Daniel Rubin: For couple in need of health insurance, good news and bad

A year has passed since Pennsylvania informed about 40,000 working poor people it was dumping them from the health-insurance program called adultBasic.

Since then, fewer than four in 10 of those people have obtained coverage through another state plan or low-cost alternative, according to a September study by the nonpartisan Pennsylvania Budget and Policy Center.

Here's the story of two of the lucky ones, although Mike and Dolores LoBiondo of Drexel Hill don't expect anyone to switch places with them.

Mike is 47, a fourth-generation barber with a shop on State Road in Media that promises regular haircuts at $15 a head, less for kids and seniors. He's been at the job since graduating from trade school nearly 30 years ago.

Sitting under a portrait of his favorite president, John F. Kennedy, he quietly details the last 10 years of health troubles stemming from his diverticulitis, inflammation of pouches within the intestinal lining that catch food and can become infected.

His insurance coverage, which cost only $36 a month, ended in March. Within a month, he was hospitalized after the pain grew so intense he says he felt he was given a preview of dying.

He couldn't pay his Riddle Hospital bill but was told a charity was picking up most of the cost. His doctor said he needed surgery.

But Mike didn't pursue that because he didn't have money. He couldn't afford a second opinion. Dolores applied with the state for Medicaid, but they were denied because, she says, the paperwork had been filled out wrong.

Meanwhile, her medical issues remained unattended as well. She's 48, a stay-at-home mother who cares for two kids, ages 9 and 13, in addition to three grown children still at home.

Like her husband, Dolores takes Klonopin for anxiety. She also takes medication for high cholesterol and high blood pressure. With no coverage, she put off a recommended liver test to make sure the pills had no ill effects. She lives with a lump in her chest that she is supposed to have checked every six months.

If you're wondering where the luck starts, it begins with a physician at ChesPenn, a community-health center in Upper Darby.

"His exact words were, 'I have to get you guys insurance,' " Mike recalls. The doctor helped them over the summer to get onto Medical Assistance for Workers with Disabilities, a more generous Medicaid program for people of Mike's income level and medical condition.

That has allowed him to have three tests for his diverticulitis. A fourth will determine whether he needs surgery.

The problem is, workers at the state welfare office told him his coverage was only temporary. Like everyone, the LoBiondos must prove their eligibility every six months. They are aware that since August, the state has taken tens of thousands of people off the Medicaid rolls.

So the stress of losing coverage increases the anxiety that can overwhelm each of them.

"I'm in a very precarious situation," Mike says. "If this test comes back and they say I don't need surgery, it's good news in one way. But I probably would be immediately cut off."

The LoBiondos' hope is that the state reverses its decision to kill adultBasic. Mike and Dolores have joined in a lawsuit that contends elimination of the program violates state law. Their lawyer, David Senoff of Philadelphia, notes the paradox, how cutting the program just makes the LoBiondos cost the government more.

Gov. Tom Ridge started adultBasic in 2001, using billions of dollars the state gets in a settlement from tobacco companies it sued for creating health problems.

After the state started tapping some of that money, the Rendell administration turned to the four insurers known as the Blues, which had large surpluses, and negotiated for a $542.7 million contribution over six years.

That funding ran out at the end of December 2010, and the Corbett administration was unable to wheedle any more money from the Blues. So adultBasic ended.

At the state welfare office in Upper Darby, the LoBiondos have been told their savior is the federal government. "The woman there told us to apply for Social Security," Dolores says.

Not so easy. Mike made about $31,000 in 2010 - more than double the income limit for qualifying. He would have to reduce his earnings. That goes against everything he believes in.

The state cannot afford to insure him. But it has put him in a program that costs it more. And the option that it recommends would require him to choose between his health and his work.

"It's confusing," Mike said.

It's shameful.