Sept. 01--Hospital emergency departments may see a continued increase in the number of uninsured people they treat, now that a federal stimulus-funded benefit that helped underwrite health care coverage for the unemployed ended Wednesday.
Deficit-conscious members of Congress last year decided to let the subsidy expire, leaving unemployed people who had been getting COBRA coverage the option of paying for it in full, finding a short-term policy or going without health insurance. Enrollment in the program ended in May 2010, and subsidies expired Wednesday for most eligible individuals.
There is little doubt that many, if not most, of those people will go uninsured, said Antoinette Kraus, project manager of the Pennsylvania Health Access Network, a coalition of organizations working to expand health coverage for working people and the poor.
"When you get down to it, more people are going to go to emergency rooms," Kraus said.
Increased demand on hospitals from the uninsured comes at a difficult time, as uncompensated care in Pennsylvania hospitals has risen 48 percent in the past five years to $891 million, according to the Hospital and Healthsystem Association of Pennsylvania.
"I think it's safe to say that any time there is the potential for people to lose insurance coverage, there is the potential for an increase in the uninsured coming to our hospitals, particularly as the number of long-term unemployed -- the most likely to be affected by the expiration of this subsidy -- remains at persistently high levels," said HAP spokesman Roger Baumgarten.
Paul Hinkel, an unemployed carpenter from Gilbertsville, said he just dropped his COBRA coverage after the loss of the subsidy sent his premium from $238 a month to $682. "I basically said I refuse to pay," he said. "It was canceled."
Congress devoted a segment of funding from the American Recovery and Reinvestment Act -- the controversial stimulus program -- to subsidize the cost of insurance for workers thrown out of jobs after the economy crashed into the Great Recession beginning in September 2008. Under the plan, qualified unemployed people could apply stimulus funds to cover 65 percent of the cost of purchasing COBRA insurance.
Under COBRA, recently laid-off workers from larger companies can purchase their former employer's insurance package for up to 18 months. Congress reauthorized the subsidy program three times.
Without the subsidy, COBRA coverage was beyond the reach of many of the unemployed, costing an average of $1,115 for family coverage, according to a 2009 Families USA report. The stimulus subsidy cut that average monthly premium to $390, the organization said. Even at that cost, many unemployed people likely could not afford COBRA coverage, according to the Employee Benefit Research Institute, an independent research agency.
With the last of the subsidies ending Wednesday, unemployed workers find themselves back where they were before the stimulus began, Kraus said. "It was a temporary benefit," she said. However, with unemployment stubbornly stuck around 8 percent, "this is still a need."
U.S. Sen. Robert Casey, D-Pa., in June 2010 pushed a measure to extend the benefits, but it failed to gain traction. The subsidies expired as lawmaker priorities shifted to deficit reduction, officials at the Ethics and Public Policy Center, a Washington, D.C., advocacy group that describes itself as "dedicated to applying the Judeo-Christian moral tradition to critical issues of public policy," told Kaiser Health News.
Kraus noted that insurance options are dwindling for the unemployed. The adultBasic insurance program ended earlier this year and Pennsylvania Fair Care, the program for the uninsured with pre-existing conditions, remains open only to those who have been without insurance for at least six months.
"Our concern is there really is no option available to them," she said.
Resourceful unemployed people may be able to find short-term insurance, said Ellen Laden, a representative of United Healthcare's Golden Rule Insurance Co. In Pennsylvania, short-term coverage of one to 11 months is available at various prices and deductibles. According to Laden, a family with parents in their 30s and two children under the age of 10 might pay $120-$556 in monthly premiums for a six-month plan.
Pennsylvania Fair Care offers higher premiums for those with pre-existing conditions at http://www.pafaircare.com. Those who qualify might purchase an individual plan for themselves and apply for a less expensive, short-term plan for other family members, Laden said.
Hinkel, the unemployed carpenter, said he purchased a rock-bottom plan that costs $236 a month, but has a high deductible and covers very little. The loss of the subsidized insurance he said, was a financial disaster. "It screwed me big," he said.
The Affordable Care Act in 2014 will expand coverage to uninsured people, Kraus said, but the expiration of the subsidies means the unemployed will have few choices until that time.
tim.darragh@mcall.com
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