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A Year of Struggle, Anxiety for Those Who Lost adultBasic
AdultBasic offered bare-bones, affordable coverage to lower-income working Pennsylvanians who either lacked access to job-based coverage or were denied outright over pre-existing health conditions. The need for it was enormous -- at the time the program was cut, nearly 500,000 Pennsylvanians were on the waiting list.
But despite adultBasic's success, and the modest amount needed to keep it going (roughly $160 million a year, funded mostly from contributions from Pennsylvania's four Blue Cross Blue Sheild insurers as part of their charitable mission required by law -- and partly from Pennsylvania's share of the Tobacco Settlement Fund), Governor Corbett chose to let the program expire, rather than challenge the big Blue insurance companies to do the right thing. We knew then that this decision would put the health, security and well-being of Pennsylvania families at risk -- and a year later, we can see that's been the case.
We're still working to track down official estimates, but the latest publicly released figures show that only 40% of those who lost adultBasic were known to have found other coverage (36% picked up Special Care, a private insurance product offered by the Blue Cross companies that costs 5 times more than adultBasic with extremely limited benefits, while 4% were able to qualify for Medicaid). The rest are likely still uninsured, going day to day putting off preventive care, skipping doctors visits and praying that nothing serious happens to them.
So what happens now? Is there any hope for these folks -- and for the 1.4 million Pennsylvanians who live with the fear and anxiety that comes with not having health insurance?
There is hope, in the promise of the Affordable Care Act, which will be fully implemented in our state by January 1, 2014. Under the new law, your coverage will be secure -- no matter where you work, how much your earn, or if you've gotten sick in the past.
Under the law, your coverage is no longer tied to your job. If you’re laid off, or want to take a risk with a good idea and start a small business, you no longer have to fear losing your coverage. How’s it work?
- Anyone who doesn’t have coverage through their employer can go into a new, competitive health insurance marketplace (each state gets to set one up, under the law) where you can choose from the same plans as your Member of Congress, and get a big tax credit, based on your family’s income, to make sure you can afford the plan you want. You’ll also be protected financially with caps limiting how much you’ll have pay each year on health care costs out-of-pocket.
- All plans offered in this new marketplace must meet certain standards for quality and value, and they must cover the “essential benefits” you need to keep yourself well -- which include: ambulatory care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, rehabilitative care, laboratory services, preventive and wellness services, chronic disease management, and pediatric services.
- Insurance companies must provide you with a straightforward, easy to understand description of what their plans cover and what you can expect to pay under their plans for common medical events like pregnancy or diabetic care.
- The marketplace can also set standards on how much participating insurance companies can raise rates -- and they’ll make sure that insurance companies are playing by the rules, treating you fairly and abiding by the new patient protections the law puts in place.
- The marketplace will also provide you with accurate, unbiased information on plans so you can make side-by-side comparisons and find the plan that works best for you, your family and/or your small business.
- Small businesses with up to 50 employees can also use this marketplace to increase their clout and bargaining power, something they don’t have in today’s marketplace. They’ll also benefit from new tax credits that help make coverage affordable.
If you work in a low-wage, low-benefit sector where you are “offered” a plan by your employer that’s too expensive and doesn’t cover what you need -- you don’t have to take your employer-based coverage. Instead, you can take the money your employer would have put toward your coverage and use it to sign up for a better, more affordable plan in the new marketplace.
And if you earn below 133% of the Federal Poverty Level ($15,302 for an individual in 2014), you’ll automatically be eligible for full coverage under Medicaid.
Insurance companies cannot cut your coverage when you get sick (“rescission”), deny you over your age, health status or gender, or set lifetime or annual limits on your coverage once the law is fully in place in 2014.
There is relief in sight -- but we need to stand strong, and show Governor Corbett and other health care opponents in Pennsylvania that we're serious about protecting these new benefits, choices and protections that we'll all have under the new law.
So on this somber anniversary, let's channel our anger and frustration into a renewed commitment to fight for the Affordable Care Act here in Pennsylvania.
Get involved, and help us make the promise of reform real to all those who lost adultBasic and all the folks who've been hurt by our broken system.