Uncertainty for thousands, Corbett after judge's health ruling

Natalie Ross, who is prone to bronchitis, can tell you how her life is different without adultBasic: She put off seeing a doctor in January until her cough got so bad she was almost throwing up.

With medication, the cough is better but still there. Her new health insurance covers just four office visits a year.

"Should I go use another visit because it hasn't gone away? I don't want to waste my second doctor visit because I could potentially need it at the end of the year," said Ross, 33, a nanny in South Philadelphia who regularly picks up infections from her 4-year-old charge. "I got comfortable with adultBasic because I didn't have the fear about getting some basic care."

A judge's decision Tuesday has drawn renewed attention to the plight of Ross and 40,785 other Pennylvanians, most of them in low-income jobs, whose state-funded adultBasic health insurance ended two years ago when Gov. Corbett declined to pursue new funding for the program, saying it was unsustainable.

AdultBasic initially had been funded by the 1998 tobacco settlement. But thanks to legislation in 2010 and 2011, a small portion of those funds was applied to state costs other than health care - a move that a Commonwealth Court judge ruled Tuesday was unconstitutional.

The implications of Judge Dan Pellegrini's ruling have yet to become clear - for Ross and tens of thousands of others and, politically speaking, for Corbett.

His administration has declined to discuss the decision by Pellegrini, a Democrat, except to say it is weighing its options. Corbett's fellow Republicans in the state House are talking of filing an appeal. But the timing is likely to increase pressure on the governor to change his mind about expanding Medicaid.

The federal health-care overhaul envisioned a mandatory expansion providing health insurance for tens of millions of people, including several hundred thousand in Pennsylvania, paid mostly by the federal government. The U.S. Supreme Court last year gave states the right to opt out, and Corbett has said he would not accept the Medicaid expansion as currently designed, in part because of added costs the state would have to cover in future years.

But he left the door open to changing his mind.

Some Democrats in Harrisburg say they believe Tuesday's ruling, which said a portion of the tobacco settlement funds must be used for "health insurance investment" during the fiscal year that begins July 1, will force Corbett and Republican lawmakers who control the state House and Senate to address health insurance for the working poor during the budget process.

State Rep. Dan Frankel (D., Allegheny), who is chairman of his party's caucus in the House, said the ruling could allow Corbett to "save face" on his resistance to expanding Medicaid. "We're sitting on the precipice of full implementation of the Affordable Care Act, and this would provide resources to cover any gaps," Frankel said Wednesday.

Ross, who earns $12,000 to $15,000 a year as a part-time nanny, would likely qualify for expanded Medicaid, which would cover people making up to 138 percent of the federal poverty level, or $15,415 for a single person such as her.

It would be basically free - and far better coverage than the bare minimum she gets now through Blue Cross Special Care. The Corbett administration directed former adultBasic subscribers, who had been paying $36 a month for full coverage, excluding dental and prescriptions, to the more-limited Special Care, now $156 a month.

About 38 percent of adultBasic subscribers ended up in that plan, according to the state Insurance Department.

Linda G. Nahrgang is among them. She and her husband run Charmingly Linda's Quality Consignments in Frazer, Chester County, a store that will be celebrating its 14th anniversary Tuesday.

Both Nahrgang and her husband had adultBasic. When it ended, they decided that she, now 59, would apply for the Special Care insurance while he, now 46, would go without.

"As small-business owners, there is a laser-thin margin we are operating on," said Nahrgang.

She said her husband, Michael Weinstein, has not seen a doctor in two years but recently applied for the same insurance because he is worried about possible high cholesterol.

Meanwhile, she said, "we do a lot of research, try to look for natural remedies."

When adultBasic ended for Dolores and Michael LoBiondo, they didn't pursue an alternative. Riddle Memorial Hospital did, she said, when her husband had a flare-up of diverticulitis and it became clear that the hospital would end up with a charity case. She said some doctor bills remain unpaid.

Michael LoBiondo, 48, and Dolores LoBiondo, 50, who has severe nerve pain in her legs from sciatica, live in Drexel Hill, Delaware County, with three of their children and four grandchildren. Both were plaintiffs in the lawsuit against Corbett that led to Tuesday's ruling.

Both LoBiondos are now on medical assistance, a state insurance program that covers specific cases, such as people who are disabled, for a limited time.

Dolores LoBiondo said, "We live every day on the edge that we are going to get cut off."

Contact Don Sapatkin