Yet, I cannot get comprehensive health care insurance in any state but Massachusetts.

It’s not even about the money. My healthcare history includes a major open heart surgery performed at 8 months. I had what you call a pulmonary stenosis, something that is routinely corrected without a major incision in today’s operating rooms. I had a fantastic surgeon and cardiologist back in my hometown of Houston; luckily I’ve had no incidents and problems since that fateful day.

When filling out insurance forms for other states, I obviously have to disclose my history.

Yes, I was born with it. No, I do not feel palpitations. Yes, I think I may have a left-over murmur. By that moment in the conversation, I pretty much know that I’ll be rejected: it’s like one bad blind date after another.

When I moved to Massachusetts in May of 2008, I decided to apply for catastrophic coverage since I am not a full-time employee at WBUR. That way, my financial life would hopefully not be destroyed if I were to get into some healthcare disaster. Getting catastrophic coverage was pretty easy:

“Have you had any health problems in the past ten years?”

“Don’t ask, don’t tell,” my father, a physician, tells me over the phone.

So I didn’t–and I was truthful; I have not had any health problems in the past ten years.
Nevertheless, I was incessantly worried that I wouldn’t be covered in the case of an accident or emergency.

I recently visited Health Care for All (HCFAMA) on an assignment for WBUR. While there, I asked the policy director, Lindsey Tucker, about my situation.

“Oh, you qualify here in Massachusetts,” she said. “It’s illegal for providers to discriminate against you based on your health history.”

Illegal?

She warned: “You’ll be fined if you don’t get comprehensive coverage by January 2009.”

“But I have coverage,” I said.

“Catastrophic is not comprehensive,” she replied.

As I left, she handed me a piece of paper with the 1-800 Helpline number. It took me a few days, but I called. I guess I thought it was too good to be true.

Someone on the other side of the phone filled out my application and said that I would probably be covered in three weeks. “There’s a slight back-up right now.” Luckily, I would avoid the fine but would I really be covered? I was still doubtful.

I called my father and he couldn’t believe it: “but they don’t know your history.”

“They didn’t ask.”

A few weeks later, I received a rejection letter from the State of Massachusetts: “Jessica Alpert does not qualify for MassHealth.”

Figures.

Health Care for All called me first. They were checking the status of my application and explained that input errors often disqualify perfectly average applicants. Health Care for All called MassHealth on my behalf and rectified the error.

But what if I didn’t have Health Care For All on my side?

I received two more rejection letters and simply threw them in the trash. I held out hope; three weeks later, I was given a “Welcome to Commonwealth Care” package.
I called the hotline and asked which plan was the cheapest. I was also interested in hospital affiliation since I heard Mass General has excellent cardiology care. I picked Fallon Community Health and have since received even more paper than I can imagine. Booklets. ID Cards. Wellness manuals. Exercise incentives.

Now I just have to find a primary care physician……

Jessica Alpert is an associate producer for Radio Boston at WBUR

About a year later my wife heard about the beginnings of Commonwealth Care on NPR. I submitted the application for what I thought was whole family coverage but when we received the insurance, my name was not included and thus, I was without health insurance. After many phone calls, it appeared that even though my data was on the application, only my wife and our children were insured. I was now a member of this country’s uninsured and it was quite scary. After many more phone calls and paperwork I was able to obtain insurance through Commonwealth Care.

Thankfully, our family has been able to keep our previous primary care providers and locations. We continue to receive excellent care and services, and are able again to save money for our and our children’s future needs.

We sincerely appreciate everyone who has enabled health care reform in Massachusetts.

Stuart Shapiro, Cambridge

Then I re-applied, as required. A few weeks later I received a disenrollment notice in the mail, saying that I was ineligible for Commonwealth Care because my wife could cover me through her job. Actually, she can’t afford to, because then we’d be living on about $400 a month. Included with the disenrollment notice were two forms—an Exception Form and an Appeal Form. Nothing on the Exception Form seemed to apply to us, so I sent in the Appeal.

Well, our appeal was denied. I called Commonwealth Care Customer Service and they said I should have sent in the Exception Form.

That’s when the real nightmare started. I sent the Exception Form and heard nothing. Then I sent it again. Still nothing. I called Customer Service several times. Over and over I was told, “You have to wait for mail from the Connector.” When I asked to speak to the
Connector, I was told it had no phone or fax number. When I asked to speak to a supervisor, my request was denied.

