In the small window of time remaining in 2007 for Massachusetts residents to enroll in health insurance and not pay a penalty, the question of the hour is what can be done to close the gap for people who have not yet signed up? Some important efforts are focused on bringing young, healthy, higher-income uninsured individuals into the fold – key to ensure that risk is well-shared. But what can we do to reach the low-income individuals who are not signing up – especially for Connector programs with premiums – and who are likely to feel a greater sting from the mandate?
Let’s go to the experts: case managers, community health workers and others working directly with low-income uninsured residents across the state. Here at the Blue Cross Blue Shield of Massachusetts Foundation, a report from some community-based health access programs that we support shines a light on barriers for low- to moderate-income residents. We asked grantees who was not enrolling and why. This is what we learned.
Legally present immigrants who misunderstand the consequences of signing up
One program reports that documented immigrants are avoiding enrolling because they fear that enrolling in Commonwealth Care will adversely affect their immigration status.
People who could not get the paperwork needed to enroll
Applying for MassHealth and Commonwealth Care requires many documents, including a birth certificate and income verification. Pulling all of this together takes time and money. People who are homeless, have medical or mental health or other challenges are often unable to complete the application.
Not actually affordable
Programs found that some clients could not afford their employer-sponsored coverage and earned too much to qualify for Commonwealth Care. These may be people trying to pay off medical or other debt.
People who opted out because they did not want to payOur grantees identified two groups here: those who didn’t want to pay premiums now when they had accessed free care before and also the 19-25 year-olds who don’t think they need insurance.
Some quick suggestions from this experience in the field
1. Get the word out through trusted sources that enrolling in MassHealth or Commonwealth Care will not bar you from becoming a U.S. citizen or jeopardize your status here. The immigration law community may be a good partner.
2. Do everything possible to help people get needed documentation. Some agencies request and purchase birth certificates and assist with signed affidavits for income verification, which could be funded statewide. Streamline the documentation process.
3. Recommit to supporting strong, grassroots outreach and education work by knowledgeable community health workers. Explore every option to finance their essential work.
4. Outreach and education alone are not enough. Decisionmakers and those of us invested in access need to understand these barriers and craft solutions.
Jarrett Barrios, President
Valerie Bassett, Director of Policy and Research
The Blue Cross Blue Shield of Massachusetts Foundation
Valerie Bassett,
We do not want this law and government intrusion! I am an American citizen and lifelong resident of this State and find this chapter 58 law disgusting. When are all of you going to get this in your heads? NO MANDATE
Attention:
Jarrett Barrios, President
Valerie Bassett, Director of Policy and Research
The Blue Cross Blue Shield of Massachusetts Foundation.
And members of the public.
Re: “Outreach and education alone are not enough. Decisionmakers and those of us invested in access need to understand these barriers and craft solutions.”
The biggest barrier to people getting the CARE THEY NEED is the status quo of health insurance as a corporate-commodity (and a royal rip-off, even from the so-called “non-profits” like BCBS and Tufts).
So let’s stop the double speak about “barriers” and “asking experts”, shall we? How much are you two being paid by BCBS, by the way? What you’re selling is “access” to an overpriced product, not to health care.
I am ashamed to be a nurse and a citizen in the state that created such a wasteful, punitive and backwards mandate law to purchase private insurance.
The public is in need of rigorous investigative journalism on this issue of how this law came to be. It should include a critical examination of the role of Blue Cross Blue Shield, Partners Health Care and other inside players who run a joint “MassHealthReform” website (Gimmeabreak!! as they say). wbur doesn’t seem to be up to the task nor the Boston Globe; gee, could they have any vested interests in keeping their advertising revenue flowing for health insurance products and hospital competition???
Taxpayers are getting soaked. The dominant players are cloaked. As usual. And too many people continue to have their health needs go unmet or go into bankruptcy trying to take care of their loved ones.
Analysts in other states are providing much better coverage and analysis on this bogus law than our own media, as in this excellent piece and the pdf document within it:
Massachusetts Mandatory Health Insurance Purchase Law Is No Model for California
http://www.consumerwatchdog.org/healthcare/pr/?postId=8676&pageTitle=Massachusetts+Mandatory+Health+Insurance+Purchase+Law+Is+No+Model+for+California
Hi Ann – Martha Bebinger getting back to you about “not being up to the task.” We reported on the alliance formed by Partners and Blue Cross to lobby lawmakers during negotiations on the law…and on their level of influence. Since the law passed, we have reported on how much health insurers stand to make on increased enrollment. If you have any other tips to pass along…I’m all eyes. And you have my e-mail address and phone number if you want to contract me directly with coverage suggestions. I hope you are having a nice weekend.
