close, ending coverage for her and about 65,000 others.

“I’m terrified they’ll cut it out. Then I would not be able to go to the doctor if I have an asthma attack,” says Brace, 52, who has had asthma for years. She earns about $12,000 a year working for a Seattle-area home health care agency that gives workers $50 a month toward health costs.

The recession is forcing states such as Washington to pare back health insurance programs for low-income people, even as growing joblessness boosts demand for help. Five of six states that use state funds to assist adults not covered by Medicaid are considering cuts, barring new enrollment or raising fees.

The more than 250,000 people in the state programs are adults who don’t qualify for the joint federal-state Medicaid program, either because they don’t have children or earn more than the tight limits states impose on Medicaid eligibility. They represent a tiny fraction of people who get government health insurance, yet the state programs are often their sole option for coverage.

“They’re not offered insurance through their jobs,” says Rebecca Kavoussi, of the Community Health Network of Washington state, which runs clinics and an insurance plan.

The Senate passed a health bill that includes some funding for the state programs. That bill and one passed by the House also expand Medicaid and offer federal subsidies to help low- and middle-income Americans buy insurance. Yet the fate of the bills is uncertain as Democrats regroup after the loss of a key Senate seat to Republican Scott Brown of Massachusetts.

Even if Congress approves a bill, much of the relief for states and the uninsured is still years away — 2013 at the earliest. 

Waiting Lists Grow

Meanwhile, state plans remain vulnerable as economies sour.

Most of these plans require participants to pay part of their monthly premiums and medical care. Benefits may be more restrictive than those in Medicaid. A Tennessee program, for example, limits members to two covered emergency department visits a year.

Among the struggling plans:

Washington: Basic Health — the first state-subsidized program of its kind when it began more than two decades ago — will fold by July unless lawmakers find $160 million in new revenue. About 300 people a day are added to its waiting list.

Tennessee: CoverTN , which subsidizes insurance for workers at certain small businesses and for adults earning less than $55,000 a year, halted new enrollment in December.

Connecticut: Charter Oak , which offers residents insurance for $93 to $296 a month on an income-based sliding scale, must freeze enrollment this year, Republican Gov. Jodi Rell says, unless lawmakers find more money.

Pennsylvania: The state’s adultBasic will double fees for doctor visits in March to $10-$20 and add a $1,000 maximum annual charge for hospital care. The wait list more than doubled in 2009, from 165,318 to 353,301.

Minnesota: The General Assistance Medical Care program, which covers adults earning less than $8,000 a year, will end in March unless lawmakers find an alternative.

Not all such programs are in trouble: Maine plans to reopen enrollment in its program this year to the 2,000 people on its waiting list. The D.C. Health Alliance is not facing cuts, nor is there a waiting list.

Future In Doubt

Sen. Maria Cantwell, D-Wash., added a provision to the Senate health bill to allow her state to seek federal funds for Basic Health until 2014. Her spokesman, John Diamond, says the provision would apply to other states with basic health plans.

Another Cantwell amendment would let states establish basic health plans after 2014. Such programs would be open to people who earn too much for Medicaid but less than twice the federal poverty level, about $21,660 for an individual.

(Robert Sumner/KHN)

Some policy experts say such state programs wouldn’t be needed if a health care overhaul passes because most adults who now qualify would fit the new Medicaid enrollment guidelines or be eligible for federal subsidies.

“There will be no reason for states to pay for this themselves,” says John Holahan of the Urban Institute, a nonpartisan think tank in Washington.

Whatever the outcome of the debate in the nation’s capital, Brace hopes lawmakers can find the money to save Basic Health.

“I take medication every day that helps me get up and go to work and do a good job,” says Brace. “If I don’t have those medications, I would end up probably in a wheelchair, having someone be a caregiver to me.”

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