{b}Having Health Insurance Does Not Mean Having Health Care{/b}

{i}Statement of Rachel Nardin, MD., President, Massachusetts Chapter of Physicians for a National Health Program, neurologist at Beth Israel Deaconess Medical Center in Boston, and assistant professor of neurology at Harvard
In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform we know a lot about what has worked and what hasn't. Examining this data critically is vitally important as the Obama administration considers elements of the Massachusetts' plan as a model for national health care reform.

On Feb. 19 we released a new study on the Massachusetts reform. This study details many problems with the reform effort. We are also releasing a letter from nearly 500 Massachusetts physicians to Senator Kennedy asking him not to push for a Massachusetts-style reform nationally. My colleagues and I see the effects of the Massachusetts reform on patients every day and know that this is not a healthy model for the nation.

The Massachusetts reform is an example of an “incremental” reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid, and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private insurance or pay a substantial fine ($1068 in 2009).

The reform has reduced the numbers of uninsured, although our report shows that the state's claim is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones—two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in Massachusetts may well be even higher than 5 percent.

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7000 before expenses before the insurance pays a single medical bill. It is not surprising that many of the state's uninsured have declined such coverage.

The study we released on Feb. 19 also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state's old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent Boston Globe/Blue Cross Foundation survey, 13% of people with insurance in our state were unable to pay for some health services that they had received and 13% could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost.

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. She told us “Under Free Care I saw doctors at Mass. General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization. Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well.” Now that she's “insured,” Kathryn's medical expenses consume almost one-quarter of her take home pay, and she wonders whether she'll be able to continue taking her life saving medications.