Best, Martha
I have a question for Martha Bebinger,
I can’t figure out if your a reporter for WBUR why are you not reporting the truth about this mess the State lawmakers and Commonwealth Connector has created and the cost to taxpayers?The people posting are all working for the State or Insurance companies. If this is a public station should’t you be telling the public the truth.The facts are the CEO’s and Senator’s who post have a totally bias agenda, What’s your agenda?
Hi Norma – your assumptions about my reporting and the blog are not quite right. If you would like to send me your phone number, I’d be happy to clarify a few things.
Best, Martha
“Not actually affordable
Programs found that some clients could not afford their employer-sponsored coverage and earned too much to qualify for Commonwealth Care. These may be people trying to pay off medical or other debt.”
These seems to be a counter-intutive statement as people whose employer offers insurance coverage are not eligible for Commonwealth Care regardless of the employee’s share of the cost.
It would seem what that is meant is:
(1) some whose income would otherwise qualify them for Commonwealth Care are disqualified because their empoyer offers coverage; and that they will lack coverage because they can not afford their share of the premiums for the employer poicy. So long as the employer plan premiums are in excess ofthe premium amount speicifed in the income/premium tables, they are not subject to the mandate.
(2) some can not afford the employer plan premiums. If the employer plan premiums or the Commonwealth Choice plan premiums are higher than the premium specified in the income/premium tables, they are exempt from the mandate.
(3) some can not afford the Commonwealth Care premiums of $35, 70 or $106+/-. For a considerable number, it should not be difficult to establish financial hardship per the regulations as there are many loopholes to the mandate. These grounds include, among others, having a shutoff notice for a utility or being 30 days in arrears on rent or mortgage. (And these 2 which are listed are easy to arrange if needed as an excuse from the mandate.)
More can not afford the Commonwealth Choice premiums. The GBIO affordability study is very instructive on this issue. Many (and my numbers put it closer to 60-70% of those above 300% FPL as compared to the Connector’s estimate of 20%) are going to be exempt from the mandate under the premium/income schedules.
Looks like the bottom line is going to be that a fair number of those between 200 -300% FPL will not be able to afford the $70-106+/- premiums. FPL is an outdated and misleading indicator of financial sufficency as it does not accurately reflect the cost of housing and necessities. The Commonwealth Choice plans are not a solution for most above 300% FPL. They may be affordable for an individual under the age of 35 -39 but they arenotaffordable for a couple, a family or most people over 40. The deductibles are a killer on the cheapest plans (and the lower dedcutible plans merely incorporate the deductible difference into the premiums.) It leaves a choice of buying the cheapest plan but not being able to afford the dedcuctible or not buying the plan and using that money to pay out-of-pocket for care.
A 2-part comment
1. Thank you, AnnS, for the detailed and sobering analysis above. The fact of having to go through these complex and tortured analyses is, to me, strong evidence that this law really misses the mark and worsens an already excessively complicated healthcare non-system. What a waste. Yes, it’s good that more poor and low-income people under the new law now have state subsidized coverage. But the financing IS NOT SUSTAINABLE. Plus this approach still LEAVES HUNDREDS OF THOUSANDS WITHOUT COVERAGE AND NEEDED CARE. These facts are very disturbing. In full balance this law is not “reform”; in major ways it makes things worse. How tragic.
2. Hi Martha – Ann here. I appreciate your reply and I do regret that as one individual you personify “wbur” in relation to this blog on MA HC “Reform”. I know you do not make all the decisions on behalf of wbur. But there certainly is a need for more investigative reporting and analysis of the facts on how this law is unfolding, in response to your comment: “If you have any other tips to pass along…”
I did pass along some useful data/tips in my above comment and I’ll repeat them here. And once you’re on the Foundation for Taxpayer and Consumer Rights (FTCR) site, you can find many items analyzing the failings of the mandate approach.
“Massachusetts Mandatory Health Insurance Purchase Law Is No Model for California” report from FTCR at: http://www.consumerwatchdog.org/healthcare/pr/?postId=8676&pageTitle=Massachusetts+Mandatory+Health+Insurance+Purchase+Law+Is+No+Model+for+California
It’s an awful Law, and I hope fails miserably.
My monthly health payment will soon put me into forclosure.also It’s made my health go down cause of incompatance of the people running this system.
a conspiracy or just Idiots?