Transcript for the Piece Audio version of Health Reform Part 3 - Who Benefits from Massachusetts Public Programs

WHEN MASSACHUSETTS PASSED ITS 2006 LAW REQUIRING EVERYONE TO HAVE HEALTH INSURANCE, LEGISLATORS REALIZED THEY'D HAVE TO HELP MANY PEOPLE GET THAT INSURANCE. SO THEY CREATED A NEW PUBLIC HEALTH PLAN FOR PEOPLE MAKING UP TO THREE TIMES THE FEDERAL POVERTY LEVEL. ALMOST A QUARTER OF A MILLION PEOPLE - WHO WERE UNINSURED -- ARE NOW GETTING FREE OR SUBSIDIZED HEALTH CARE. HOWEVER, THERE ARE STILL HOLES AND COMPLICATIONS WITH THE NEW SYSTEM – AND QUESTIONS ABOUT ITS LONGTERM VIABILITY. IN THE LAST OF A SERIES ON MASSACHUSETTS HEALTH REFORM, WFCR’S KAREN BROWN REPORTS.

[OUTCUE, if time: KAREN BROWN’S SERIES ON MASSACHUSETTS HEALTH REFORM WAS MADE POSSIBLE BY A KAISER FOUNDATION FELLOWSHIP.]

IT'S NOT HARD TO FIND PEOPLE WHO HAVE BENEFITTED FROM MASSACHUSETTS' GREATLY EXPANDED HEALTH PROGRAMS.
“can I help the next person?” FADE UNDER
START AT THE HOLYOKE HEALTH CENTER, A DOWNTOWN CLINIC IN THIS FORMER MANUFACTURING CITY. JEFFREY, A 53-YEAR-OLD PART-TIME JANITOR WHO DIDN’T GIVE HIS LAST NAME, IS WAITING IN URGENT CARE WITH STOMACH PAINS. BEFORE HE LEARNED OF COMMONWEALTH CARE – THE STATE’S NEW HEALTH PLAN – HE HADN’T SEEN A DOCTOR IN YEARS.
They told me, if you make less than this amount of money, come here, and I qualified.
0:22:10.5 KB: & what was that like to have health insurance?
0:22:13.5 JEFFREY: a good feeling. just a big load off the shoulders.
(coughs)

SIXTY-TWO-YEAR-OLD GLADIAS PACHECO IS A RETIRED FACTORY WORKER BEING TREATED FOR DEPRESSION AND HEART DISEASE. SHE RECENTLY QUALIFIED FOR THE STATE’S MEDICAID SYSTEM, WHICH WAS EXPANDED UNDER THE HEALTH CARE LAW. A STAFF MEMBER TRANSLATES.
'before she got mass health, she had to pay for some of her meds, not all.... "so things are better now?" Si, gracias a dios.
FOR PACHECO, THEY ARE. BUT FOR MANY OTHERS, THE SYSTEM IS NOT WORKING. VIRGINIA O'CAMPO IS A 47-YEAR-OLD COLOMBIAN IMMIGRANT WHO MAKES 1500 DOLLARS A MONTH AS A HOTEL HOUSEKEEPER. SHE NEVER TOOK UP HER EMPLOYER’S OFFER OF HEALTH INSURANCE – BECAUSE HER SHARE OF THE PREMIUM WOULD HAVE COST HER ALMOST HALF HER SALARY. FOR YEARS, SHE’D BEEN GETTING MOSTLY FREE HEALTH CARE AT COMMUNITY CLINICS. AFTER THE HEALTH LAW PASSED, SHE THOUGHT SHE QUALIFIED FOR COMMONWEALTH CARE. HER SON JOHANN GOMEZ TRANSLATES.
0:32:53.9 VC: porque fui al medico porque unas boracherras que me daban. y pague diez pesos la semana ....0:33:09.2 TRANSLATION: she was having dizzy spells, & so she went to the doctor... she got the letter that said you need to fill out what’s going on, & that's when they told her okay, you're not covered anymore.
THAT’S BECAUSE COMMONWEALTH CARE DISQUALIFIES ANYONE WHO TURNS DOWN AN EMPLOYER-SPONSORED PLAN, WHATEVER THE REASON, EVEN IF THEIR SALARY IS OTHERWISE LOW ENOUGH. THEN THERE ARE PEOPLE WHO DO QUALIFY FOR THE STATE PROGRAM.... BUT FIND IT VERY COMPLICATED TO SIGN UP. ONE PHONE CALL TO THE STATE’S HEALTH PLAN CAN LAST HOURS, AND IT OFTEN TAKES SEVERAL MONTHS TO GET APPROVED OR DENIED. 23-YEAR-OLD TYLER GORMAN WAITED HALF A YEAR TO GET INTO COMMONWEALTH CARE. THE ASPIRING PUNK ROCKER LIVES WITH THREE HOUSEMATES IN HADLEY. WHILE HE WAS TRYING TO GET INTO COMMONWEALTH CARE, HE WAS MAKING $800 A MONTH AS A BABYSITTER AND PAYING $200 FOR A PRIVATE HEALTH PLAN. HE STARTED TO RATION HIS FOOD.
TYLER2: 0:03:25.8 TG: just no one seemed to know what they were talking about, any of them. And the pp in the Springfield were like angry I was asking them things 0:04:05.7 ... just the worst customer service i guess i've ever had to deal with....just really annoying bc they were constantly sending me all over.

