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Health Insurance Is Not Synonymous With Health Care

Feb. 18, 2009 

Health Insurance Is Not Synonymous With Health Care

Statement of Rachel Nardin, M.D., President, MassachusettsChapter of Physicians for a National Health Program

My name is Dr. Rachel Nardin, a neurologist at Beth Israel Deaconess Medical Center in Boston and assistant professor of neurology at Harvard.

In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform, we know a lot about what has worked and what hasn’t. Examining this data critically is vitally important as the Obama administration considers elements of Massachusetts’ plan as a model for national health care reform.

Today we are here to release a new study on the Massachusetts reform. This study details many problems with the reform effort. We are also releasing a letter from nearly 500 Massachusetts physicians to Sen. Edward Kennedy asking him not to push for a Massachusetts-style reform nationally. My colleagues and I see the effects of the Massachusetts reform on patients every day and know that this is not a healthy model for the nation.

The Massachusetts reform is an example of “incremental” reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009).

The reform has reduced the numbers of uninsured, although our report shows that the state’s claim of near-universal coverage is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones – two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in the state may well be even higher than 5 percent.

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7,000 before the insurance pays a single medical bill. It is not surprising that many of the state’s uninsured have declined such coverage.

The study we are releasing today also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state’s old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent   Boston Globe/Blue Cross Foundation survey, 13 percent of people with insurance in our state were unable to pay for some health services that they had received and 13 percent could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost.

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs 12 prescriptions a month to stay healthy. She told us, “Under Free Care I saw doctors at Mass General and Brigham and Women’s hospital. I had no co-payments for medications, appointments, lab tests or hospitalization …Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That’s $340 per month, provided I stay well.” Now that she’s “insured,” Kathryn’s medical expenses consume almost one-quarter of her take home pay and she wonders whether she’ll be able to continue taking her life-saving medications.