Massachusetts health reform builds momentum

But will a physician shortage lead to long waits for enrollees in the state's new insurance plans?

By Doug Trapp — Posted Oct. 1, 2007

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Kelly Tondo and her husband have had health insurance on and off for several years, beginning in 2001 when he left his job to start an espresso machine company.

The Tondos, of Methuen, Mass., tried a family policy through their local chamber of commerce, but the monthly price nearly doubled from $932 in 2004 to $1,735 this year. They tried catastrophic coverage, but it only took care of emergencies.

Their children eventually qualified for Medicaid, but the couple did not find affordable plans for themselves until Massachusetts unveiled its Commonwealth Health Insurance Connector late last year. Now they each pay $106 a month for one of the state-subsidized Commonwealth Care plans. The state waives the $86 monthly Medicaid premium for their kids.

Tondo couldn't be happier. "I would give [the experience] a nine or a 10. I'm just so grateful because I've been through the loop," she said.

The Tondos are two of at least 105,000 people in Massachusetts who signed up for Commonwealth Care plans between Nov. 1, 2006, and Aug. 1, 2007. Those earning up to 300% of the federal poverty level without access to employer-sponsored insurance qualify for these plans. Those earning less than 150% of poverty qualify for free insurance with minimal, if any, co-payments.

Another 5,000 people enrolled in unsubsidized Commonwealth Choice plans between July 1 and Aug. 1, said Dick Powers, spokesman for the Connector Authority, the board implementing the reforms. This coverage is for those earning more than triple the poverty level without access to insurance from an employer.

These new insurance options are part of Massachusetts' massive health reform package, adopted in April 2006 and implemented in phases starting in October of that year. Coverage is provided by privately run but state-supervised health plans. The reforms also established mandatory health insurance, a first in state health reforms. Those who remain uninsured this year face a financial penalty of $219 on their 2007 taxes, with higher penalties in 2008.

But will there be enough physicians to see the Commonwealth Care and Choice enrollees? For the second year in a row a Massachusetts Medical Society survey reported a shortage of primary care physicians.

There have been anecdotal media reports about Commonwealth Care enrollees calling dozens of physicians before finding one who would accept new patients. But that may be the extent of the issue, at least in the short term.

Tondo, for example, had to check with several physicians before finding one who was accepting new patients. "That part was a little difficult."

Patricia A. Sereno, MD, president of the Massachusetts Academy of Family Physicians, said people with existing insurance aren't having trouble accessing doctors, but she's not sure about new enrollees, including those in the Connector plans. Dr. Sereno said physicians can't tell if they're seeing enrollees from one of the Connector plans because the coverage is handled by private insurers. But any of her patients might have to wait several weeks for a routine appointment, she said.

The Connector Authority's Powers said that in "only a handful of cases" have enrollees had trouble accessing physicians, and all were guided to a doctor by the Connector's customer service representatives. Also, the four managed care organizations offering Commonwealth Choice plans have signed up more than 1,000 primary care physicians between late last year and July 31.

Network Health, which has about 46,000 Commonwealth Care enrollees, hasn't seen an increase in complaints in its customer service system. The company has added more than 600 physicians to its network in the last three months, said Deborah Gordon, the company's marketing director.

Christine Cassidy, a spokeswoman for Fallon Community Health Plan, the smallest of the four participating insurers, said it contracted with enough doctors ahead of time to handle its 2,000 Commonwealth Care and 800 Choice enrollees. "We're not seeing a problem on our end of things."

The MMS isn't aware of any specific physician access problems. But the society's 2007 Physician Workforce Survey reported a critical shortage of internists and a severe shortage of family physicians, just as there was in 2006. MMS President Dale Magee, MD, said half of medical school graduates would have to become primary care physicians to meet the demand, but at most only 35% choose that route.

Uninsured count dips

Although the Connector plans are reducing the number of uninsured people, that group is still large.

Massachusetts' uninsured population declined by about 40,000 between January and July, to 355,000, according to a survey of 10,500 adults by the Massachusetts Division of Health Care Finance and Policy released in late July.

The state's count is likely too low, said Brian Rosman, research director for Health Care For All, a state patient advocacy organization that supported the Connector reforms. A recently revised U.S. Census Bureau estimate indicates 653,000 Massachusetts residents were uninsured on average between 2004 and 2006. An accurate number is likely somewhere between the census count, which typically overestimates the uninsured, and the state count, which underestimates it, Rosman said.

More people are enrolling in private insurance, the state's Powers said. In May and June about 12,500 people signed up for non-Connector private coverage offered by insurers that are participating in the program.

Issues worth watching

The Connector board has made most of its tough decisions about how to implement the reforms, but there are still some issues to watch.

In October, businesses that provide little to no insurance to workers will start paying $295 per employee per year. Rosman said some attorneys argue this fee violates the federal Employee Retirement Income Security Act, which exempts certain -- mostly larger -- employers from state insurance mandates. As of press time no one had filed a lawsuit.

Next year residents without insurance could face a penalty of up to half the annual cost of an affordable insurance plan in their area, but the Connector board hasn't finalized those regulations, Rosman said.

A long-term issue is the balance between keeping insurance plans affordable and state subsidies under control, said Michael J. Widmer, president of the Massachusetts Taxpayers Foundation. "That tension is embedded right in the center of the reform," he said.

The MMS's Dr. Magee said he's comfortable with the progress of the Connector reforms. "I think they're framed well," he said.

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Short staffed

For the second straight year, Massachusetts is short of family physicians and internists, among other types of physicians, says an annual Massachusetts Medical Society survey released in late July. The report found that:

  • 70% of physicians are having difficulty filling physician vacancies.
  • 32% of practicing physicians said physician supply problems have made it necessary to alter the services they provide.
  • 42% of patients in 2007 were able to see a primary care doctor in a week, down from 53% in 2006.
  • 72% of physicians said their patients are having difficulty getting timely specialist consults.
  • 68% of teaching hospitals and 83% of community hospitals said they are experiencing trouble filling physician vacancies.

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External links

Massachusetts CommonwealthConnector (link)

CommonHealth, a blog maintained by Boston radio's WBUR 90.9 (link)

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