commonwealth care

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Mass. Experience: Even $1 Co-Pay Can Block Needed Care

(Wikimedia commons/Bloodshedder)

It’s not enough to get everybody insured. You have to get everybody insured well enough so that they get the care they need. And in the case of very poor people, even a $1 or a $3 co-pay can be a barrier to care.

That’s my take on a new Massachusetts-based study, done by Harvard Medical School researchers and just out in the Journal of General Internal Medicine. Other states may want to take heed, now that the federal health overhaul has been upheld by the Supreme Court and they’re moving towards getting more people insured. All insurance is not the same, and for some, even the relatively generous Massachusetts Medicaid benefits may not be enough.

More on the study soon, but first, here’s the human side from its lead author, Dr. Danny McCormick of the Cambridge Health Alliance:

“For people who aren’t in the position of being at 133% of poverty, it’s inconceivable that [a $1 or $3 co-pay] would inhibit you from getting a medication if the doctor prescribed it. But I saw a patient last week, a young man with a chronic medical condition, who works at a deli, earns minimum wage, and rides his bike to work because he can’t afford a car.

‘I have actually no dollars in my pocket.’

I had seen him two months before and told him, ‘Your blood pressure is dangerously high, here’s a prescription for medication. You’ve really got to take it.”

So he comes back last week and he says, ‘You’re going to be unhappy with me but I didn’t take it.’

I said, ‘Okay, what were the problems?’

He said,’I’ve got Medicaid but I’m so far behind on bills I have actually no dollars in my pocket. I’m waiting for a check from work, and as soon as that gets here I can get that medication.'”

Moral of the story: “Even very small co-payments — and this is borne out in the literature — can inhibit extra-low-income people. This was a particularly striking case because he had such high blood pressure, and he showed up again and it was worse, and I ended up sending him to the ER, and that ends up costing fantastically more than the minimum co-pay he would have had to pay. I see it all the time as a primary care doctor: even very low co-payments inhibit needed care.” Continue reading

Connector: Commonwealth Care Insurance To Get Five Percent Cheaper


This just in from the Connector, the agency that helps Massachusetts residents shop for and obtain health insurance:

For the second year in a row, the Massachusetts Health Connector’s Commonwealth Care program will provide private health insurance to eligible residents at a lower cost than the previous year. At tomorrow’s monthly meeting, the board of directors of the Health Connector will vote on bids from private insurance carriers that provide an average five percent reduction in per-person cost. Combined with similar savings achieved this year, tomorrow’s action will save the state approximately $91 million with no benefit reductions or member co-pay increases.
[…]
Commonwealth Care is the Health Connector’s health insurance program for uninsured adults who meet income and other eligibility requirements. There are currently 173,000 Commonwealth Care members and enrollment may exceed 200,000 during the next year. In the six years since health care reform became law, the per member per month rate the state pays to insurance carriers has increased by an average of less than two percent, while member satisfaction remains consistently high. In the most recent survey conducted during FY 2012, members rated their Commonwealth Care experience favorably, with 77 percent of all members being satisfied or extremely satisfied with the program. Continue reading

How Is Network Health Cutting Its Premiums 15%?

Network Health president Christina Severin

Stop the presses! Somebody’s health insurance premiums are actually going down!!

Network Health, a managed care plan owned by Cambridge Health Alliance, has just announced that as of July 1, its Commonwealth Care plan will cut its premiums by 15%. The cut will bring Network Health to the same price level as Celticare, which, with about 15,000 members, had been the only “lowest cost” Commonwealth Care plan. Now both will share that designation.

The announcement is timed to appeal to potential members during the open-enrollment period for Commonwealth Care, the state-subsidized health insurance for people with low and moderate incomes. The Network Health plan currently serves about 44,000 members, who’ll generally see a drop in monthly premiums of between $10 and $30.

WBUR’s Martha Bebinger reported in April that “plans that cover moderate-income residents through Commonwealth Care are holding rates flat by limiting where patients can go, negotiating tougher contracts with hospitals, and with better oversight of the sickest patients.”

In fact, The Globe reported then that the proposed limited-network contract from Network Health excluded all hospitals in the (expensive) Partners HealthCare system except two.

