Tens of thousands of Pennsylvanians woke up without health coverage Tuesday morning, as the state's subsidized insurance program for working people ran out of money and moves to save it failed to gain traction.
"The fiscal reality is there is no money in the budget," said Kevin Harley, a spokesman for Gov. Corbett, who is confronting a $4 billion deficit.
The loss of the program - three years before the federal health overhaul that would cover most of its subscribers is due to kick in - meant a stark choice for the husband-and-wife owners of Charmingly Linda's Quality Consignments in Frazer.
"We can't afford for both of us to be insured," Linda G. Nahrgang said Monday night. She's 57 and he's 44, she said, so she will get the most bare-bones insurance possible. He will go without.
AdultBasic, as the state program is known, ended with about 40,764 subscribers - and a waiting list that has mushroomed during the economic downturn and totaled 505,624 in February. While coverage was basic, the premiums were an unusually low $36 a month.
The most likely alternatives for most subscribers, and the one suggested by the Corbett administration, are the unrelated low-income Special Care policies that are offered by the state's four Blue Cross Blue Shield plans. Insurance for a single adult costs about $148 a month, and is more basic than adultBasic - with a limit of four doctor visits a year, for example. (Neither policy covered prescriptions.)
But former subscribers to adultBasic, which was operated by the Blues under contract with the state, are being accepted with preexisting conditions into Special Care through May 2 - an extension that Corbett requested of the Blues. Many would have difficulty finding insurance of any kind on the private market.
More than 14,000 Special Care applications have been requested and about 3,900 returned for processing so far, said Rosanne Placey, a state Insurance Department spokeswoman.
Some people have suggested that up to half of adultBasic subscribers might be able to get coverage under Medicaid, the state-federal program for the poor and disabled, but Placey said that subscribers had been automatically evaluated upon annual renewals and any who were eligible for Medicaid were transferred.
AdultBasic was begun a decade ago by Govs. Tom Ridge and Mark S. Schweiker using money from the state's tobacco settlement, and expanded by Gov. Rendell under a deal he negotiated with the Blues for additional funding. It generally has enjoyed bipartisan support but is ending with a nasty dispute between Corbett and Rendell over who is responsible for the money running short before the end of the fiscal year on June 30.
A Democratic bill to use money from a legislative surplus has attracted interest from Corbett but not from Republicans in the legislature. Another bill, to borrow money from a medical-malpractice insurance fund, has been introduced by Democrats.
The Democratic Senate leadership met last week with representatives of both the nonprofit Blues and for-profit insurers to propose that the program be continued through June 30 with $25 million from the insurers, another $25 million from the state, and $4 million to be raised by increasing premiums from $36 to $68.
They were turned down, said Lisa Scullin, a spokeswoman for the Senate Democrats. Elizabeth Williams, a spokeswoman for Independence Blue Cross, said that she did not know details but that "there is no agreement about further funding for adultBasic."
State Rep. Paul I. Clymer (R., Bucks), meanwhile, has been circulating two potential bills that he said had at least some bipartisan support. One would raise the tax on casino table games from 14 percent to 25 percent, with most of that going to adultBasic instead of the general fund as it does now. A second would raise the premiums for adultBasic subscribers from $36 to $100.
Clymer said that several other states collect gambling taxes over 20 percent, and Pennsylvania taxes slots at 34 percent.
But Harley, Corbett's spokesman, said the administration's support was unlikely because "the governor is generally opposed to any new tax increases."
Nahrgang, who lives in Phoenixville, said she has always wanted to buy private insurance - and had it in the early days of her consignment shop a decade ago - but could not afford it when the economy turned down.
Although her husband was on adultBasic, he has never actually needed it, she said. And she has used it only for routine screenings and tests.
After getting a letter from the state a month ago that the program was ending, however, she went to her doctor "for every possible test."
"All my life I've never had a problem. And this time the doctor found something. A nodule on my thyroid. Which is not uncommon, but it is something that we have to watch," she said. So she now has a preexisting condition.
Natalie Ross, 31, a nanny from Philadelphia, is in a similar position. She has suffered from migraines for years - they are now under control with drugs she gets free from pharmaceutical companies with her doctor's help - and recently began experiencing a rapid heartbeat.
She saw her doctor last week, and needs to see a cardiologist to get evaluated but had no time for an appointment before the program's end. "So I'm going to have to grin and bear it and hope that it is nothing," said Ross, who will probably end up with Special Care.
Ross was one of about 50 people who protested outside the governor's mansion at dusk Monday. Neither the governor nor any legislators showed up.
"People were pretty somber," said Antoinette Kraus, an advocate with the Pennsylvania Health Access Network, an umbrella for numerous organizations, who was one of the organizers.
The event was planned as a candlelight vigil.
"We tried to light candles, but it was cold and rainy so we just held them," she said.