Finally I sent the Connector a certified letter pleading for a response. No reply.

My problem would never have been solved if it weren’t for Representative Byron Rushing’s office. His Director of Constituent Services advised me to call Health Care for All, and even called ahead for me. At Health Care for All, Kate Bicego looked up my Connector file and told me that—surprise!—I was eligible for a $40/month plan.

The upshot is, I was without any health insurance for four months, during which time I spent $200-$300 that the Connector will never refund to me, all because I sent the wrong piece of paper to a government agency that won’t even answer a certified letter, let alone the telephone.

Hilary Brant, Boston

I tried a few insurance companies before finding out about Commonwealth Care. There plans were not that good and costly. But with the help of Health Care for All I found about Commonwealth Care and they helped me to enroll and get started on the plan.

I have gone for my yearly physical blood work, mammogram. It is great coverage I have not had any out of pocket expenses just my co-payments which are very good. It’s a really good plan and a big price difference from 500.00 to 35.00 a month. If not for this I would not have been able to go part time. With every thing else that is going on I am glad I have good health insurance. It makes things easier for me.

Kathy Riley, Wilmington

I had been buying my health insurance since May 2006. The monthly premiums then, were $650 a month for a 35 year old + Spouse and family. No prescription coverage and $25 copay. This seemed high but I could afford it. Then in December that year the premium was raised to $750 a month. Kirsten and I started paying real attention to how much we were using insurance. Over the next year we only had about 15 doctors visits between all 6 of us. In December 2007 my premium jumped to $890 a month. When I called Blue Cross Blue Shield about this I was told that there was a 20% premium increase because they were not offering the plan anymore. The reason for not offering the plan was due to the new Massachusetts Connector plan. That plan would have cost me $905 a month, the only difference was that now it included prescription coverage. At this point my wife and I decided to just put the monthly premium into a savings account just to cover health costs.

The other issue is that the insurance companies pay a different amount for the same services than what I pay for me or my family. They will say it is free market economy, well that is were they are wrong. That is where this system is messed up and the state is just helping it out, towards total collapse. I have a current example of this system at work.

Yesterday my son fell and cut open the bridge of his nose. My wife called and said that she had to go to the ER with him. She was questioned several time about the lack of insurance. They asked if she really wanted the Plastic surgeon to look at and seal the cut. They thought we could not afford the care. When the surgeon came in he told my wife that we could pay his office directly at the checkup in 10 days, $900, because the hospital would probably charge up to twice that. It will be interesting to see what the rest of the bill looks like. I will easily pay for this because I have been saving for such a situation. What would this cost me on insurance, oh $50 for an unauthorized ER visit and the $10,000 for my annual premiums. $900 for 1/2 hours work seems a little steep and the hospital may have charged me double for that same work.

My last point is this is really silly thing that we are doing in this state. While it is a noble idea, it is a bad idea because it goes against many of the founding principles of this country. Freedom of choice. What do I mean by this? This is worse than any tax ever because there is no way to not pay for the insurance. If I do not want to pay property taxes, I just rent. If I do not want to pay excise and fuel taxes I use public transportation. If I do not want to pay income tax I just get a job were I earn less money. I want the choice of whether or not I have insurance. As long as one does not burden society the they should be free to make those choices.

My wife and I are both of a similar mind that to many Americans have lost site of the simple things in life. They have to see a doctor for every little cough they have and have medicine every time they have a runny nose. Here in the United States of America we seem to have lost sight of the fact that we live and die, no matter what we do to intervene, and it is the quality of life that we are forgetting to live for.

Peter MacDonald, Brockton

Thanks for reading, Martha Bebinger

John Kulig lives in Central Massachusetts. He works 2 part-time jobs as a chiropractor and as a physiology instructor. Neither job offers health insurance. John purchased insurance in time to avoid the penalty on his 2007 tax return. Here is his description of that process and his concerns looking ahead.