HEALTHCARE PROVDERSARE ALSO FRUSTRATED WITH THE ADMINISTRATIVE PROBLEMS – LIKE LOWER AND LATER PAYMENTS. IT ALSO FALLS ON HOSPITALS, CLINICS, AND CONSUMER GROUPS TO EDUCATE THE PUBLIC ABOUT THE NEW PLANS.
IT HASN'T HELPED THAT THE STATE SLASHED THE BUDGET FOR OUTREACH AND EDUCATION. ADVOCATES SAY IT'S EVEN HARDER FOR NON-ENGLISH SPEAKERS AND IMMIGRANTS, MANY OF WHOM DON’T REALIZE THEY COULD BE UNENROLLED IF THEY DON’T REAPPLY EACH YEAR. OTHERS ARE DROPPING OUT OF COMMONWEALTH CARE BECAUSE THEY CAN'T AFFORD EVEN THE SUBSIDIZED PREMIUM OR CO-PAYS. MANY OF THESE SAME PEOPLE GOT FREE CARE THROUGH A SPECIAL STATE FUND FOR THE UNINSURED – A POOL OF MONEY THAT HAS BEEN DRASTICALLY SHRUNK. THAT’S ONE REASON CAMBRIDGE-BASED DOCTOR DAVID HIMMELSTEIN – A SINGLE PAYER ADVOCATE -- BELIEVES THE PUBLIC PROGRAMS WERE A FALSE PROMISE.
DH: I'm not a politician, I'm a doctor. what i see is that actually a lot of my patients are worse off w/ the reform than they were before it.
(CLINIC AMBI – do you have any chronic conditions…? I have diabetes…FADE UNDER)
BACK AT THE HOLYOKE HEALTH CENTER, ADMINISTRATORS HAVE MIXED FEELINGS ABOUT THE STATE'S HEALTH COVERAGE. ON THE ONE HAND, SAYS MEDICAL DIRECTOR JACQUELINE SPAIN, LOW-INCOME PATIENTS WHO USED TO GET ONLY EMERGENCY CARE HAVE MANY MORE OPTIONS.
SPAIN: a colonoscopy. or a mammogram, or cancer treatments …things that are very challenging to get for an uninsured patient , now they're able to get it for them & that's wonderful.

BUT SHE SAYS BASIC PREVENTATIVE CARE – A MAIN GOAL OF HEALTH REFORM -- HAS NOT MATERIALLY IMPROVED. THAT'S BECAUSE THERE AREN'T ENOUGH PRIMARY CARE DOCTORS TO TAKE CARE OF THE EXPLODING DEMAND – ESPECIALLY AMONG THE NEWLY INSURED. BUT KATE BICEGO OF THE CONSUMER GROUP HEALTH CARE FOR ALL THINKS THEY’RE STILL BETTER OFF NOW THAN THEY WERE BEFORE.
BICEGO: 0:27:23.5 ...Massachusetts may not be the perfect model. it isn't the perfect model obviously, we have people falling through the cracks, we haven't covered everyone. it definitely has proven what we can do. we can insure a huge amount of people in a little amount of time … & will save lives & will save money through out the long run.

IN THE SHORT RUN, THE PROGRAM IS COSTING ABOUT 900 MILLION DOLLARS A YEAR. TO KEEP IT SUSTAINABLE, THE STATE DECIDED TO LOWER REIMBURSEMENT RATES TO DOCTORS AND HOSPITALS. THE LEGISLATURE IS ALSO CONSIDERING REDUCING MEDICAL BENEFITS UNDER COMMONWEALTH CARE, AND TAKING AWAY COVERAGE FOR SOME GROUPS, SUCH AS REFUGEES. THAT’S WHY LEGISLATORS, CONSUMERS AND ADVOCATES – IN MASSACHUSETTS AND BEYOND -- ARE LOOKING CLOSELY AT WHETHER THE GAINS OF MASSACHUSETTS HEALTH REFORM CAN KEEP UP WITH THE COSTS, AND WHETHER IT COULD, OR SHOULD, BECOME A NATIONAL MODEL.
I'M KAREN BROWN.