Mass Health Course at: As Obama Aims to reduce costs and exp

Copyright: The Philadelphia Inquirer
Source: Philadelphia Inquirer, The
Wordcount: 1578


Mar. 31--BOSTON - Many here say the state of the experience of health care reform is a great success. The governor said last week that 97 percent of residents have health insurance - the highest percentage of the nation.

But now comes Round 2: control health care costs.

The State can hardly claim to buy personal insurance - a program - if they can not afford it.

"Once you take on this cost issue, it goes down and dirty," said Paul Hattis, a physician at Tufts University and a member of the Greater Boston Interfaith Organization, which has the initial reform. "The dollar has come out of the pocket of someone."

All this has implications for the nation. President Obama is trying to do both - to expand access to 46 million Americans without insurance and cost control.

Some here say it is doomed if it tries to do it this way.

"We have done right in Massachusetts. It is the most important lesson," said Stuart Altman, an expert in health policy at Brandeis University. "The first part was to cover all world, making it work .... Trying to control costs brings all the elements of the group against you. "

It is now hoped that the groups that came together to extend coverage to 436,000 residents will have an interest to preserve these achievements and backgrounds to control costs.

Exactly what has been created?

Bipartisan health legislation passed in April 2006.

The State has an obligation to everyone to have insurance. It was presented nobly as health care for all, and people embraced the concept. Even the Red Sox did television for the plan.

In accordance with the law, young adults up to age 26 were allowed to remain on their parents' plans. Companies with 11 or more employees who do not have insurance are required to pay $ 295 per worker in the State.

To help people obtain insurance, the state created the Commonwealth Health Insurance Connector Authority.

The authority plans offers grants to residents who earn too much to qualify for Medicaid but not enough to afford their own insurance - up to $ 32,200 for one person, and $ 63,000 for a family of four.

So far, 170,000 have signed up to this grant scheme, known as Commonwealth Care.


Many pay nothing, in essence get free care. Others, depending on their income, pay $ 39 to $ 140 per month.

Daniel Forlano, 33, an artist who works in front of Quincy Market, has never earned enough from his hat to pay insurance. He felt he was young and healthy and does not need. Why spend money on something he would never use?

But he sent in forms and qualifications for free care. "This is completely prepared," he said.

Hurmon Hamilton, senior pastor of Roxbury Presbyterian Church in Boston, said 17 members of his congregation - the work of people who previously could not afford insurance - has received coverage through the Commonwealth, including a woman who has not visited a doctor in 17 years.

When she went to her first examination, doctors found a tumor if it is not detected could have become life threatening.

Reforming health care to save her life, "said Hamilton.

Steve Crawshaw, 48, of Framingham, a suburb of Boston, has lost a job in November.

"The HR manager at my company that laid me told me about the connector," he says of the new agency. "This leads to a lot of browsing websites, telephone calls. Nobody knows the whole system within the government. It is heavy. It is awkward .... Getting to where I am now a took a lot of work. "

Crawshaw and his wife pay $ 39 per month each, with no dental coverage, and can not use their family doctor. He was grateful, but believes that Massachusetts has done so far is not a solution, just cost-shifting - the shifting of the burden of the employer to the taxpayer.

Kate Bicego is manager of the online help for health care for all, an advocacy group. She responded to the organization of the hotline before the redesign of health care and more.

"We are so blessed to have this option to know," she says. "In other states, these people fall through the cracks."

Some people still do.

Michelle McElroy, 34, who lives in Framingham, lost his job last month. It was $ 42,000. Her husband earns a little more like independent web designer.

On one income, the couple still earn too much for the care of Commonwealth grants. McElroy shopped online for private insurance, but did not count as one of the plans - or the fact that it is obliged by law to buy one.

It is expected to continue with insurance coverage from his former employer, as allowed under the federal COBRA law. Stimulus federal money pays 65 percent of the cost for the nine months.

