Nov 04 2013

MassHealth and ObamaCare: The Unpleasant Reality

MassHealth's own version of the ObamaCare error screen.

MassHealth’s own version of the ObamaCare error screen.

It seems everyone wants to compare ObamaCare to MassHealth these days, and even creator Mitt Romney himself had difficulty coming up with differences in the two plans during the 2012 presidential elections. Healthcare reform began here in Massachusetts back in 2006 under then governor Romney – the program was aimed at providing health insurance to low income families and has an individual mandate. Punishment for not having insurance takes the form of a fine on your taxes. Employers with over 10 employees that do not provide insurance also get fined. Many people call MassHealth – and Obamacare – a safety net. Everyone will get medical care and everything will be sunshine and rainbows.

But is it really so wonderful? Let’s take a peek at what MassHealth actually looks like.

I work at a non-profit mental health clinic that serves low income individuals. My job includes providing mental health counseling, hooking up clients with appropriate medical services, getting reauthorizations and reimbursements from insurance companies for my services, and providing referrals to housing, medical, substance abuse, and financial services. Most of our clients have MassHealth, and the reality is that most cannot get the medical and mental health care they need. Under MassHealth, the state decides everything – what services you’re entitled to, what procedures you can get, what medications you’re allowed to take, which doctors you’re allowed to see. Dental includes fillings on visible teeth only. Otherwise one’s only option is extraction, so many MassHealthers end up without a single tooth in their head. Dentures and implants are not covered. Individuals report that their doctors treat them badly since their switch to MassHealth. Life-saving medications still cost them hundreds or thousands of dollars because MassHealth does not “authorize” their usage. People with severe mental health issues find many of their medications are also not authorized. The insurance often will not cover basic procedures like MRIs until every single lower-end option has been exhausted. Have a busted knee that requires surgery? They’ll tell you to go to physical therapy before actually taking an x-ray. At the hospital and need to be sent up to ICU? Better get permission first. Need emergency surgery? Need special permission for that too.

Another Massachusetts requirement is free mental health care for children and low income families, largely in part to the Rosie D court decision made in July of 2009. The state mandates that all Medicaid and Masshealth eligible children receive mental health screenings at no cost to the family. Masshealth offers some of the lowest reimbursement rates for these services, and has very strict rules on when, how often, and for what reasons someone can be seen for mental health. Masshealth requires a person to be diagnosed on the first visit, or they will not pay the provider at all. If the diagnosis itself does not meet enough requirements to be deemed “serious” or treatment is not considered “medically necessary,” they also will not pay. If you visit your therapist, and happen to have an appointment with any other doctor on the same day, Masshealth will not pay. All Masshealth, Medicare, and Medicaid have established rates for services, and will pay providers roughly 50-65% of the “allowed amount” for services – which usually ends up being around 30% of the bill. So, if you normally bill $100 for a service, you will receive $30, and are not allowed to make up the difference. As a result, mental health agencies are going out of business and people are losing jobs. Prices of services are going up to try and make the up difference through patients with private insurances.

In 2007, the fine for not having insurance was $219. Beginning in 2008, the fine jumped up to 50% of the average monthly premium for health insurance in Massachusetts and is adjusted by income. The 2013 tax year could have families facing a fine of nearly $1300 per uninsured person. That’s a good chunk of change. Employers that do not provide insurance are expected to pay $295 per employee to a Health Safety Net Trust Fund as well as a fine during tax season. Under ObamaCare, all those numbers are expected to go up.

The main reason cited for the birth of MassHealth was to decrease emergency room visits, decrease unpaid hospital bills, and make services more readily available. Years later, studies here still show that emergency room visits are steadily increasing and wait times in the ER have skyrocketed. Because MassHealth pays very little of the cost of care, hospitals and providers still, essentially, have unpaid bills. Further, many providers have simply opted out of accepting MassHealth – making services no more available than they were to begin with. Everyone else’s premiums rose as well, making MA’s premiums the highest in the nation. Cost of care went up. Patients often report that, after switching from private insurance to MassHealth, their providers are not as warm, not as friendly, and spend far less time with them.

And to those who would say, “But surely these people on MassHealth are under insured, and ObamaCare will give them better care” – nope. All MassHealth plans except for Commonwealth Care, the only plan with a premium, are ACA approved! When faced with the shortcomings of MassHealth, many ObamaCare supporters say that the two plans are very different, but the reality is that they’re not. So look out, America – this is what the rest of you have to look forward to.

1 ping

  1. Doctors Don’t Want ObamaCare Either » Liberty Doll

    […] « MassHealth and ObamaCare: The Unpleasant Reality […]

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