Six months after Pennsylvania terminated adultBasic, the state-funded health plan for low-income adults, many of the nearly 41,000 former enrollees who lost their coverage at the end of February likely have been left uninsured.
About 40 percent have enrolled in either Medicaid or the limited benefit Blue Cross Blue Shield plan that was opened to them, according to data provided by the Pennsylvania Insurance Department. Some of the remaining 23,000 individuals who lost their coverage may have found other options, but the insurance department believes many are accessing free or reduced-cost care through community health centers.
The insurance department numbers are similar to an analysis by the Pennsylvania Budget and Policy Center (PBPC). "We think many of them have fallen through the cracks, we just don’t know how many," says Sharon Ward, director of PBPC, which is the research arm of Pennsylvania Health Access Network, a coalition of consumer health advocacy groups.
Ward says the results of the study were surprising given the "very strong effort" by the state insurance department, Blue Cross Blue Shield and advocacy groups to enroll individuals in coverage alternatives.
AdultBasic insurance was one of only a handful of health plans funded by states to provide coverage to low-income adults who do not qualify for Medicaid, the joint federal-state health insurance for the poor. It was funded through money from the state's tobacco settlement and donations from the state's four Blue Cross and Blue Shield insurance companies, and cost $166 million in 2010. AdultBasic enrollees paid $36 per month, although it cost $600 per member each month.
When the program ended, there were 505,624 still on the waiting list.
With the cost of health care increasing and the state facing a hole in the budget of around $4 billion, Gov. Tom Corbett, a Republican, closed the program Feb. 28. For many individuals, there were few options. Since former enrollees have been uninsured for at least six months, they can now sign up for the state high-risk pool created under the 2010 federal health law. It costs $283 per month and covers prescription drugs.
Blue Cross Blue Shield companies allowed adultBasic subscribers to join Special Care, a low-cost, limited benefit insurance product, without consideration of the applicants' pre-existing conditions. Yet, that policy can cost up to $192 a month. It also provides fewer benefits, including only four doctor visits each year. Nearly 15,700 former adultBasic participants enrolled in Special Care, despite the limitations. Another 1,525 qualified for Medicaid.
Paula Michele Boyle and her husband Tom, both self-employed cancer survivors who need regular medical care, moved to Special Care after adultBasic closed and pay about $300 a month for coverage. They couple earns about $25,000 per year.
Boyle was turned down by several private insurers because she had Hodgkin's lymphoma, and her husband was offered a plan that cost $1,000 each month.
"Things are really tight, and we're living a really frugal lifestyle," says Boyle.
But the limited coverage provided by Special Care is "not covering our needs," she says. The couple is trying to preserve a few of their allotted doctor appointments for the year in case of an emergency, so they are "trying very, very hard not to utilize the medical system." Her husband needs surgery for a shoulder injury but has postponed it in the hopes that they might be able to find more comprehensive coverage. "We're sweating out at this point," she says. "We're still in a really tough spot."
Sharon Ward says that since adultBasic recipients tended to have a lot of chronic health conditions, Special Care is often not adequate coverage, and many do not qualify for private insurance because of preexisting conditions.
In addition, says Ward, Pittsburgh Blue Cross insurer Highmark announced it would seek a nearly 10 percent increase in premium rates for its Special Care Plan. The insurer has since reduced the requested increase to 4.9 percent after receiving strong criticism.
"This is obviously not a good situation," said Pennsylvania state Sen. Ted Erickson, a Republican, in response to the insurance department figures. Emergency room visits in the state have increased since adultBasic ended, including one Philadelphia hospital where visits increased by 30 percent, he says, adding additional costs to the health system. Erickson adds that it's unclear whether ending adultBasic was a mistake, but "it happened. Now we have to deal with it."
He has sponsored legislation to fund more community health clinics to care for those who lost coverage rather than offering them a new insurance product.
But Auditor General Jack Wagner, a Democrat, argues adultBasic funds were wrongly diverted to non-health related programs. He released a report in June advocating for adultBasic to be restored using money from the Tobacco settlement funds (which continue to be paid to the state each year), the Blues plans, private health insurers and the foundation community. Wagner conducted five public hearings across the state and says, "overwhelmingly, across the board, the public supports adultBasic."
Sen. Jay Costa, Democratic leader of the Pennsylvania Senate, says it's unlikely that the adultBasic plan will be reinstated. He says Democrats were disappointed that they weren't able to push through funding of the program even after the state learned it had a $785 million revenue surplus this year.