Posts Tagged ‘Massachusetts’

Medical Bills Major Cause of Bankruptcies

Wednesday, February 29th, 2012

Most Americans are just one illness away from bankruptcy – even those with healthcare insurance.  Unfortunately, there are millions of other Americans who don’t have the cash to cover their medical bills.  Hospitals expect quick payment and offer insured patients little flexibility if they have difficulty paying bills.  Those unpaid bills are sent to collection agencies, and damage the individual’s credit history for years.  The crisis in American healthcare is not restricted to emergency rooms where uninsured people wait – often for long periods of time — for care.

In fact, a study has estimated that as many as 62.1 percent of all bankruptcies are due – at least in part – to medical expenses that the person simply cannot afford to pay.  And, according to the study’s authors, that might well be a conservative estimate.

“Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country,” said Steffie Woolhandler, M.D., of the Harvard Medical School.  “If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that’s the major finding in our study.”

Yet, 75 percent of the people with a medically-related bankruptcy had health insurance.  “That was actually the predominant problem in patients in our study — 78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” Woolhandler said.  “Other people had private insurance but got so sick that they lost their job and lost their insurance.”

Even patients who have coverage “may not be protected from high out-of-pocket costs when they are diagnosed with cancer,” according to a report by the Kaiser Family Foundation and the American Cancer Society.  In addition to high insurance premiums, those costs may force patients to amass debt as they attempt to pay for the care they need — or postpone or skip lifesaving treatment.  “Having insurance increases people’s ability to access care,” said Mark Rukavina, an expert on medical debt and the executive director of The Access Project, a Boston-based healthcare advocacy group.  “The good news is that they get the care, but the bad news is it’s unaffordable.”

The days of Cadillac health plans are pretty much over,” said Peter Cunningham of the Center for Studying Health System Change in Washington, which found that 20 percent of American families have problems paying medical bills.  More than 44 million Americans currently are paying off medical debt, the Commonwealth Fund said, an increase over the 37 million in 2005.  Two years ago, Congress reported that 30 million Americans of working age had been contacted by a collection agency for unpaid medical bills.  One survey asks how people have been affected by their unpaid medical bills.  “Two-thirds of people say … they’ve had problems paying for some of the basic necessities — food, rent, mortgage, clothes, basic stuff,” Cunningham said. “They’ve put off major purchases.  They’ve taken money out of savings or borrowed money.  An increasing number consider filing for bankruptcy.”

Although it’s not yet known how the Patient Protection and Affordable Care Act (ACA) will impact medical bankruptcies, a study from Massachusetts since its healthcare reform became effective in 2006 offers scant good news. The study, which was published in the American Journal of Medicine, determined that between early 2007 and mid-2009, the share of all Massachusetts bankruptcies with medical grounds fell from 59.3 percent to 52.9 percent, a 6.4 percent decrease.  Because there was a sudden rise in total bankruptcies during that period, medical bankruptcy filings in the state rose from 7,504 in 2007 to 10,093 in 2009.

According to the study’s authors, “Even before the changes in healthcare laws, most medical bankruptcies in Massachusetts – as in other states – afflicted middle-class families with health insurance.  High premium costs and gaps in coverage – co-payments, deductibles and uncovered services – often left insured families liable for substantial out-of-pocket costs.”

“Despite a marked decline in the un-insurance rate in Massachusetts since the implementation of health reform, the proportion of bankruptcies that occurred in the wake of medical problems has not decreased significantly, and the absolute number of medical bankruptcies has actually increased by one third,” said David U. Himmelstein, M.D., from City University of New York School of Public Health, and the study’s lead author.

Survey: Massachusetts Residents Like Their Healthcare Coverage

Tuesday, February 28th, 2012

Despite GOP presidential hopeful Mitt Romney’s wish to distance himself from the law he passed, an overwhelming majority of Massachusetts residents support their state’s landmark universal health insurance program. Even though backing for its central feature — the mandate that most residents have coverage – is not quite as popular, nearly 75 percent of respondents to the Harvard School of Public Health and the Boston Globe poll said they supported the law.  When asked if they wanted changes, more than 50 percent said they did.  Another 24 percent support continuing the law as it is.