But that was when the news was about holding rates flat. Network Health is going a step further with its 15% cut, and I asked the plan’s president, Christina Severin, today how they were doing it.

She declined to discuss “exclusions,” like the Partners limits reported by the Globe. In general, she attributed the rate cuts to three main factors:

-Network Health had already been working “extremely hard” to control costs. In the current fiscal year, it had already seen zero growth in its medical expenses.

-Of the 15% cut, 10 percent comes through a “high value network”

-and 5% through “medical expense management.”

In other words, 10% from using lower-cost (though still high quality) facilities and 5% through the kind of proactive “care management” that keeps patients in better shape and thus avoids unnecessary expenses.

Christina provided a few telling examples of Network Health’s efforts at care management: Continue reading

Health Insurance Hassle: Massachusetts Portal Can’t Handle Macs

If Franz Kafka were writing in 21st-century Massachusetts, he might have penned a tale like this:

J., an educated and technologically capable man, went online to the state’s “health information portal” hoping to create an electronic account for Commonwealth Care, a subsidized insurance plan. He entered his name, social security number and date of birth. But the site spat back at him, “ReferenceError: Can’t find variable: ActiveXObject.” He tried again, and yet again. Finally, he called the functionaries responsible for the site, and after many minutes untangling the bureaucracy, received this answer: You cannot create an account on a Mac. You cannot use Firefox or Safari or Google Chrome. You can only use Microsoft’s Internet Explorer. This is a problem we hope to fix soon.

Sadly, Kafka is not here to do it justice, but this tale is true. When Jeff, a Hyde Park resident, first shared it, I confess that I doubted him. Can’t be! When was the last time I heard of an official Website that could only work with certain browsers? A decade or so ago??

So I tried it, on a Mac. I got the same error message. Try it yourself using Safari, Firefox or Chrome. Here’s the link. Hit the “Log In” button for Commonwealth Care, then try to Create a Login.

I called the Connector, the agency that helps Massachusetts residents shop for and obtain our (mandatory) insurance, and that manages the site that contains the health information portal. To be clear: You can use any browser to shop for and compare insurance on the Connector’s user-friendly site. And you cannot sign up with any browser for the Commonwealth Care program; you have to do it by mail. But if you’re already signed up and want to manage your account, you need Explorer.

Spokesman Richard Powers confirmed that the portal, which launched in June 2010, can only work with Microsoft’s Internet Explorer. The vendor that created it was Dell, he said. In his words:

“Our vendor’s product was initially written exclusively for Microsoft products and, in that sense, was somewhat outdated. It has always been their intention to upgrade the system to be compatible with other browsers such as Firefox 3.6, Apple Safari 5.0 and Google Chrome 9.0. We’re hoping to have that work completed by the end of the summer.”

Um — “somewhat outdated”??! Flamers, where are you? What do you have to say about a state that creates a Website in A.D. 2010 that cannot interact with any browser but Explorer? Please comment below. I can tell you that in an informal poll of the tech types I know, the word I heard most often was “Ridiculous!” The close runner up was “You’ve got to be kidding!” Though, they say, it’s not at all unheard-of, it’s just outdated.

Again, any browser can be used to explore and shop for insurance on the Connector’s broader site, Richard Powers emphasized. It’s just the “health information portal” — which about 36,000 Commonwealth Care members use to register, pay a premium or change a health plan during open enrollment — that has the browser limitations.

Sounds like a nice, convenient online interface — if you have a PC, that is. Jeff messaged CommonHealth: Continue reading

Court Backs Immigrant Rights In Health Care Dispute

In a decision hailed by consumer advocates, the Massachusetts Supreme Judicial Court today ruled that the state’s removal of thousands of legal immigrants from a subsidized health care program likely violated the state constitution’s “equal protection obligations, ” The Boston Globe reports.

The court said that Massachusetts erred in 2009 when it cut health coverage for about 26,000 immigrants after state lawmakers eliminated $130 million in funding to help balance the state’s budget.

The ruling did not order the state to reinstate full coverage for legal immigrants, but it paves the way for legal action by immigrant advocates that could do so.

