Pa. leading way on new health coverage

Pennsylvania has signed up more people than any other state for a state-run, federally funded program to help sick people pay for health insurance. This is one Philadelphia man’s story. Fairmount resident Matt Stetson is unemployed and was without health insurance for 17 months. In October he enrolled in PA Fair Care, the health insurance program designed to provide affordable coverage for people with pre-existing medical conditions.  He’s one of 1,600 Pennsylvanians signed up for the program, which is part of the federal health insurance overhaul. “Basically I’m a 51-year-old man,” Stetson said. “You have to see doctors, you never know if something’s going to happen. You get taken into an emergency room and a week is over and you have a $20,000 bill.”  PA Fair Care was set up as a bridge to 2014. That’s when insurance companies will no longer be allowed to reject customers because they already have medical problems. When Stetson first started hunting for insurance, he got several call backs. One insurance broker said she’d have no trouble finding him a plan, until she learned he had a heart defect. “Once I was turned down the first time. I never heard from her again even though I tried to get in contact with her,” Stetson said. Stetson’s heart malformation has not caused any health troubles. But he’s like many people with diabetes or asthma who say they can not find an insurer willing to take their business. PA Fair Care members pay $283 a month. That flat rate may make Pennsylvania’s plan more affordable than other state programs that price their premium on a sliding scale based on a person’s age and health condition. Melissa Fox is a press secretary with the state Insurance Department. “I think another reason that Pennsylvania is doing so well is that we have a very, very broad and comprehensive list of pre-existing conditions,” she said. Government-run insurance plans, such as Medicaid, have a reputation for paying low rates to doctors, so some people worried that PA Fair Care enrollees would have trouble finding providers willing to accept their new coverage. Melissa Fox says that shouldn’t be problem. “When you go to a doctor’s office or if you go to the hospital, they will not know you are in PA Fair Care, they will see that Highmark is your insurance company,” she said. The number signed up for the program so far accounts for 20 percent of those enrolled in this type of program nationwide since the health overhaul took effect.  PA Fair Care has slots for 5,600 people.