States Cutting Back Special Programs For Uninsured
Feb 02, 2010
Sherie Brace fears the coming of summer when a special insurance program for
low-income adults in Washington state is set to end. (Robert
Sumner/KHN)
Sherie Brace fears the coming of summer. Thatfs when a special health
insurance program for low-income adults in Washington state is set to close,
ending coverage for her and about 65,000 others.
gIfm terrified theyfll cut it out. Then I would not be able to go to the
doctor if I have an asthma attack,h says Brace, 52, who has had asthma for
years. She earns about $12,000 a year working for a Seattle-area home health
care agency that gives workers $50 a month toward health costs.
The recession is forcing states such as Washington to pare back health
insurance programs for low-income people, even as growing joblessness boosts
demand for help. Five of six states that use state funds to assist adults not
covered by Medicaid are considering cuts, barring new enrollment or raising
fees.
The more than 250,000 people in the state programs are adults who donft
qualify for the joint federal-state Medicaid program, either because they donft
have children or earn more than the tight limits states impose on Medicaid
eligibility. They represent a tiny fraction of people who get government health
insurance, yet the state programs are often their sole option for coverage.
gTheyfre not offered insurance through their jobs,h says Rebecca Kavoussi, of
the Community Health Network of Washington state, which runs clinics and an
insurance plan.
The Senate passed a health bill that includes some funding for the state
programs. That bill and one passed by the House also expand Medicaid and offer
federal subsidies to help low- and middle-income Americans buy insurance. Yet
the fate of the bills is uncertain as Democrats regroup after the loss of a key
Senate seat to Republican Scott Brown of Massachusetts.
Even if Congress approves a bill, much of the relief for states and the
uninsured is still years away — 2013 at the earliest.
Waiting Lists Grow
Meanwhile, state plans remain vulnerable as economies sour.
Most of these plans require participants to pay part of their monthly
premiums and medical care. Benefits may be more restrictive than those in
Medicaid. A Tennessee program, for example, limits members to two covered
emergency department visits a year.
Among the struggling plans:
Washington: Basic Health — the first state-subsidized
program of its kind when it began more than two decades ago — will fold by July
unless lawmakers find $160 million in new revenue. About 300 people a day are
added to its waiting list.
Tennessee: CoverTN , which subsidizes insurance for
workers at certain small businesses and for adults earning less than $55,000 a
year, halted new enrollment in December.
Connecticut: Charter Oak , which offers residents
insurance for $93 to $296 a month on an income-based sliding scale, must freeze
enrollment this year, Republican Gov. Jodi Rell says, unless lawmakers find more
money.
Pennsylvania: The statefs adultBasic will double fees for doctor visits
in March to $10-$20 and add a $1,000 maximum annual charge for hospital care.
The wait list more than doubled in 2009, from 165,318 to 353,301.
Minnesota: The General Assistance Medical Care program,
which covers adults earning less than $8,000 a year, will end in March unless
lawmakers find an alternative.
Not all such programs are in trouble: Maine plans to reopen enrollment in its
program this year to the 2,000 people on its waiting list. The D.C. Health
Alliance is not facing cuts, nor is there a waiting list.
Future In Doubt
Sen. Maria Cantwell, D-Wash., added a provision to the Senate health bill to
allow her state to seek federal funds for Basic Health until 2014. Her
spokesman, John Diamond, says the provision would apply to other states with
basic health plans.
Another Cantwell amendment would let states establish basic health plans
after 2014. Such programs would be open to people who earn too much for Medicaid
but less than twice the federal poverty level, about $21,660 for an individual.
Some policy experts say such state programs wouldnft be needed if a health
care overhaul passes because most adults who now qualify would fit the new
Medicaid enrollment guidelines or be eligible for federal subsidies.
gThere will be no reason for states to pay for this themselves,h says John
Holahan of the Urban Institute, a nonpartisan think tank in Washington.
Whatever the outcome of the debate in the nationfs capital, Brace hopes
lawmakers can find the money to save Basic Health.
gI take medication every day that helps me get up and go to work and do a
good job,h says Brace. gIf I donft have those medications, I would end up
probably in a wheelchair, having someone be a caregiver to me.h