Support for the law has risen from the last time Bay Staters were asked their opinion by the Harvard researchers in 2009.  At that time, overall support was 53 percent.  Since then, it has risen to 63 percent.  That will likely come as a surprise to those who have called the state’s law, which served as a model for the federal Patient Protection and Affordable Care Act (ACA), an abject failure.

“The picture of how the Massachusetts healthcare law is working out is different than many national commentators suggest,” said Harvard’s Robert Blendon.  “Most people in Massachusetts approve of this law, and it hasn’t negatively affected them.  A large share of the audience (outside of Massachusetts) believes that something is terribly wrong because they’ve heard stories about how expensive it is…and people who live in the state just have a very different view of what’s going on here,” he said.

“Even with all the attention the Massachusetts law has gotten nationally, it really hasn’t driven down support among voters here in Massachusetts,” said Steve Koczela, president of the MassINC Polling Group, which conducted the poll.  “Taking that in concert with the level of influence people thought the state law had on the national law, at least it suggests there’s some difficulty distancing yourself from what happened nationally to what happened here at home,” Koczela said.

The myth is that the Massachusetts law failed to significantly reduce the ranks of the uninsured in the state. The fact is that the Massachusetts law dramatically increased the state’s insurance rate over a period when the national health coverage rate declined.  At the end of 2010, 98.1 percent of the state’s residents were insured compared to 87.5 percent in 2006 when the law went into effect.  Almost all children in the state were insured in 2010 (99.8 percent).  By comparison, at the national level the health insurance rate dropped from 85.2 percent in 2006 to 84.6 percent in 2010.

Approximately 77 percent of private companies are providing health insurance to their employees, compared to 70 percent before the law, according to Governor Deval Patrick’s office.  The law requires all employers with more than 11 full-time employees to make a “fair and reasonable” contribution toward their workers’ health plans or face penalties.  The mandate that requires all state residents to carry health insurance has also proved to be effective, with nearly 97 percent of taxpayers in compliance.

The problematic part of the law is its failure to curb rising costs.  Although implementation of the law itself didn’t damage the state’s budget – according to an analysis by the independent Massachusetts Taxpayer Foundation, the increase in net spending for the law was just one percent in 2010 – it hasn’t reduced overall costs for policyholders.  Private spending per member grew an average of 15.5 percent between 2006 and 2008.  Meanwhile, average premiums for full insurance increased 12.2 percent from 2006 to 2008, according to the Massachusetts Division of Health Care Finance and Policy.

Still, two-thirds of adults in the state support the law, while 88 percent of doctors say it improved, or did not affect, the quality of care.

30 Percent of Companies May Drop Employee Health Insurance

Monday, June 13th, 2011

As many as 30 percent of American companies plan to drop employee insurance when the Patient Protection and Affordable Care Act becomes fully effective,  according to a report in the McKinsey Quarterly.

According to the report, “Many of the law’s relevant provisions take effect in 2014.  Our research suggests that when employers become more aware of the new economic and social incentives embedded in the law and of the option to restructure benefits beyond dropping or keeping them, many will make dramatic changes.  The Congressional Budget Office (CBO) has estimated that only about seven percent of employees currently covered by employer-sponsored insurance (ESI) will have to switch to subsidized-exchange policies in 2014.  However, our early-2011 survey of more than 1,300 employers across industries, geographies, and employer sizes, as well as other proprietary research, found that reform will provoke a much greater response.”

If this prediction is true, the number of Americans who could see changes to their health insurance would be far more than the nine to 10 million estimated by the CBO.  That means that the cost of subsidizing plans for those people — approximately $19 billion a year, according to the CBO — could grow by more than 30 percent.  If the report’s predictions are correct, many Americans will lose their health insurance.  The study contradicts at least three others predicting that reform will have a negligible effect on employer-sponsored insurance.  A Rand study determined that the number of employees who would lose insurance is “small,” and the Urban Institute believes that the percentage “would not differ significantly.”  “History has shown that reform motivates more businesses to offer insurance,” said an administration healthcare expert. “Health reform in Massachusetts uses a similar structure, with an exchange, a personal responsibility requirement, and an employer responsibility requirement.  And the number of individuals with employer-sponsored insurance in Massachusetts has increased.”

