Wednesday, September 16, 2009

The Massachusetts Model: Care-Keeping Costs

"Costs are keeping patients from care; Copayments rise as families struggle" by Kay Lazar, Globe Staff | June 21, 2009

People with robust health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

Not that long ago, such dilemmas were typically faced by lower-income families, often on publicly subsidized insurance. But with many consumers struggling to pay rising healthcare costs amid today’s shrinking family budgets, these tough choices are becoming commonplace - even among families with employer-provided health insurance, consumer advocates say....

You know what? There really is no choice.

END the WARS, no more BAILOUTS, and GIVE US DECENT, GOOD, QUALITY health care like those other places get!

Mark Rukavina, executive director of the Boston-based Access Project, a nonprofit organization that helps consumers with healthcare issues: “Previously it was the uninsured. Now we are seeing people with insurance, but they are struggling to pay their bills.’’

The problem appears particularly acute for people with chronic illnesses such as diabetes, asthma, and cancer. They make frequent visits to doctors and often take multiple medications.

The issue has become so widespread that state lawmakers have scheduled a hearing Wednesday to address aspects of the problem, including a proposal to allow residents with chronic illnesses to buy prescribed medications and medical devices without facing a copayment or deductible.

As healthcare costs rise and the recession’s grip has tightened, more employers have slashed their health costs by shifting more costs onto their workers, according to Families USA, a Washington-based consumer group. As a result, more employees are shouldering heftier copayments....

When you can LEAST AFFORD IT, worker!

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And the lesson from the model, America?

As part of Massachusetts’ pioneering 2006 healthcare overhaul, the state created the Safety Net program, which helps people of any income pay large medical bills. But it specifically excludes coverage for copayments.

“Oftentimes, these people end up using their credit cards to pay their copays and end up with medical debt,’’ said Kate Bicego, help line manager at Health Care for All, one of the state’s largest consumer groups....

Oh, that is JUST PERFECT, isn't it, cui bono?

Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, said the state’s Connector Authority, which oversees the 2006 law that requires most adults to have health insurance, carefully considered the issue of high copayments and deductibles when it crafted rules that define the minimum health plan a resident must have in order to avoid a tax penalty.

They get you either way (and now I need to see a doctor about that butt poke)!

Those rules generally say out-of-pocket costs - deductibles, copayments and other patient fees - cannot exceed $5,000 for individuals and $10,000 for families, but allow copayments and deductibles for prescription drugs to be excluded from the calculation.

For people who are ALREADY TAPPED OUT!

“The state struck a delicate balance to make sure individuals have adequate coverage, while guarding against standards too few could afford,’’ Buyse said....

And NOW we are OUT of BALANCE, big time!!!

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