Pennsylvania

adultBasic Program – In June 2001, the Health Investment Insurance Act (Act 77 of 2001) was signed into law.  Act 77 was an initiative that invested the proceeds of the state’s tobacco settlement in the health of Pennsylvania consumers. The program created as a result of this legislation, adultBasic, is designed to provide health insurance for adults with incomes up to 200 percent of the FPL who do not have health care coverage.  It is administered by the Pennsylvania Insurance Department. adultBasic offers basic benefits including preventative care, physician services, diagnosis and treatment of illness or injury, in-patient hospitalization, outpatient hospital services, emergency accident, and medical care.

In early 2003, the tremendous response to the program quickly outstripped the allocated funding, and a waiting list was created.  In 2005, nearly 38,000 Pennsylvanians were enrolled in the adultBasic program with approximately 110,000 people on the waiting list.  To ensure that the program continues to offer adultBasic coverage to the maximum number of people, every month an assessment of the total adultBasic expenditures is performed in conjunction with the budget and a determination is made as to whether sufficient funding is available to add new enrollees.  Offers are made as funding is available and people are enrolled on a first-come, first-served basis.

In February 2005, Pennsylvania Governor Edward G. Rendell announced an agreement with Pennsylvania's four Blue Cross/Blue Shield plans for an ongoing annual commitment of funds for Annual Community Health Reinvestment (ACHR).  Overall, this represents a commitment of nearly $1 billion over the life of the agreement.  In its first year, more than $85 million of the nearly $150 million in committed ACHR was used to provide affordable basic health care coverage for thousands of low-income and uninsured Pennsylvanians.  The remainder was committed to other health care-related services in the community. 

The Blue Plans agreed that a certain percentage of their premiums, based on a formula, will go toward providing health care for low-income Pennsylvanians.  For the next six years, 60 percent of those funds will be dedicated to providing health insurance through state-approved programs for both low-income and uninsured persons through programs like adultBasic.

As of May 2008, adultBasic covered 54,893 people.

For more information on Pennsylvania’s adultBasic program, visit www.ins.state.pa.us (click on “adultBasic”) or read more about the Community Reinvestment Agreement.