The case was brought by Health Law Advocates, a partner to the consumer group Health Care for All, which said in a statement:

The ruling affects some 40,000 people, all legal, taxpaying residents of Massachusetts who were eligible for Commonwealth Care before the fall of 2009. About 20,000 people are enrolled in the Commonwealth Care Bridge program, which has lesser benefits and higher co-pays than CommCare. Another 20,000 are uninsured, locked out of coverage and relying on the Health Safety Net program for some care.

The recent substantial growth in tax revenues above forecast amounts (some $587 million in April alone) will allow the state to fund their re-integration into CommCare.

“We are very pleased that the Supreme Judicial Court has firmly and clearly stated that immigrants must have equal access to health care in our society. From the time legal immigrants were excluded from the benefits of the State’s health care reform law, we believed that law was unfair and unconstitutional. Now, it is time to remove this stain from our historic movement to provide health care for all and allow immigrants back into the Commonwealth Care program which has provided health care access to so many in our communities,” said Matt Selig, Executive Director of Health Law Advocates.

The Connector: $80M Savings Through Limiting Choices, Tougher Contracts

Connector Chief Glen Shor

WBUR’s Martha Bebinger reports that the state is not budgeting any additional money for subsidized health insurance that covers low to moderate income residents. Instead, it’s relying on insurance plans due out today which provide the same benefits with no increased cost.

She explains:

For most of us, the price of insurance went up at least 7-10% this year. But plans that cover moderate income residents through Commonwealth Care are holding rates flat by limiting where patients can go, negotiating tougher contracts with hospitals, and with better oversight of the sickest patients. Glen Shor runs, who runs the state’s Health Connector says: “We’re very excited to test new models for delivering coverage in a more effective manner. We hope there’s something to learn from this experiment that can help other cost containment efforts.”

Shor says the state will save $80 million dollars by level funding Commonwealth Care.

The limits placed on where patients can seek care may be significant. The Boston Globe reports:

Shor said that a proposed limited-network contract from Network Health excludes all hospitals in the Partners HealthCare system except two, on Martha’s Vineyard and Nantucket.

Pennsylvania Slashes State Health Insurance, In Contrast To Mass.

Tom and Paula Michele Boyle, Pennsylvania residents who are about to lose their state-funded insurance


File under “Reasons to be glad we live in Massachusetts.”

NPR reports today that Pennsylvania’s entire state-funded health insurance program for low-income adults is about to be cut, leaving 42,000 members uninsured. Nearly 500,000 people had been on the waiting list, hoping to join the program.

States around the country are facing similar cuts in this season of exploding budget crises. In California, Gov. Jerry Brown is proposing to slash more than a billion-dollar swath out of state health programs, as reported here.

Not here in Massachusetts. As WBUR’s Martha Bebinger reported earlier this month:

In a tough budget year, the Patrick administration is out with a strategy to maintain subsidized coverage for 174,000 low to moderate income residents. While states around the country are trimming government health insurance, Secretary for Administration and Finance Jay Gonzalez says Massachusetts will preserve near universal coverage. Continue reading

Big Decisions For Commonwealth Care

State administrators today discuss how to provide health care coverage for some of the most vulnerable residents in Massachusetts. WBUR’s Martha Bebinger reports:

In a tough budget year, the Patrick administration is out with a strategy to maintain subsidized coverage for 174,000 low to moderate income residents.

While states around the country are trimming government health insurance, Secretary for Administration and Finance Jay Gonzalez says Massachusetts will preserve near universal coverage.

“Our goal is to continue to provide coverage to everyone who is eligible for it, continue our nation leading record in access to affordable health care and to do in a way where we aren’t cutting benefits,” he says.

But there’s no additional money for subsidized coverage, known as Commonwealth Care, and enrollment is expected to grow. In return for more members, Gonzalez is telling Commonwealth Care insurers they must provide the same care at lower costs. He says this is doable if the insurers limit where patients go and do a better job of managing care.

(Gonzalez will outline his plan for the next Commonwealth Care contracts at meeting of The Connector board today. He says he doesn’t expect any of the plans to stop participating in the program.)

Connector board member Dolores Mitchell, who is also Executive Director of the Group Insurance Commission, the agency that provides life, health, disability and dental and vision services to state employees, retirees and dependents, says Massachusetts, unlike other states, is not cutting benefits or limiting access to government insurance. “By and large we made a promise and we’re keeping it and I think that’s something to be proud of.”