Pa adultBasic May Be Restored

Pa adultBasic, the state funded healthcare plan for low income adults may be making a triumphant return. Earlier this month, with the help of former policyholders through a class-action lawsuit, Judge Dan Pellegrini declared that it was unconstitutional for the state’s tobacco settlement funds to be diverted away from the program. Although the ruling does not make any retroactive changes, it still is a big win for lower wage-earners

Thus, adultBasic must be reinstated or another program must be created that closely mirrors the benefits. And 30% of the tobacco funds are to be used for the fiscal year of 2013-2014. Currently, those funds are earmarked for other programs. However, there should be ample time to make the appropriate changes to those specific affected programs.

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The Return Of adultBasic

The Pennsylvania Health Investment Insurance Act 77 was enacted in 2001 and created the program for the needy. Some of the money awarded from tobacco litigation in 1998 was expected to total approximately $375 million and $425 million dollars each year.  However, in February of 2011, the program came to an abrupt halt when funding stopped and money ran out.

More than 40,000 Pennsylvania residents were left without medical coverage and another 500,000 were on a waiting list. At that time premiums were less than $40 per month, making it a lifesaver for many of the poorer Pa residents that had no coverage through work or made too much money to be Medicaid-eligible.  Special Care was the replacement, but the Blue Cross plan has been much more expensive and offers fewer benefits. Less than half of eligible  participants switched to Special Care.

During all of this turmoil, many consumers have been able to obtain low-cost coverage through the Pennsylvania Marketplace (You can view free detailed quotes through our website). For many households that saw their incomes increase beyond Medicaid levels, the federal subsidy will often pay from 50%-100% of the premium. This applied to both single and family policies.

So should adultBasic be resurrected and started up again? It may make sense since it appears that it would not cost the taxpayers any of their own money. Or creating a program that offers similar benefits at a reasonable price could accomplish the same goals. We are confident the Governor will make the most prudent (and popular decision).

UPDATES:

May 2014 – adultBasic will not be resurrected. However, the expansion of Medicaid in Pennsylvania may be coming shortly, which should help many persons that previously lost coverage. Linking a work requirement to the expansion (the program is called “Healthy Pa”) would be a first in the US. So far, the administration has resisted approving this program.

We expect an announcement within the next three months that could make thousands of persons eligible for Medicaid. However, unlike most states, specific employment-related requirements will have to be met.

September 2016 – It’s now been more than one year since Medicaid expansion was implemented by Governor Tom Wolf. More than 600,000 persons have enrolled, and obtained low-cost healthcare benefits, and reducing the state’s uninsured to below 15% of the population.

Although many parts of the Keystone State have benefited, Philadelphia has more than 10,000 new covered persons, with many of the new applicants able to utilize coverage for addiction issues. And although adult dental benefits are not included, the new expansion seems to be considered a success. Currently, the federal government pays for the expansion, although “only” 90% will be covered in 2020.

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