At least 30 percent of employers would gain economically from dropping coverage, even if they completely compensated employees for the change through other benefit offerings or higher salaries,” the report said.  “Contrary to what employers assume, more than 85 percent of employees would remain at their jobs even if their employers stopped offering (employer-sponsored insurance), although about 60 percent would expect increased compensation.”

According to the McKinsey study,  found that those who are informed about the health-reform measure are more likely to consider an alternative to employer-sponsored plans, with 50 percent to 60 percent in this group expected to make a change.  It also determined that for some, it makes more sense to switch.

“Employers must quickly examine the implications of health care reform on their benefit and workforce strategies, as well as the opportunities and risks that reform generates,” the McKinsey study notes.  “Of course, the type and extent of the changes employers make will vary by industry, collective-bargaining agreements, and other constraints.  Most employers, however, will find value-creating options between the extremes of completely dropping employee health coverage and making no changes to the current offering.  Even employers that intend to provide benefits similar to those they currently offer can take no-regrets moves, like tailoring plans to maximize what their employees will value most about ESI (employer-sponsored insurance) after 2014.  Employers pursuing more radical changes will have to rethink benefit packages for higher-income employees.

“And all employers must continue to keep in mind their employees’ health and wellness needs, even as insurance coverage levels evolve.  To serve employers, insurers must retool their business models to provide more consultative support during the transition and develop innovative approaches to support employers’ new benefit strategies.  For employers and insurers, success after 2014 will require a better understanding of employee and employer segments, and the development of the right capabilities and partnerships to manage the transition.”

According to the report, “Healthcare reform fundamentally alters the social contract inherent in employer-sponsored medical benefits and how employees value health insurance as a form of compensation.  The new law guarantees the right to health insurance regardless of an individual’s medical status.  In doing so, it minimizes the moral obligation employers may feel to cover the sickest employees, who would otherwise be denied coverage in today’s individual health insurance market.  On the other hand, reform preserves the corporate tax advantages associated with offering health benefits — except for high-premium ‘Cadillac’ insurance plans.”

The Doctor Is In – But Patients Must Wait and Wait

Monday, June 6th, 2011

A shortage of primary-care physicians in Massachusetts means that some patients must wait up to 48 days for an appointment. A poll of 838 Massachusetts physicians called the “Patient Access To Health Care Study found that Bay State residents often have to wait weeks — in some cases as long as a month and a half — for non-urgent appointments with primary care physicians and certain specialists.  The Massachusetts Medical Society (MMS) called doctors’ offices in February and March and asked when they could come in for routine care.  They asked for a new patient appointment with internists, family practitioners, and pediatricians; an appointment for heartburn with gastroenterologists; a heart check-up with cardiologists; an appointment for knee pain with orthopedic surgeons; and a routine exam with obstetrician/gynecologists.  The typical waiting period ranged from 24 days for an appointment with a pediatrician to 48 days to see an internist.  The wait for an internist was less than the 53 days in a 2010 survey, but the waits for family doctors, gastroenterologists, orthopedists, and ob/gyns rose.

Additionally, 50 percent of Massachusetts’ primary-care physicians are not accepting new patients.  The report has serious repercussions on the cost of healthcare in the state.  Patients with no access to a primary-care physician are more likely to visit the far more costly emergency room when they are sick.  “Massachusetts has made great strides in securing insurance coverage for its citizens,” said Dr. Alice Coombs, MMS president, in reference to the state’s ground-breaking 2006 universal health insurance law.  “But insurance coverage doesn’t equal access to care.”  Dr. Lynda Young, a Worcester, MA-based physician, counters, noting that “There’s only so many patients you can see in a day.”  The situation is especially dire in rural areas.  Dr. Joseph Viadero, whose Turner Falls, MA-based four-physician, three nurse-practitioner practice includes 12,000 patients, says “We’re overwhelmed and just have difficulty taking care of our own patients.”  As a result, more people don’t get the preventative care they need.