In October 2007 I had the opportunity to attend a weekend informational meeting sponsored by the Health Connector at the YWCA in Worcester. The most comprehensive plan, in my opinion, was the plan offered by Blue Cross and Blue Shield. But at $400.00 per month it was quite expensive and beyond my means. I also spoke with a representative from Fallon Clinic. I was surprised when she stated that my working two part-time jobs was a “life style” decision. (It isn’t – I have not been able to find full time employment.) Fallon’s plan was approximately $300.00 month and allowed me to see my current physician but there was a $2000.00 per year deductible. The representative then gave me a phone number to call. After several days of leaving messages, I was directed to a web site. I was emailed an application but was not able to personally contact a representative at Fallon on line. I found Fallon very difficult to deal with. Most of the other plans offered by the Health Connector also had $2000.00 per year deductibles.

While at the October meeting I had the opportunity to speak with a Health Connector Official in the hall. I asked him why the health care reform law was based upon income only and NOT income vs. expenses. He just smiled and stated a person could file for an exemption. When I asked what the guidelines would be for an exemption, he said he didn’t know-they hadn’t been developed yet. His smirk made me feel as if I was being patronized.

From a fiscal point of view, it made more sense for me to pay the fines rather than purchase health insurance. However, I also realized than having health coverage is important. With the December dead line approaching, I finally purchased a health plan, independent of the Health Connector, but one that met the guidelines of the Massachusetts Health Care mandate. But the plan I purchased is less than desirable. While the monthly premium is $275.00, it has a $2000.00 deductible per episode not per year. If I get a kidney stone, I pay the first $2000. If I break a leg that same year, I have to pay another $2000.00 deductible. It does, however, cover annual eye exams, routine laboratory testing and medical treatments if I’m diagnosed with cancer.

At this point in time I have three important tasks ahead of me:
1. Search for affordable health insurance with better coverage
2. Find a third part-time job to help pay for it or…
3. Continue to search for fulltime employment with benefits.

John Kulig

Here’s Chris…

As a part-time employee, I am wondering whether my employer will be required to offer me any medical insurance. I am guessing not from my survey of various web logs, news reports, and the Connector’s web site. There is discussion in all of these places
about the requirements for covering full-time employees, but I haven’t found any mention of what will happen to part-timers.

I am assuming that I will be required to purchase my own medical insurance without government subsidy. This assumption is based on my income from last year, which was above the benchmark of 300 percent of the Federal Poverty Level. As a part-timer, though, my income varies from year to year. This makes me wonder whether I will need to move from health plan to health plan, as one year I may qualify for Commonwealth Care, and the next, not. If so, this would require a lot of time and effort in filling out applications, providing proof of income, informing organizations of my previous coverage, transferring records to new
doctors, etc.

I am frankly hoping that I will qualify for the waiver recently adopted by the Connector authority, as I would rather save my money and cover medical costs myself than pay for mandated medical insurance. It would seem that the high-deductible plans being offered through the Connector will mainly give me the
opportunity to pay $2,000 or more a year in premiums for the right to pay another few thousand dollars in deductibles for medical care.

I would hasten to add that I am not relying upon emergency rooms for basic treatment, kidding myself that I’ll be healthy forever, denying that I could ever get into an accident, etc., as is sometimes noted about uninsured people. I do my best to monitor my health by watching my diet, exercising regularly and seeing a physician when a health problem merits attention by an expert. The costs of such visits when needed, albeit expensive, are still cheaper than paying for medical insurance that will be offered to me through the Connector.

Speaking of costs: I do wish that all the professionals, practices, groups, etc. who charge patients for treatment would not only inform us of the charges in advance, but also explain these costs. In my experience, a visit to a medical professional can cost at least one or two hundred dollars, even though the professional may spend only about ten or fifteen minutes with me. I appreciate those professionals who lower their usual charges when they learn that I have no medical insurance, but I am still astonished by the high cost. I am assuming that the charge to me is helping the medical professional to pay some cost that he or she is burdened with. If I’m right, I would like to know where my medical dollars are ultimately going. If I’m wrong, I would like to know why medical examinations are so expensive. This information would make me feel more comfortable as a patient, and would add to my admiration of and thanks to the professionals who have helped me to get and stay well.

If I do not qualify for the waiver, I will seriously need to consider whether it will be less expensive for me to take the financial penalty and go without insurance than to pay for an insurance plan offered through Commonwealth Choice. I would note that by
paying the fine, I would still be complying with the health reform law; I would just be in essence telling the Commonwealth that I am willing to suffer the penalty imposed under the law.