Citing the desire to cover as many uninsured residents as possible and the effect of rising health care costs, the Pennsylvania Insurance Department has announced premium and cost increases for the adultBasic program.

The hardest hit by the increase will be the 3,500 uninsured residents purchasing adultBasic coverage while on the waiting list for enrollment. Those individuals will see their costs nearly double, from $330 a month to a monthly bill of $600.

The adultBasic program, which as of this month covers 40,685 state residents, provides coverage for uninsured individuals between the ages of 19 and 65 who meet eligibility requirements. The waiting list for the program now sits at 369,112 individuals, more than twice the number a year ago, the insurance department said.

Program participants will see their monthly rate rise from $35 to $36 March 1, as well as the doubling of co-pays for primary care physician office visits, specialist doctor office visits and emergency room visits, also effective March 1.

Items now provided at no charge, including diabetic supplies, outpatient surgery and home health care, will be subject to a 10% coinsurance fee, with a $1,000 maximum per year, starting March 1.

‘Daunting’ challenge for states

Joel Ario

“States are facing a daunting health care challenge, as evidenced by the problems our adultBasic insurance program is facing,” Pennsylvania Insurance Commissioner Joel Ario said in a statement. “The bottom line is that Pennsylvania cannot solve the health care crisis without federal health reform.”

If the PID did not adjust the adultBasic premium and benefit package, “a portion of individuals enrolled in the program would have lost coverage,” Ario said.

“People who come to adultBasic have been without coverage and so are generally in need of costly care,” he said. “With our limited funding, we either had to increase costs or drastically cut benefits, as opposed to the modest changes we chose to make for enrollees. The cuts we’re instituting are only sufficient to allow the available funds to cover costs for the current enrollees.”

Regarding those on the waiting list who will see their fees increase, the insurance department said it would like to offer subsidized coverage, “but lacks the needed funds.”

The department pointed out that although the benefit package is the same regardless of whether an individual is enrolled in the program or purchases the coverage while on the waiting list, the monthly premium is substantially different. Enrollees pay a subsidized premium and waiting-list purchasers pay the full cost.

Legislation has stalled

Last summer, the Pennsylvania House passed a measure to increase the eligibility for adultBasic to cover nearly 130,000 individuals, but the bill did not win approval in the state Senate.

Noting that such legislation has “failed repeatedly” in the state’s General Assembly Ario said in light of the state’s current budget crisis, “the only viable option is federal health reform.”

Ario’s department noted that under proposed reform legislation being considered by Congress, more than 85% of the Pennsylvania’s uninsured adults would be eligible for federally subsidized health insurance, through a combination of expanding the Medical Assistance program and providing targeted subsidies to the working poor.

In mid-2008, a survey of Pennsylvania residents found that more than 10% of adults are uninsured, including about 878,000 adults age 19 to 64. More than 40% of the uninsured people were eligible for adultBasic.