Bill to expand Pa. health insurance sparks debate

Democratic leaders in Pennsylvania hope to double the number of residents who receive state-sponsored health insurance, known as adultBasic, but Republicans fear the costs may be too high.

The Pennsylvania House on Monday voted, 104-98, in favor of HB 1, to increase the number of individuals receiving adultBasic from 45,000 to 90,000.

Republican leaders in the Senate say they might oppose the effort. Carolyn Scanlan, president and CEO of the Hospital & Healthsystem Association of Pennsylvania, also expressed reservations.

Pennsylvania, like the nation, has seen the numbers of uninsured soar in the last year as the economy has declined, making a bad situation much worse.

AdultBasic is designed for people who earn too much to qualify for poverty programs such as Medicaid but can't afford insurance themselves.

An individual is eligible for adultBasic if he or she earns $21,600 or less; a family of four can earn $44,000 or less.

The program can't begin to meet the rising need. The waiting list, officials say, is growing by 20,000 a month and projects 270,000 as of today.

A year ago, it was at 96,000.

Ann Torregrossa, director of the Governor's Office of Health Care Reform, says the cost of expanding adultBasic - $130 million - will be paid with federal Medicaid funds available through a special waiver.

"The people that adultBasic services are the people that serve us - waitresses, grocery baggers, cabdrivers," Torregrossa said. "It's absolutely insane not to take advantage of the waiver. We can more than double the number of people we cover without spending one dollar more of state money."

Republicans, however, say the expansion will cost state taxpayers money. They also question the wisdom of expanding the program when the state faces a $3 billion budget shortfall.

Charmaine Humphrey, 37, of Kensington, is on the waiting list.

She is homebound, unemployed, uninsured, and taking six medications daily to deal with five medical conditions, including fibromyalgia, which can cause chronic pain and inflammation.

As an Air Force medic, sales manager, and most recently executive assistant, she always had health insurance - until illnesses forced her to resign in 2007, she said.

She and her husband have been on the waiting list for a year.

They owe $50,000 in medical bills, she says. She pays $200 a month out of pocket at Walgreens for discount drugs, which are called in as a favor by her former doctor, whom she can no longer afford to see.

She hopes a three-week ear infection won't get worse and require her to see a specialist whom she cannot afford.

Two previous efforts by Gov. Rendell to expand coverage of the uninsured have died in the legislature. This year's effort is more modest in scope - at its best only denting the waiting list.

Republican leaders in the Senate say they want to review the House bill before making any final decision.

Sen. Edwin "Ted" Erickson (R., Delaware), chair of the Senate Health and Welfare Committee, said the $130 million in waiver money for adultBasic would mean cuts elsewhere in the state's Medicaid budget.

Torregrossa agreed the waiver must be "budget neutral." She said the state would withhold unspent federal funds earmarked for hospitals that treated a disproportionate share of the uninsured and funnel that money into the waiver for adultBasic.

The first two years of expansion of adultBasic would be funded from waiver money, Torregrossa said. In years three and four, waiver funds would be supplemented by 8 percent of the state's Mcare Abatement Fund. That money comes from a 25-cent cigarette tax intended to help doctors pay malpractice settlements. The fund has a $700 million surplus, Torregrossa said.

Given the degree of crisis, she said, "isn't that reasonable?"

Republican leaders and Scanlan don't think so. Once the Mcare funds have been exhausted, they say, the state will expect taxpayers to pay for the expanded adultBasic.

"We think using that Mcare money is shortsighted," Scanlan said.

"They're using one-time moneys that have accumulated in various accounts that will pay for the program in the beginning years but will not pay for the long-term impact," said Senate Majority Leader Dominic Pileggi (R., Delaware).

Since 2007, when his wife's employer folded, the Rev. George Petrella, 57, of North Philadelphia, has lacked health insurance. A diabetic, he applied for adultBasic - and went on the waiting list.

Since last fall, when his big toe was amputated, he has accumulated medical bills of more than $38,000.

One member of his church, Presbyterian Evangelistic Fellowship, is a doctor at Esperanza Health Center in North Philadelphia, which serves low-income, uninsured adults and children. He took Petrella as a patient, ensuring him access to primary care and discounted insulin - $80 a month - from the clinic's dispensary.

"I would say God is good and he's been caring for us," Petrella said. "But I don't necessarily know how this is going to end."

Scanlan said that her hospital group supported broadening programs for the uninsured, but that the House bill would reimburse doctors at a Medicaid rate, not a commercial rate. She said too many doctors already did not participate in Medicaid because the reimbursement was so low.

Torregrossa rebutted this, saying that adultBasic would pay "actuarially sound rates."

Under HB 1, benefits will also be expanded to include prescription drugs and mental-health care.

Scanlan favors adding more people but thinks the additional benefits would be too expensive.

But to Torregrossa, the drug coverage "only makes sense."

"We pay for them to go to a doctor, but they can't afford prescriptions that will make them better. It seems like a no-brainer," she said.

The Rendell administration sees this bill as a bridge, helping Pennsylvanians until national health-care reform efforts are passed and implemented.

Some Republican leaders say this is unwise.

"Common sense says to wait and see what the federal government finally lands on in their health-care policy before we enact a major expansion of one program and create a new entitlement program in Pennsylvania," Pileggi said. "I don't know that a state government facing a $3.2 billion budget-revenue shortfall should be trying to fill the gap ahead of the federal government."

Republicans in Pennsylvania are pushing their own solutions - in particular, an expansion of clinics.

Torregrossa said $15 million from the federal stimulus package had come into the state for expansion of clinics.

"Clinics will continue to be an important point of access for care until we get universal care," she said. "But we can't get federal match through clinics. We can only get federal match through coverage."

Erickson, the Senate Republican, said that despite his reservations, "it may be necessary to expand adultBasic."

Torregrossa said she feared the Senate might stall.

"There's no real deadline, and that's the problem," she said. "It could just languish for another year and a half, while the waiting list grows another 20,000 a month."