What Health Care Programs are there to Help the uninsured?

By Jack Etzel

The cost of health care appears to be a one-way street that’s always going uphill. As costs rise, an individual or family can suffer financial hardships nearly as devastating as the illness or injury itself. We sought the answers to our Perspective question this month in Harrisburg from Rosanne Placey, who has served as the communications director for the Pennsylvania Insurance Department for the past eight years. As such, she manages all of the department’s press and communications, as well as the agency’s website, which receives more than 1 million hits a month.

North Hills Monthly Magazine (NHMM): There are many reasons a person might be without health insurance. Let’s start with someone unemployed who used to receive insurance through an employer. What help is there?

Rosanne Placey: According to a recent insurance department survey, about 91 percent of those with private insurance secured it through their employers. When they lost their jobs, they lost their insurance. That leaves people who are used to having benefits with only limited options. People who have been laid off and had employer-based benefits should check first with their human resources coordinator who should be providing them with information on COBRA.

COBRA does have a long title (Consolidated Omnibus Budget Reconciliation Act) but basically it’s a federal law requiring employer-based, group health plans to offer workers and their families the chance to extend their health insurance for a period of time. The former employee would have to pay for the continuation coverage. However, at the current time, the federal stimulus plan provides a 65 percent premium reduction to laid-off workers.

NHMM: I’ve heard about a Mini-COBRA, too. What’s that?

Placey: Mini-COBRA is a state law that extends federal COBRA to smaller employers. So now all employers, small or large, are on the same page when it comes to offering former employees an option to continue their health benefits.

NHMM: Still, the COBRA premiums for the unemployed are another burden…

Placey: COBRA can be expensive, but I mentioned that people can take advantage of the premium reduction through the federal stimulus plan. Also, if a person declined COBRA in the past because it was too expensive, they should ask about it again. They may be eligible for another chance to enroll.

NHMM: Let’s get to kids and the CHIP program for children. How does that work?

Placey: CHIP stands for Pennsylvania’s Children’s Insurance Health Program. CHIP’s been serving our children with comprehensive insurance benefits and quality care for almost 18 years. Currently, we have 195,932 children enrolled. By the way, some 14,622 of those children are in Allegheny County. Many children are growing up healthy because of CHIP. If you have uninsured children in your family—up to age 19—they are likely eligible for CHIP. Most families will get CHIP for free, and at higher income levels, pay accordingly.

NHMM: What are the benefits and who or what provides the care?

Placey: Benefits include things such as immunizations, check-ups, prescriptions, dental care, hospitalization, vision coverage and much more. In western Pennsylvania, there are four insurance companies providing coverage. Families have a choice of Aetna, Highmark Blue Cross Blue Shield, Unison Kids and UPMC for Kids.

NHMM: What’s available for children too old for CHIP?

Placey: A recent change to Pennsylvania law can benefit the older children of insured parents. A senate bill was signed into law by Governor Rendell in June of this year that allows adults up to age 30, under certain conditions, to remain covered by their parents’ health insurance. Those eligible children are unmarried, have no dependents, are residents here or are enrolled as full-time students at institutions of higher education, and are not provided private insurance coverage nor eligible for government benefits.

This coverage expansion occurs at the discretion of the employer, so the parents want to check there first. Also, they will need to ask if there would be an increase in premiums related to covering dependents for these additional years. Because of the implementation date of the new law—which enables insurance companies to gear up for these changes—there is likely no policy that will include this benefit before January 2010. For young adults who are working but do not have health benefits, I strongly recommend that they look into purchasing some type of individual coverage. Young adults can generally find coverage options at a reasonable rate because they are young and healthy.

NHMM: Can you address the Pennsylvania program ‘adultBasic?’

Placey: The program ‘adultBasic’ provides money to pay for health insurance for uninsured Pennsylvanians between 19 and 65 whose household income and number of dependents falls within certain limits and who don’t have health care coverage. It provides preventative care, physician services, treatment of illness or injury, medical care and much more. At this time there is a waiting list, so if you qualify, it’s important to sign up now and get on that list.

NHMM: What’s the overall picture of who or how many are uninsured in Pennsylvania?

Placey: A 2008 statewide study shows that more than 1 million Pennsylvanians lack health insurance coverage. This is an increase from a 2004 study indicating fewer than 900,000 Pennsylvania residents were uninsured. Overall, the percentage of Pennsylvania residents who are uninsured rose from 7.5 percent in 2004 to 8.2 percent in 2008. Individuals in the 19 to 44 age bracket are the most likely to be uninsured.

NHMM: The stats between the uninsured and the insured must be significant . . .

Placey: They are. Nearly 18 percent of those who are uninsured have lacked coverage for more than five years, and 61 percent have not seen a doctor or health care provider at all for routine care during the last 12 months, compared to 24 percent of those with coverage.

NHMM: I’m getting the idea that there’s enough on this subject to fill a book. How do our readers find out more?

Placey: I encourage your readers to call our Pittsburgh Consumer Services Office where there are people available to address anyone’s questions and concerns.