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Access to health insurance in Mass. still complicated, inconsistent

Access to health insurance in Mass. still complicated, inconsistent

ncqaThe truth about the health insurance system is it’s just very complicated,” “there are people who are truly ineligible for subsidies, people who don’t know the subsidies are available, and people who, even with the subsidies, insurance is too expensive,” Boros said.

A recent survey about health insurance access and costs reveals that while Massachusetts still leads the nation in the percentage of insured residents, health-care costs continue to outpace inflation and income growth, leading roughly one in six respondents to forgo medical care because of potential costs.

In terms of long-term trends, Massachusetts has led in the percentage of those with insurance but has struggled with high cost of health care for many years and families have had to adapt to that for many years,” said Aron Boros, executive director of the Center for Health Information and Analysis, which undertakes the annual survey.

But Mr. Boros said he was surprised to see that the survey revealed that health insurance for many is inconsistent.

“One thing that surprises me is that even though we have an insurance coverage rate of 96 percent, there are still a large number of people (13.6 percent ) who are uninsured at some point in the year,” said Boros. – best coffee grinder

The Center for Health Information and Analysis undertakes an annual survey to gauge health insurance coverage, health care access and use, and health care affordability for state residents. The survey was administered between May and August and involved 5,002 individuals including children, adults between 19 and 64 and adults aged 65 or older.

The survey includes findings that:

– Massachusetts continues to lead the country in the percentage of residents with health insurance in 2015, with 96.4 percent of residents covered by health insurance versus 90.8 percent of residents nationwide.

– 87.3 percent of the uninsured in Massachusetts in 2015 are working age adults and were disproportionately likely to be male, single, Hispanic and with a family income of less than $46,800 a year. Many of these uninsured may be eligible for Medicare or subsidies for health care.

– One in six respondents reported an unmet need for health care because of cost, and one in five reported an unmet need for dental care due to cost. Moreover roughly one in six respondents reported difficulty paying family medical bills in the last year.

– More than half of those who are uninsured cited the cost of coverage as a key factor in their decision, the most cited response.

– 13.6 percent of respondents reported changing to their current form of coverage from being uninsured at some point in the past in 2015.

Mr. Boros said health care and the care system is so complex that it was difficult to give any one explanation to why people remained uninsured when subsidies are available.

The truth about the health insurance system is it’s just very complicated,” “there are people who are truly ineligible for subsidies, people who don’t know the subsidies are available, and people who, even with the subsidies, insurance is too expensive,” Boros said.

Looking closer at the issue in Worcester – where approximately 20 percent of the population is Latino and the median income is $45,994, according to the 2015 Greater Worcester Community Health Assessment – supports this statement.

Ivelisse Delgado, reception/benefits supervisor at the Edward M. Kennedy Community Health Center, said that most of the center’s uninsured patrons haven’t decided to reject health insurance – in fact, they often don’t realize they lack insurance.

Most of them are coming in with inactive insurance,” Ms. Delgado. “They have lost their coverage, and we see more of those people coming in than anything else.”

Ms. Delgado said that most of these patrons have been dropped from Medicaid/MassHealth for failing to renew their insurance, provide proof of income and residency, or other documents necessary to retain coverage. The health center does not keep statistics on the ethnicity of its uninsured patients without insurance. But the center services clients who speak nearly 100 different languages (Spanish is the second most common language after English) and many clients are new to the area and/or new to the country, Ms. Delgado said. Language barriers, a lack of cultural awareness or lack of access to information can also make the renewal of insurance difficult.

So Ms. Delgado oversees the effort to help patients and community members sign up for or re-enroll in health insurance.

Staff educate clients on the benefits of insurance in terms of receiving medical care and avoiding tax penalties. If the client desires, staff will help them evaluate insurance options, select a plan, and fill out the application for coverage.

Ninety-six percent of patients who participate in the process are approved for insurance, Ms. Delgado reported.

The health center also has a federal grant to offer insurance-counseling services throughout the community, giving presentations or offering walk-in services at various locations in the Greater Worcester area.

Through these services, the health center assists 11,000 people a year, and enrolls an average of 8,000 people a year in health insurance, according to Paula Green, vice president for advancement.

As for cost of health care, the health center offers a sliding fee for services dependent on income, so Ms. Delgado said that they are not having patients report that they are forgoing care because of ability to pay.

But other data presented puts the issue of affordability in sharper focus.

The Health Policy Commission’s 2015 cost trends preliminary report, presented last week, raises concerns about a 6.3 percent premium increase scheduled to take effect in January in the state’s merged insurance market. The preliminary report also notes a 5 to 6 percent increase in U.S. health care spending growth in 2015 – a larger growth than in recent years – and that increases in health insurance premiums have outpaced income gains, consuming more than 40 percent of family income growth since 2005.

The presentation was optimistic, however, about low rate of growth in physician and hospital services, a well-functioning Health Connector website “marketplace for insurance,” and stabilizing numbers of enrollees in Medicare.

But it echoed the CHIA report in reporting that 16.9 percent of residents reported an unmet need for health care due to costs. Furthermore, 19 percent of Massachusetts residents paid more than $3,000 out of pocket for health care, 17 percent of residents were paying off old medical bills and, of these, 9 percent owed more than $8,000.

Mr. Boros said that the CHIA survey is trying to better analyze such costs by including, for the first time this year, questions about medical debt and access to care non-physician healthcare providers who generally offer lower cost services.

One of the principals of health care reform is that you always want to have right care at the right time and in the right setting, and you always want to pay the smallest amount for the right care,” Mr. Boros explained.

But he said that a lack of a multi-year data set concerning access to non-physician service providers makes it difficult for CHIA to suggest policy changes and to see if this is a trend.

But David Auerbach, deputy director for research, at the Health Policy Commission, said that Massachusetts is one of the most restrictive states in the types of services a nurse practitioner can provide, primarily because Massachusetts does not allow nurse practitioners to prescribe drugs or work without an affiliated physician. Mr. Auerbach also referred to the commission’s prior work on this issue that concluded these restrictions may represent an unnecessary barrier to cost-effective care, and that nurse practitioners are, nationally, more likely to treat poor, minority or rural populations.

Dr. Dennis Dimitri, president of the Mass. Medical Society, said that pairing physicians with nurse practitioners, nurse assistants and other non-physician care providers enable a collaborative, team approach that can provide a wider range of expertise. Dr. Dimitri described this as part of an “integrated model of care” that aligns care providers to offer patients’ many levels and types of services. But this model also consolidates services among a few provider networks. So asked whether this model – which Dr. Dimitri said was increasing in medical systems – was cost effective, Dr. Dimitri gave a familiar response…

That’s tough to answer,” Dr. Dimitri said. “Economists always warn of reduced competition…but what I described to you can also lead to control of costs. If you have multiple points of care monitoring conditions you can avoid unnecessary emergency department visits, unnecessary re-admissions; it’s preventative, so heart disease or diabetes can be managed and isn’t out of control and then you encourage large efficiency.”

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