Jon Kingsdale, executive director of the Authority of connection, said people whose incomes are too high for Commonwealth Care could buy private insurance available through his agency.

Insurers to submit bids for connection to meet minimum standards, including drug coverage. These are the Commonwealth Choice plans.

According to the web site connection, the cheapest plan for a couple of Framingham, 34, is $ 442 per month with a deductible of $ 4000 and $ 500 for each hospital Copayments night.

This year, the state will impose a fine of $ 1065 who can afford insurance but do not buy it. Since 2007, the state collected $ 16 million in fines.

McElroy, such that residents can apply for exemptions, if affordable insurance is not available, the state has established guidelines and 70,000 were exempt from the law last year.

Robert Blendon, a health policy and polling expert at Harvard University, has the public support for health reform, 75 percent.

But he agreed that "the plans do not leave everyone happy .... There is a problem for people on the margins of society. Therefore, the margin will be difficult to sell at the national level .... Many more people live in this range of national income. "

The grant program Commonwealth Care has been budgeted at $ 472 million in 2008, but eventually cost much more - $ 628 million - as enrollment grew faster than expected. The state has budgeted $ 869 million this year.

So far, the state has not had to raise taxes to pay for the grants program. But it also faces budget gaps of $ 4 billion of the economic crisis. As people lose their jobs, the number of the demand for care could increase the Commonwealth.

Pennsylvania argued that the Commonwealth model of care is not realistic because the Keystone State has more than one million uninsured residents and lacks the resources to subsidize insurance for them.

The Rendell administration's sweeping efforts to extend health insurance stalled last year in the state Senate. Governor Rendell in the current budget, it hopes to expand AdultBasic, a state funded insurance program-16000. Currently AdultBasic serves 44,000 people, with a waiting list of 205,000.

Tom Traylor, Vice President of Boston Medical Center, which deals with the poorest in Massachusetts than any other hospital, explains that persons under the Commonwealth Care has been a good idea, but that overall the reform of Health has weakened his hospital.

Partly because of the cost of health reform, Traylor said the state cut its Medicaid reimbursement rates for hospital and put at risk care.


He asks: What is to give people insurance cards if the place of care they receive is worse?

Some critics are in favor of a single payer, in which the government should pay doctors and hospitals, insurers and commercial play no role.

"One thing is clear - the [Massachusetts program] is not a solution," said Steffie WOOLHANDLER, a Harvard professor and co-founder of Physicians for a National Health Program. "We do not have universal access to care, and we spend much money to have a mixed result.

"In my own practice last week," she added, "I had two people come in One is literally crying. She received free care under the state's free care program, and pass the state insurancelike program, and she cried because she could not afford care. [She now co-pays and premiums.] Another patient came in and received new insurance, and he was happy. "

A problem almost everyone is in agreement with the lack of practice of family physicians - a result of insurance more than 436,000 patients.

Sarah and Nick Newlin, 38, moved to Boston last fall and said they must wait eight months for an appointment with a family doctor.

"We were lucky," said Sarah Newlin, walking with her husband and her baby in a stroller through the North End of Boston. "We have someone we see in a clinical within four months. "

"I think it's great," she said of the health care program. "But look at the national level, they will have to do something about the supply problem."

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Who are newly insured in Massachusetts?

About 150,000 people have bought insurance by employers, after already choosing not to buy.

A 76,000 registered for MassHealth, the state version of Medicaid, known in Pennsylvania

medical assistance.

Nearly 40,000 purchased through the individual insurance

plans on the open market. Half of these procurement plans that are regulated by a new state agency, the Commonwealth Health Insurance Connector Authority.

Nearly 170,000 people earn too much to qualify for Medicaid, but are considered too poor by the State

buy insurance themselves. They receive subsidized health insurance under the Commonwealth Care, managed by the Authority of connection.

- Michael Vitez

Contact staff writer Michael Vitez at 215-854-5639 or mvitez@phillynews.com.