Yesterday’s Boston Globe included a front page story on the problems of underinsurance. Underinsurance is a glass half-full/half empty story. It’s a real problem, but we’re making progress.
The Globe cited results of an unreleased Globe-Blue Cross Blue Shield of MA Foundation study that found that some of Massachusetts’ insured residents have plans with significant cost-sharing that create barriers to needed medical care. According to the survey, 13% of insured residents have unaffordable medical bills and 9% said they were forced to forgo or delay needed medical care because of their medical debt. Some 14% have failed to fill a prescription in the last year because they could not afford the cost-sharing.
This is not surprising – it’s not a new phenomenon, nor is it isolated to Massachusetts. In fact, underinsurance rates are decreasing in Massachusetts (thanks to health reform) and they are far lower in Massachusetts than they are in other states. The article also cites the recent Urban Institute study that found that the state’s underinsurance rate has dropped substantially since health reform implementation began and that underinsurance is a problem for three times more people nationally than in Massachusetts.
Underinsurance is a major threat and one that Massachusetts must continue make strides against. The ultimate goal of health reform is access to care not just access to coverage. Having an insurance card does you no good if you can’t get access to the care that you need. Thanks to health reform, we have the tools we need to take this threat head-on. The legislature wisely included two provisions to address underinsurance in Chapter 58 – the Minimum Creditable Coverage standards (adopted by the Connector, they set the baseline of insurance coverage that residents must have to satisfy the individual mandate) and the Minimum Coverage Standards (to be adopted by the Division of Insurance, they will set the baseline of insurance coverage that can be sold in Massachusetts). Only by ensuring adequate MCC and Minimum Coverage Standards can we ensure that the coverage that is sold in Massachusetts, and the coverage that people must buy to satisfy the individual mandate, provide all insured with adequate access to care for their basic health care needs.
Lisa Kaplan Howe
“Underinsurance is a major threat and one that Massachusetts must continue to make strides against.”
Much like the Commonwealth Choice Bronze plans, where coverage is skimpy and premiums outrageous.
Great job on the healthcare reform.
These uncertain economic times add an additional variable to the landscape of medical debt due to gaps in coverage and underinsurance. As the BCBS Foundation study found, there is real pain associated with inadequate coverage. We at Health Law Advocates can attest to that fact as we have seen our case load due to medical debt triple in the past 12 months, from 53 to over 150 cases. In addition to developing and enforcing good MCC standards, state government and health insurance carriers have to be vigilant about some other factors that we see adding to the incidence of medical debt in these hard economic times. For example, there are employers who are taking health insurance premiums paid by employees and not remitting either the employees’ or the employer’s premiums to the health insurance company. The result is cancellation of the policy by the insurer but there is lag in notice and consumers end up incurring medical costs not knowing they had no coverage. Similarly, consumers who are wrongfully terminated from state-subsidized insurance, but for which consumers pay a premium, suffer the same fate. They incur medical bills thinking they have insurance but then learn they are uncovered and obtaining retroactive coverage is oftentimes a difficult battle. In this economy, consumers can ill-afford any gaps in coverage or lack of adequate coverage for necessary treatment. When these events occur through no fault of the consumer, state and carrier policy should serve to protect the innocent consumer and not add additional hardship.