Dr. Richard Dupee, a geriatrician, says he sees poor, sick and elderly people traveling from Boston to the suburbs, just to see a doctor.  Because relatively few Boston-area doctors are willing to see new patients who pay with government-subsidized insurance, “people are always taking the T from Boston, to get to my office.”  Although Massachusetts’ healthcare law was written to get moderately ill people out of costly hospital emergency rooms and into less expensive doctors’ offices, the report finds that difficulty accessing care is sending some people back to the emergency room.  “These people are insured, but they end up in the ER anyway, because they can’t find a doctor to treat them,” Dupee said.

The study also examined the types of insurance accepted by each specialty.  Medicare acceptance ranged from 98 percent in orthopedic surgery to 85 percent for internal medicine.  While 92 percent of cardiology practices accepted MassHealth and Medicaid, that fell to 62 percent for family medicine and 53 percent for internal medicine.  Two additional insurance types were included: Commonwealth Care, which serves low- and moderate-income adults lacking coverage and ineligible for Medicaid, and Commonwealth Choice, which is offered through an unsubsidized exchange run by the Commonwealth Connector.  Acceptance ranged from 82 percent for ob/gyn to 43 percent for internal medicine with Commonwealth Care, and from 76 percent for cardiology to 35 percent for internal medicine with Commonwealth Choice.

The Association of American Medical Colleges estimates that the nation will be short of 91,500 physicians over the next 10 years.  “Physicians are very heavily loaded with patients that have been in their practice for a long time,” said Dr. Robin Richman, executive vice president of medical affairs and chief medical officer at Fallon Clinic.  “Over time, as we all age, we develop a complexity of care issues, and those take more time and management skills for physicians.”

“We still have much work to do to reduce wait times and widen access,” Coombs said.  “This has important implications for health care cost control, as difficulty or delay with routine access to care leads people to seek other options, such as the emergency room, which is much more costly.”

Healthcare Reform May Not End Medical Bankruptcies

Monday, March 21st, 2011

Is healthcare reform a cure-all for the issue of medical bankruptcy?  Depends.  Bankruptcies occur when a person has a serious illness and cannot keep up with paying the bills.  Since RomneyCare became law n Massachusetts, the number of medical-related bankruptcies fell from 59.3 percent to 52.9 percent between 2007 and 2009, according to a recent study.

“Health costs in the state have risen sharply since reform was enacted.  Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance.  High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs.  None of that changed.  For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” according to the researchers.  According to the authors, an insured couple earning more than $44,000 a year – a level that is higher than the eligibility requirement for subsidies – might pay as much as $20,512 a year for medical services.  “Massachusetts’ health reform, like the national law modeled after it, takes many of the uninsured and makes them underinsured, typically giving them a skimpy, defective private policy that’s like an umbrella that melts in the rain: the protection’s not there when you need it,” lead author Dr. David Himmelstein said in a Physicians for National Health Reform news release.  The organization’s goal is a national single-payer healthcare system.

The study’s results, which were published in the American Journal of Medicine, suggest “that reducing medical bankruptcy rates in the United States will require substantially improved – not just expanded – insurance.”,0,7832154.story To determine if RomneyCare had cut the number of bankruptcies, the research team examined a random sample of Massachusetts bankruptcy filings from July of 2009.  After sending surveys to 500 households, they compared the results to national and Massachusetts data assembled during 2007.  The Massachusetts healthcare law went into effect in 2008. According to Dr. Steffie Woolhandler, one of the study’s authors, health insurance in Massachusetts has risen since RomneyCare was implemented.  “It’s really too much money for the average family – especially if the breadwinner is the one who gets sick,” she said.  “We need to reduce limits on deductibles and out-of-pocket costs.”

“People think they have reasonable insurance until they try and use it,” said Dr. David Himmelstein, another study author.  “You are carrying an umbrella and it starts to rain and you put it up and it’s full of holes.  For most people, it just hasn’t rained yet.”  High premiums, large co-payments and deductibles mean that even families with insurance have to pay substantial out-of-pocket costs, said Himmelstein, a professor of public health at City University of New York.  Himmelstein said his survey’s findings suggest that the national health overhaul — which was modeled on the Massachusetts law and takes full effect in 2014 – is unlikely to ease the number of medical bankruptcies, either.

