National data show that being underinsured is nearly as bad as being uninsured. More than a quarter of insured Americans have medical bill problems or medical debt. Hardly deadbeats, a third of them used up all of their savings to pay their medical bills and many did not get needed care because of the cost. If the purpose of health insurance is to allow people to get the care they need without suffering overwhelming financial loss, the data indicate high rates of product failure.
The Access Project recently interviewed insured people with medical debt in seven states, including Massachusetts, to understand their experiences in detail. Our findings have some important implications for current discussions about what insurance qualifies as Minimum Creditable Coverage under the Massachusetts health insurance mandate and what level of premiums can really be considered affordable.
First, even when premiums were relatively low, our interviewees lived in fear of becoming ill because of high out-of-pocket costs. Many went without needed care. Others sacrificed their financial security to get the care they needed. These findings are consistent with national data that show that health plans with high levels of cost-sharing are often not affordable when people get sick.
Second, our report found that confusing insurance policies and error-prone claims handling processes left many patients with coverage denials and unanticipated bills, sometimes for services that should have been covered.
These findings mean that we cannot judge the success of Massachusetts health reform only by the number of uninsured people who purchase insurance. What are their experiences after they have insurance? Can they get the care they need? Is their financial stability undermined in the process? Are their claims processed quickly and accurately? Are they treated fairly?
Our health reform law requires Massachusetts residents to purchase private health insurance. The Connector and Department of Insurance have an important role in ensuring that, in exchange, they receive value. This means setting clear rules about the coverage and services insurers provide, and then monitoring people’s experiences to make sure their insurance provides them with real protection when they get sick and need to use it.
Our report, The Illusion of Coverage, tries to give a voice to the people who will deal with the consequences of health insurance reform, here and in other states. We think they are worth listening to.
Carol Pryor
Senior Policy Analyst
The Access Project
The Access Project is a national healthcare research and advocacy organization.
Wonderful entry, Ms. Pryor. This issue has not gotten nearly enough attention in all the self-congratulory back-slapping over the “Creditable” products and “affordable” premiums. The Connector board has a difficult policy question to decide: is it better to require everyone to buy some insurance, even if the insurance is not nearly as good as most people have, and even if it will still leave those who are compelled to buy it with significant financial burdens if they have a serious illness? The policy decisionmakers might decide yes, but we’ll soon hear the most important voices. Thanks for urging us to listen to them carefully.
Carol, thanks to you and the others at the Access Project who care deeply about this issue. I heartily agree that real people’s voices are worth listening to. In fact I believe that they have been heard on this issue for a long long time.
I want to pose a sincere question to you and other CommonHealth readers:
Do we really need more studies?
I mean, most people who have insurance know the realities that you compile in your very thorough and well-written report.
Do we need more studies? Or are they just allowing us, the advocacy community, to delay creating what needs to happen. Taking Action. Building a movement and taking more action. Demanding of our elected officials that we have a helath care system that exists primarily for people not for corporate profit.
I am compelled to ask the study question and am grappling with it myself after hearing about Paul Farmer’s (of Partners in Health http://www.pih.org) Keynote Speech at the Public Health and Human Rights conference last Fall.
Paul, whose work is grounded by an abiding commitment to social justice and sound health and economic policy, suggested that regarding health inequities the facts are in and that WE DO NOT NEED ANY MORE STUDIES. (I’d say we’re drowning in data and anecdotal evidence, actually). He said maybe it was time for advocates start wearing buttons that read “NO MORE STUDIES”.
I tend to agree with him. Poll after national poll show that the American people want a government administered national health program that will GUARANTEE quality coverage to all using public funds that are publicly administered, NOT administered by the insurance industry.
Isn’t the real issue at hand here the far-reaching “influence” (”control” may be more accurate) of corporate special interests on the political and policy-making process?
Real people do not want an individual mandate. The insurance industry does.
Are more studies what is needed?
Once again, I must point out that this study neglected to mention that Massachusetts (and most other states) has a health insurance consumer protection law that provides individuals with among other things, access to an independent external appeal process for medical necessity denials. The Office of Patient Protection (OPP) within the Massachusetts Department of Public Health administers this process and will also assist consumers with various managed care issues such as denials of and access to care and coverage. Although the law does not extend to individuals enrolled in self funded plans, Mass Health or Medicare, it does provide valuable protections for insureds enrolled in Massachusetts fully funded plans. For more information, visit www. mass.gov/dph/opp.
Carol Granoff states that if the sick, stressed and severly incapacitated individual (the “patient”) can simply hop on the internet and receive help to get needed care that has been denied.
Please, let’s get real. This looks wonderful on paper but is simply a new way to add more bricks to the dark tunnel that is sickness.
Please picture the “patient”. He/she is sick.
He/she is dealing with everything that goes with the sickness, i.e. the physical illness itself, financial loss, uncertaintiy of the future, etc.
He/she does not have the physical, mental, emotional and probably not even the technical capacity to chase down this wonderful O.P.P.
In fact, how is the “patient” even supposed to know where to start?
The benificent politicians and scholars who are busy inventing our new “health care system” need to look at the real lives of real people.
True single payer universal coverage is the only way to attain the quality care that all citizens deserve.