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State-sponsored
insurance plans slow to catch on
(July
2007 Issue)
By Phyllis Hanlon
According to the National Center for Health Statistics, 41.6 million
individuals under the age of 65 were uninsured in 2004. Several
states across the country are attempting to address this critical
problem. New England is making inroads but, in some cases, budgetary
concerns and other stumbling blocks are holding up the process of
implementing affordable and accessible health insurance plans for
all citizens.
Massachusetts has been hailed for its efforts to provide coverage
for residents. According to Alan Gruber, DSW, Ph.D., M.D., of Neurobehavioral
Associates in Hingham and president of the Massachusetts Psychological
Association (MPA), recruiting efforts are underway, but not many
people have subscribed to the new plan, dubbed Commonwealth Health
Care Connector (the Connector).
Gruber admits that he has had no direct experience with patients
under the Connector plan, but notes that other professionals are
finding little impact. "My hospital colleagues say just as many
uninsured are coming in now as before," he says. "Based on anecdotal
experience, very few new patients have the new policies."
The Commonwealth has launched an intensive state-wide awareness
campaign to boost enrollment. However, individuals with mental health
and poverty issues will probably fall through the cracks. Gruber
says, "They're less likely to enroll spontaneously. We have to create
a safety net for the psychologically impaired. We have to do more
than put up billboards."
While the Connector plans include mental health coverage, how they
establish internal policies is not yet known. "There are concerns
regarding higher deductibles and higher co-pays," says Gruber. He
adds that mental health professionals also have unanswered questions
about accessibility, authorizations, requirements for providers
and provider panels.
In spite of the problems with the Connector, Gruber expresses
pride in the state's efforts. "It's great that we've taken leadership
in trying to get all residents covered notwithstanding the shortcomings,"
he says. "The intent is wonderful."
According to Wayne F. Dailey, Ph.D., senior policy advisor in Connecticut's
Department of Mental Health & Addiction Services, discussions continue
regarding the best way to insure the state's 400,000 uninsured residents.
He notes that the current state government exists in an "interesting
dynamic," because of a Republican governor and predominately Democratic
legislature. Each side has its own proposal "floating in the legislature,"
according to Dailey.
Although the Connecticut legislature adjourned the first week in
June, no decisions regarding health insurance were reached. "They're
still deadlocked on the healthcare issue and it's unclear whether
they'll meet the Wednesday [June 6] deadline. They may go to special
session," says Dailey.
Jack Hutson, executive director of the Rhode Island Psychological
Association (RIPA), reports that although the state is seeking a
fiscally responsible way to insure its approximately 100,000 uninsured
residents, the situation remains "unsettled." He says, "The state
is trying to hit a $340 per month price point, but has been unable
to do this without imposing tremendous co-pays and deductibles."
Hutson reveals that as many as 20 mandates, four percent of which
relate to mental health, are preventing the state from moving forward
with healthcare insurance plans. He adds that Rhode Island is currently
trying to fill a $300 million budget deficit, which complicates
the healthcare picture. "Next year, we're looking at starting with
a $360 million hole," he says. Between significant cuts in Medicaid,
reimbursement issues and haggling over pharmaceutical costs, Rhode
Island has several challenges to overcome before designing an affordable
and adequate health insurance plan.
Gov. John E. Baldacci made insurance coverage for all of Maine
within five years the cornerstone of his campaign, says Sheila Comerford,
executive director of the Maine Psychological Association (MePA).
Approximately 140,000 uninsured call the state home.
In 2003, Maine implemented the Dirigo Health Program, which combines
public and private sector resources and has three components: healthcare
coverage, cost control and quality control. "The insurance is intended
for individuals and small businesses primarily, since they have
the most problem getting healthcare coverage. They would get discounted
premiums based on their ability to pay. There is no lifetime maximum,"
Comerford says.
Additionally, the plan heavily emphasizes wellness and mental health
care. "Dirigo covers 80 percent of the fee for 40 outpatient mental
health visits. The goal is to cover everyone by 2009," says Comerford.
However, the plan has met with some challenges along the way. Lower
than expected enrollment has disappointed creators of the plan.
Comerford reports that only between 11,000 and 13,000 residents
and 2,300 small businesses have enrolled. She anticipates that 140,000
residents will be covered by 2008.
Higher than anticipated premiums have also posed a problem. "In
2004, premiums were estimated at $180 per month for the employer
and $120 for the employee," Comerford says. "In 2006, the cost rose
to $219 for the employer and $146 for the employee."
Comerford notes that funding has proven to be one of the biggest
stumbling blocks. "Original funding of $53 million came from tobacco,"
she says. Additional fiscal support has been more difficult to generate.
A proposed annual tax of between two and four percent on premiums
raised a ruckus, according to Comerford.
In fact, the Maine Chamber of Commerce and the insurance companies
sued the state over the matter. "They don't want to pay the tax
and question its legality," she says. In response, the Governor
suspended collection of the tax, but recently reinstated it, Comerford
reports. "The state thought they'd be able to rely on bad debt charity
care. But that has not materialized."
Comerford says that the legislature is currently considering alternative
funding mechanisms, including possibly tapping the general fund
or imposing other types of taxes.
Mental health providers in the Pine Tree State have fared badly
under the plan, also. "Maine psychologists have seen no payment
yet," Comerford says. Despite the lack of reimbursement, she has
"heard no grumbling from psychologists."
In spite of the seemingly bleak picture, Comerford sees a couple
of bright spots. "Even though the [enrollment] numbers are small,
there is significant support in the legislature. There is a lot
of momentum going forward," she says. "Also, a blue ribbon commission
was established last year to look at other ways to fund the program."
Leslie Ludtke, health policy analyst for the New Hampshire Insurance
Department, reports that the Granite State does not have a plan
similar to those in the surrounding New England states.
Representatives from Vermont were unavailable to comment on that
state's Catamount Health plan for uninsured.
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