Sally Pipes, a conservative healthcare expert, is a long-time critic of the Massachusetts healthcare law.  “In fact, a substantial portion of Massachusetts’ newly insured still can’t afford to purchase even basic medical services, and are effectively no better off than before the law’s passage. Meanwhile, government health spending is spiraling out of control, adding to the state’s already massive public debt.  Nearly 30 percent of Massachusetts residents report that their medical costs have increased since MassCare’s implementation.”

Massachusetts Healthcare Reform: Part II

Monday, February 28th, 2011

Massachusetts Governor Deval Patrick has unveiled legislation to rein in spiraling insurance costs by setting boundaries on the healthcare market.   The move to slow soaring costs in Massachusetts has strengthened since the state passed its ground-breaking 2006 MassHealth law that now insures approximately 98 percent of residents.  Although the law significantly expanded coverage, it did little to curb rising costs that are now putting pressure on the state budget and family finances.  Patrick told the Greater Boston Chamber of Commerce that Massachusetts led the way in expanding health coverage and is now “poised to lead again on health cost containment.”  The plan will move Massachusetts toward a “global payment” system where physicians are rewarded according to their patients’ health, rather than by the number of procedures or office visits they schedule.

We have an expensive system that doesn’t provide the best care for patients and that has to change,” Patrick said. “Universal health care in Massachusetts has been a resounding success, and rightly serves as a model for what’s possible for the rest of the nation, but it costs too much.  “Healthcare in Massachusetts is now universally accessible but it is not universally affordable,” according to Patrick.

Critics of Massachusetts’ healthcare system say MassHealth currently includes incentives that increase physician and hospital compensation based on the number of procedures or tests they perform.  Under Patrick’s new proposal, a primary-care physician will be compensated for treating a patient’s overall health.  Some Massachusetts healthcare providers are already moving in that direction.  Blue Cross Blue Shield of Massachusetts and physicians at Beth Israel Deaconess Medical Center in Boston signed an “alternative quality contract” to cut costs by paying doctors and hospitals for the quality — not the quantity — of the care they provide.

Patrick’s proposal would establish a more formal structure, including the creation of a new healthcare council made up of leading public health officials to act as a central clearinghouse.  The council’s goal is to pressure the market.  Although it won’t have the power to directly set prices, it will try to establish boundaries for the market.

Not everyone in the Bay State likes Governor Patrick’s proposal.  Writing in the Boston Business Journal, Julie Donnelly says that “The bill would require those who cannot afford private health coverage or do not have the option of enrolling their child in a private plan to reimburse the state up to eight percent of their gross income for the cost of that dependent child’s health coverage under Medicaid.” According to Donnelly, “The proposed revisions to the healthcare law would hit low-income, working divorced fathers who pay child support but cannot afford health insurance.  The bill also hurts kids who are low income and live with a single parent.”

Will Martha Coakley Sit in Ted Kennedy’s Old Senate Seat?

Tuesday, January 12th, 2010

Kennedy family goes to bat for Democratic Senatorial candidate Martha Coakley.  The Commonwealth of Massachusetts will elect a new senator on Tuesday, January 19, to replace  the late Senator Ted Kennedy (D-MA).  If the Kennedy family has their way, the winning candidate will be Martha Coakley, who is currently the Bay State’s Attorney General.  Coakley, if she wins the election in this heavily Democratic state, plans to continue the legacy of the late Senator Kennedy in assuring that meaningful healthcare reform legislation is passed this year.

At a rally attended by members of the Kennedy family – including Vicki Reggie Kennedy – Coakley said “The choice is very simple.  With your help and your vote on January 19, we can make Senator Kennedy’s vision of affordable, quality healthcare for all Americans a reality.”  Coakley is a strong supporter of healthcare reform legislation, which Ted Kennedy called “the cause of my life”.  The other candidates on the ballot – including Republican Scott Brown – have said they would vote against the bills currently pending in Congress.

