Home budget plan would make mass healthcare more affordable – CommonWealth Magazine

MASSACHUSETTS HEALTHCAREit’s the best in the nation, but assistance is still out of reach for too many residents. From doctor visits to life-saving medications, too many people cannot access vital services when they need them. Fortunately, a House proposal is currently under consideration by the conference budget committee that would provide significant cost relief for these residents across the state.

Doctors and patients alike recognize the urgent need to make healthcare more accessible and more equitable. Doctors know all too well the consequences when their patients forgo follow-up care or prescribed treatments because they can’t afford them, and consumers often seek help finding coverage options they can afford. At a time of rising costs across the board, we must pursue more affordable coverage options for all Commonwealth residents.

That starts with making sure everyone can get and stay covered. As the state is now reviewing eligibility for MassHealth, the state’s Medicaid program for the first time since the pandemic, there is a risk that people will lose their insurance coverage or land on a plan that is too expensive for them because their income is now too high to qualify for the state-funded insurance program, ConnectorCare. It has never been more important to ensure there are affordable coverage options for people who learn they are no longer eligible for MassHealth to ease their transition and maintain our best national insurance coverage rates.

Access to affordable health insurance is also a matter of health equity. Despite our high coverage rates, over 40% of residents report difficulty providing care, and Black and Hispanic/Latino residents are more likely to report difficulty providing care than their white counterparts. One report found that 75 percent of black adults and 68 percent of Hispanic/Latino adults in Massachusetts face difficulties offering care compared to only 46 percent of white adults. The disparities are actually starker for those who exceed the ConnectorCare eligibility level due to a lack of affordable coverage options.

The two-year pilot program included in the House budget would address these challenges by expanding eligibility for ConnectorCare. Individuals and families earning up to 500 percent of the federal poverty level (about $73,000 annually for an individual) would become eligible for insurance with reduced premiums and minimum dues and deductibles under the pilot. An estimated 47,000 to 70,000 Massachusetts residents would again be eligible for the cheaper coverage. Leveraging savings from increased federal subsidies, the pilot project would require no additional state funding.

The expansion would almost certainly help Debbie, who lives in Brookline and cares for her husband with Alzheimer’s. She has been on MassHealth for several years but in the last year her husband’s Social Security income has increased and now, with the end of MassHealth’s coverage protections, she knows she will have to find coverage elsewhere. Unfortunately, Debbie’s income places her just above current eligibility for the state’s low-cost ConnectorCare program. Her remaining option is a plan too expensive for her budget, costing more than $300 a month in premiums and with a $3,000 deductible. Debbie takes medication to manage her arthritis, high cholesterol and high blood pressure, and worries about the cost of more co-pays adding up to a more expensive plan.

Even Arthur of Newton experienced this challenge firsthand. The only health insurance plan he and his family of three could afford has a $4,000 deductible, which leaves them with onerous out-of-pocket expenses like a $150 fee for a doctor’s visit and a $260 fee for a blood test. These costs make Arturo worried about future care for his family.

Massachusetts doctors too often patients like Debbie and Arturo are worried and this has a negative impact on patients’ health. When patients cannot afford the care they need, they often delay or forgo that care, leading to adverse health outcomes that could have been avoided had they been able to access and afford the care they need.

For tens of thousands of Massachusetts residents, like Debbie and Arturo, the ConnectorCare expansion pilot would make a huge difference in their lives, giving them access to plans with lower premiums and much lower cost sharing so they don’t should worry about offering future care. . We are close to achieving this policy milestone and hope that the proposal will be included in the final conference budget to help make Massachusetts more accessible to these health care consumers.

Massachusetts has a history of coming together to take on big challenges. This is the time for us to do it again to address this moment and ensure that everyone can afford access to the coverage and care they need.

Amy Rosenthal is executive director of Health Care For All. Dr. Barbara Spivak is president of the Massachusetts Medical Society.