Health Coverage a Struggle Even After Reforms

by Vanessa Jones on  March 31, 2014 at 2:36 PM Health Insurance News
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The residents of Massachusetts - USA- struggle with health insurance even after the health care reform law in 2006. Many more residents had health insurance covers in 2012 but were struggling to pay medical bills since 2006.
 Health Coverage a Struggle Even After Reforms
Health Coverage a Struggle Even After Reforms

Families are forced to use savings, working longer hours cutting back other expenses and at times even declaring bankruptcy to pay for prescriptions, surgeries and medical tests according to reports commissioned by the Blue Cross Blue Shield of Massachusetts Foundation and the Robert Wood Johnson Foundation.

"Even though people have coverage, they can't get care," Audrey Shelto, president of Blue Cross Blue Shield of Massachusetts Foundation, said. In 2012 a record of 94.6% non elderly people had insurance the highest rate in the country. Many residents can't afford the cost of co-payments and deductibles.

Brian Rosman of Health Care for All, a patient advocacy group, said "You could be stuck with really bad out-of-pocket bills every time you go see a doctor or fill a prescription," he said. "This trend is getting worse and affecting more people." People enrolled under employer sponsored insurance had high deductibles and these numbers were higher for people who worked in small firms. "The small business guys get stuck every time with higher rates," Wendy Northcross of the Cape Cod Chamber of Commerce said. "It's going to get worse."

William Zammer of Cape Cod Restaurants Inc. said his company dropped Blue Cross Blue Shield because of an 18 percent price increase in favor of a less expensive Harvard Pilgrim option that charges $22,000 a year for a family plan, half of which he pays. The escalating costs of health care are forcing Cape Cod Beer to make some hard decisions, Marcus said. She said the company started requiring employees to pay a deductible only this year and has always covered 100 percent of the premium cost.

Now, Marcus said, "We're going to have to push some of it back onto the employees." And patients are delaying care, Dr. Timothy Biliouris said. He said patients sometimes wait until they are age 65 and qualify for Medicare to get certain treatments. "Health insurance has become the single largest monthly expense for many families, often surpassing mortgage payments," he wrote in an email. "And the cost increases EVERY year. There are simply too many horses feeding at this trough. Overpriced medications, astronomical hospital fees, assembly line medical procedures, growth-based insurance strategies, and barriers to medical care are all important contributors. One entity must be created to control costs and waste. I call it the Harry Truman model of medicine."

Among the common types of care that led to high medical bills were tests, surgical procedures, emergency care and treatment for chronic ailments. A health cost containment act passed in 2012 allowed people to find out the price of procedures in advance and to compare what hospitals pay insurance companies. The new federal health coverage act expands the number of individuals who qualify for subsidized insurance under Massachusetts Health Connector programs by increasing income eligibility from 300 to 400 percent of the federal poverty level.

In addition, the federal health reform law allowed Massachusetts to expand the income eligibility guidelines for its long-standing MassHealth program, also known as Medicaid. Those who meet the income eligibility guidelines are happy with their coverage, Coxe said.

Massachusetts health reform advised people who were offered insurance by their employer to take it, regardless of whether their income level qualified them for subsidized care. The new federal law allows individuals who meet certain criteria to reject their employer's insurance in favor of subsidized care, Coxe said. The rising costs of insurance and availability of subsidized care are putting some employers in confounding situations.

Zammer said an employee asked him to decrease his salary by $500 so that he could qualify for a subsidized plan through the Massachusetts Health Connector. In a similar mode, another employee asked to have hours cut, Zammer said. Consultants have advised him to stop offering insurance and let employees who qualify get subsidized care, he said. "It's a very complicated situation for an employer."


Hannah Punitha (IRDA Licence Number: 2710062)

Cynthia McCormick, March 2014

Source: Medindia

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