According to Kennedy, Coakley would continue the “world-class” representation provided by her late husband. “We can’t take this election for granted. Our enemy is complacency,” said Vicki Kennedy.  “As Ted would say, ‘January 19 is the date, Martha Coakley is the candidate.’ “

Massachusetts Physicians Give a Thumbs Up to Mandatory Healthcare Insurance

Monday, November 9th, 2009

Massachusetts Physicians Give a Thumbs Up to Mandatory Healthcare InsuranceAs Massachusetts begins its fourth year under a law that requires almost every citizen to have healthcare insurance – only three percent are not insured, the lowest rate in the nation – let’s look at how mandatory coverage is working in the Bay State.  Although critics claim it costs too much and creates too many newly insured patients, the fact remains that a majority of the state’s physicians think the program is succeeding and strongly support it.

A case in point is primary-care physician Dr. Phil Treffletti, whose practice is in Chelsea, MA, a working-class town just north of Boston.  Addressing the critics who claim that accessibility to physicians is an issue, new patients wait an average of just three weeks for an appointment with Dr. Treffletti.  “It’s certainly nicer for me to be able to be available to more patients in my community.  I can’t say that we’ve been swamped or overwhelmed,” Treffletti said.

A poll conducted by the Harvard School of Public Health and published in the New England Journal of Medicine backs up Dr. Treffletti’s opinion.  The poll showed that 70 percent of the state’s physicians favor the law and overwhelmingly want it continued.  Earlier polls have found that while the state’s residents like the mandatory insurance law, Massachusetts physicians are even more supportive.

According to Dr. Robert Blendon, Harvard Professor of Health Policy and Political Analysis who conducted the poll, “They were just quite impressed, both in their own practice and statewide, that the uninsured problem has essentially disappeared from their lives.”

Senate Advances on Reshaping Healthcare Coverage

Tuesday, July 21st, 2009

A crucial Senate committee has approved legislation to reform the nation’s healthcare system.  This is significant because it marks the first time the committee has acted on legislation to fulfill President Obama’s goal of reshaping how healthcare is paid for in the United States.s-obamated-large

Specifically, the Health, Education, Labor and Pensions Committee voted 13 – 10 — along strict party lines — to endorse a $600 billion measure to expand coverage to virtually all Americans by requiring individuals to get insurance with their employers contributing to the cost.  If enacted into law, the legislation would provide federal aid to families and individuals who make less than four times the poverty level – approximately $88,000 for a family of four.

The committee’s chairman, Senator Ted Kennedy of Massachusetts, missed the vote because of his ongoing treatment for brain cancer.  Even though Senator Kennedy is acting behind the scenes in the push to pass this legislation, he remains one of the prime movers for enacting healthcare reform.

America Losing War on Obesity

Tuesday, July 14th, 2009

A new report — “F” as in Fat:  How Obesity Policies are Failing in America 2009 gives America a failing grade on its efforts to control obesity among children and adults.

The report, released by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, found that obeseobesity rates rose in 23 states during 2008, with no states showing decreases.  The number of overweight children is at or above 30 percent in 30 states.

Mississippi came in dead last for the fifth year in a row, with an adult obesity rate of 32.5 percent.  Three states were close runners up:  West Virginia reported a 31.2 percent obesity rate; Alabama had 31.1 percent; and Tennessee had 30.2 percent.  On the opposite side, the states reporting the lowest obesity rates were Colorado with 18.9 percent; Massachusetts with 21.2 percent; Connecticut with 21.3 percent; Rhode Island with 21.7 percent and Hawaii with 21.9 percent.

“Our healthcare costs have grown along with our waistlines,” according to Jeff Levi, PhD, TFAH’s executive director.  “The obesity epidemic is a big contributor to the skyrocketing healthcare costs in the United States.  How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?”

Fully two thirds of American adults are now overweight or obese.  Adult obesity rates are higher than 25 percent in 31 states, and above 20 percent in 49 states and Washington, D.C.  Compare this with 1991, when no state reported an obesity rate higher than 20 percent.