Diverting funds from adultBasic ruled unconstitutional. Now what?
A Pennsylvania judge has declared two laws diverting money away from the adultBasic program unconstitutional.
It is unclear what that means for the 41,000 former enrollees who were covered by the insurance program for the working poor.
The program was funded by tobacco settlement money until March of 2011, when the last of the money was directed into the state's general fund. More than 100 former enrollees sued the state to try to get the program reinstated.
Six months after the program disbanded, about 40 percent of former enrollees had gotten coverage through Special Care, a new low-income, limited coverage insurance plan, or through Medicaid.
"I had to borrow from family, friends, wherever I could get money on loan to keep health insurance because I had pre-existing conditions," said Sheryl Sears of McKeesport, Pa., the lead plaintiff in the lawsuit.
The other 60 percent either had to pay for private insurance or go without.
Michele Galasso of Consohocken was one of those who went – and is going -- without.
"It's either a roof over our head or have health care," Galasso said of her and her husband.
A cancer survivor, Galasso has skipped doctor appointments, blood tests, bone scans, and a colonoscopy because she can't afford them.
"It makes me nervous," Galasso said. "I feel like I could be walking around having cancer and I don't know it."
Uncertain future for adultBasic
According to the suit, the money once earmarked for adultBasic now flows to Medicaid. The judge in the case, Commonwealth Court President Judge Dan Pellegrini, said, legally, the two programs must share the money.
One state lawmaker has already vowed appeal, and it remains unclear whether the court has the power to resurrect the adultBasic program.
"We're still trying to sort it out, and how the state responds is yet to been seen," said Sharon Ward of the Pennsylvania Budget and Policy Center.
The court finding has put more pressure on Gov. Tom Corbett to expand the Medicaid program under the Affordable Care Act, said Community Legal Services lawyer Jonathan Stein.
"The population affected by adultBasic, who are lower-income, working people, would generally be totally covered by a Medicaid expansion," Stein said.
The federal government would pick up the tab for that coverage for three years, eventually ramping down to a permanent 90 percent contribution.
Corbett has said he is unwilling to expand Medicaid unless reforms are made, but conversations with the federal government appear to be ongoing.
The judge in the adultBasic suit against the state found the laws diverting roughly $100 million a year away from program conflicted with the uses defined by the state's Tobacco Settlement Agreement.
A Corbett spokesman said the legal and budgetary impact of the ruling are under review.
The adultBasic program was also funded by contributions from Blue Cross insurers, which are not addressed in this court case.