Cape & Islands News

What Cape Codders can expect from Heathcare Reform

It's here, and like it or not, you must join
A half million Bay Staters are still not insured

By Diana Woebcke 

Like it or not, as of this past July 1st, everyone who lives in Massachusetts, 18 years of age or older, must sign up for health insurance. 

In 2006 there were 495,000 uninsured citizens in  the stateIn 2006 there were 495,000 uninsured citizens in Massachusetts. The goal with new legislation is to bring that number to zero.  To achieve this new goal some of the most aggressive reforms include required insurance for all Massachusetts residents, steps towards elimination of racial and ethnic differences in care and mandatory employer to employee contributions. 

By requiring insurance coverage for all its citizens, the Commonwealth is able to provide insurance for everyone. If all goes well people who need health insurance and those who take the risk of not having it will draw from the same pool of benefits and everyone will be covered, regardless of income.
Good news for Cape Codders who have been without insurance
For Cape Codders who have been without insurance, this is good news.  Vision, dental, medication and emergency care are all part of the new plan.  The co-pays are very minimal.  The difficult part is finding a provider.  There is currently a shortage of primary care physicians statewide and with only a few on the new plan accepting new patients, there are wait lists and doctors already turning people away. 

According to statistics from Claire Goyer, Executive Director of the Duffy Center 32% of individuals who used free care in the past, (uninsured), have enrolled into the BMC Health Net Plan. The State is currently tracking the number of people who are leaving free care and signing up for the new Commonwealth Care Plan.

Meanwhile, here on Cape Cod

The Duffy Center in Hyannis, adjacent to Cape Cod Hospital has been in service for two and a half years. Part of their program involves getting the most needy population on the Cape health care.  They provide care for homeless and those at risk of homelessness. Their services include the walk-in clinic, group therapy for addiction and an outreach program.  Some of the individuals they try to treat live in camps in the woods or over by the railroad tracks in Hyannis.  Administrators are on hand to insure they get enrolled
for care on the spot.  Since they became providers in October of last year there has been "a steady growth of patients," says Ms. Goyer.

"Cape Cod Health Care is committed to expanded insurance for everyone"
   - David ReillyDavid Reilly, spokesperson for Cape Cod Healthcare, says "Cape Cod Health Care is committed to expanded insurance for everyone."  With the mandate for insurance requirement for everyone who is 18 years or older he states, "In the long term there are still a number of questions," and he is for "responsible reform that is sustainable."   He thinks the fact the State wants to reduce the number of people who are uninsured is a good first step." He also notes there are many details that are still being worked on and it's early to tell if the plan will work.

What about those who can not afford it?

For Cape Codders with limited or no income the State will subsidize plans through Commonwealth Connector.  For those who earn less than 100% of the federal poverty level ($9,600), there are also subsidized insurance rates.  The new Commonwealth Care Plan provides individuals in need coverage including no premium, little to no co-pay,($2-3 dollars), medication and dental coverage and no deductible. 

And individuals who relied on free care in the past will still be covered through free care in the future. Regardless of residency or insurance status, there will be free care available for emergency room visits. The only difference is there will be a change in funding from what is now known as the Uncompensated Care Pool to the Health and Safety Net Trust Fund.  Both funds will remain in place until October 1st.

In the past a total of $600 million dollars has been budgeted to partially fund free care programs for hospitals.  The plan hopes the use of free care will begin to decrease as the result of an enrollment increase.  October 1st, 2007 is the scheduled date the funding will shift from the Uncompensated Care Pool to the new Health and Safety Net Trust Fund, administered in the office of Medicaid.  The new Health and Safety Net Trust Fund will provide funding for individual health plans like Commonwealth Care through Commonwealth Connector, an organization which provides individuals and groups with the new health care.  As it stands now the fund will also provide reimbursement to hospitals for free care.

The new health care reform bill in Massachusetts is also working toward equal treatment for everyone.  Studies have raised questions why there are higher rates of certain illness among African Americans, Latinos and Asian populations.  This section of the bill puts into action a plan to collect and evaluate how these populations are treated in an health care setting.

If this section of the bill is passed, providers will be reimbursed for language interpretation services and there will be support for community health care workers.  The program will also provide services to help people manage their illness and education programs to increase awareness of health risks in communities with high rates of certain illness, like diabetes and asthma.

Employers fined if this section passes

With the new bill in place employers must provide coverage if they have eleven or more employees or pay a fine.  The Fair Share Contribution is required for employers who do not provide for or contribute to an employees health insurance.  An estimated $295 per year, per employee will be assessed and charged, pro-rated for seasonal and part-time employees.  This fee will go directly into the Health and Safety Net Trust Fund.

The new plan requires everyone to pick a primary care doctor.  There are providers on Cape, but only a few taking on new patients and the waiting lists are getting longer, so it's important to schedule first time appointments as soon as possible.  Each provider has a limited number of slots for Commonwealth patients. They are already turning patients away stating they have "reached their cap" or  "closed their panel" meaning they have a limited number of Commonwealth patients they can add to their practice. 

According to patient representatives at Commonwealth Care this number is entirely up to the individual physician or practice.  With sometimes only one or two doctors in a given area accepting Commonwealth patients, and the new open enrollment in place, the waiting lists are increasing rapidly. They are also increasing at Commonwealth Care listed dental offices. Some are now booking into December and January 2008, unless there is an emergency. 

Mass Health is starting to provide more coverage than it did in the past.  Dental and vision, cut in 2002 will be reinstated.  People with disabilities, HIV and unemployed will also receive an increase in enrollment and benefits.  The new plan does provide coverage for individuals whom Mass Health did not cover in the past; single individuals with no dependents, who are neither disabled nor have a limited work history.

For more information and resources go to:
www.hcfama.org
www.macommonwealthcare.com
www.massmedicaid.org
www.mahealthconnector.org
www.bmchp.org