Home > Pa. sued after it allowed adultBasic health plan to end
Pa. sued after it allowed adultBasic health plan to end

Three people who were covered by a state-run health care plan for lower-income adults that stopped being funded two weeks ago began a lawsuit Monday to force Pennsylvania to re-establish the program.

The lawsuit filed in Commonwealth Court alleges that money set aside for the plan, called adultBasic, was unlawfully diverted to other purposes, and is directly responsible for the plan's end on Feb. 28. The suit, filed by Sheryl Sears of McKeesport, Ronald Guiney of Butler and Florence Spanos of Pittsburgh, also seeks a class-action order. More than 41,000 were covered under adultBasic.

It names Gov. Tom Corbett, his budget secretary, the Treasury Department, House Speaker Sam Smith and Senate President Pro Tempore Joe Scarnati.

The plaintiffs' lawyer, Bill Caroselli, told reporters in a conference call that the Legislature and the executive branch had no legal power to end the program.

"It is not discretionary, and the Legislature and executive branch must fund this program," Caroselli said.

The program was created by a 2001 law, which also calls for the state to annually set aside up to 30 percent of money it receives from its 1998 settlement with major cigarette manufacturers. The state is scheduled to receive another approximately $370 million in April.

Spokesmen for Smith and Scarnati, both Jefferson County Republicans, said they had not seen the lawsuit, and a spokeswoman for Corbett released a two-sentence statement in response.

"The lawsuit is without merit and will be successfully defended in court," the Corbett administration said. "The fiscal reality is that adultBasic is not a financially sustainable program."

AdultBasic coverage ended amid partisan finger pointing over who was to blame and the state government facing a projected multibillion-dollar deficit.

Sears, 63, makes money babysitting, but lives alone and is having trouble affording the new health care plan she's paying for. That plan, called Special Care, is a subsidized plan run by Highmark Blue Cross Blue Shield and costs Sears $162 per month, compared with the $36 per month average adultBasic premium. To fit it into her budget, she's putting off paying other bills.

"I don't know how long I'll be able to afford $162 a month," she said.

In the meantime, Corbett has said the state doesn't have the money to continue paying for adultBasic, and he instead proposed diverting money from the tobacco settlement into the state's main bank account, which pays for hundreds of programs.

The state's Blue Cross/Blue Shield insurers, who have paid for the lion's share of adultBasic in recent years, have decided against continuing to pay for it and the Legislature made no move to extend it.

AdultBasic began in 2002 as a basic health insurance program for low-income working adults who weren't poor enough to qualify for Medicaid and weren't old enough to qualify for Medicare. It didn't cover dental needs or prescription drugs, but it covered the cost of major surgeries and is considered better coverage than Special Care.

In 2005, the state's Blue Cross/Blue Shield insurers, which were under scrutiny from then-Gov. Ed Rendell's administration for the size of their surpluses, agreed to help finance adultBasic for six years, ending Dec. 31, 2010.

Corbett, a Republican, and top GOP lawmakers claim that Rendell bankrupted the program by keeping premiums too low, enrolling too many people in it and relying too heavily on the time-limited agreement with the Blues.

Rendell, a Democrat, has said that "there is no financial or moral reason" that the four Blues insurers' commitment to underwrite adultBasic should have expired. Their collective surpluses stood at well over $6 billion on Sept. 30, according to the state Insurance Department.

 

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