the rate of inflation every year. William van Fassen, CEO of Blue Cross Blue Shield, retired in late 2007 with $16.4 million in retirement benefits after having been paid a multi-million dollar salary before retirement.

Do an Internet search and see how much insurance company execs make, and don’t forget that they have stellar health insurance and great Golden Parachutes - which reminds us - the Massachusetts health insurance law allows board members of the Connector to receive pension benefits.

Those of lesser means (Commonwealth Care) are limited to five insurance plans, all with limited coverage territory. These are:

- BMC HealthNet
- CeltiCare
- Fallon Community Health Plan
- Neighborhood Health plan
- Network Health

It can be very difficult to find a primary care doctor or a specialist who will accept this insurance, especially for non-city dwellers. The Connector's list of participating doctors is often incorrect which can send a patient on a wild goose chase. Even if approved for the insurance, the patient does not become enrolled until he\she can find a primary care doctor who will accept the plan. 

What the Law Says - Primary Care Physician Shortage and the HMO business model

All Commonwealth plans are based on the HMO (managed care) business model, which requires a primary care physician.

What this means

A shortage of primary-care physicians existed in Massachusetts prior to this law. This problem has been exacerbated by the influx of newly-insured residents combined with the fact that many doctors will not accept Commonwealth Care or MassHealth members because the reimbursement rate is very low - they can’t afford to add staff and/or cover their overhead and support their families. There is also an enormous amount of paperwork and phone time involved because every procedure and lab must be approved. One doctor we spoke with recently said that he can spend an hour on the phone obtaining an OK from a CSR in Texas and be reimbursed next to nothing, so he had to make the hard decision to stop accepting subsidized plan members in order to have the time to focus on his other patients.

What this boils down to is: subsidized insurance - either free or with a premium - may allow more people to be covered, but they can’t find a doctor who will accept them. Many who live outside the Greater Boston area must travel long distances taking time off from work and spending precious money for gas to see a doctor they don’t know which discourages care. Some don’t drive, and for low-income folks in rural areas, there is no public transportation. Due to the lack of primary care doctors, others end up having to use the E.R. which is inefficient and costs much more. 

NOTE: Connector board members find a 50-mile radius acceptable. We were told that Commonwealth Care members in Franklin County have asked if they could see doctors in Vermont which is just across the border, but the Connector won’t allow this. Limited primary care doctors participating in the health plans also means long waits for appointments.

“Difficulties finding a physician were much more common for low-income than higher-income residents. And adults with state-subsidized health insurance were much more likely to be told that a physician was not taking their type of insurance - 24 percent - compared with those with private insurance, 7 percent.” Boston Globe, May 28, 2009. 

Many residents cannot continue to maintain their relationships with a specialist or hospital because neither are in the plan where the resident resides, or the specialist doesn’t take subsidized plan members. This is not good for continuum of care or patient morale. Some residents who want to continue seeing their primary care or specialist have to opt out of paying for the insurance in order to put aside money for their doctor visits and must also figure out how to ration their care because this is expensive.

A volunteer health care clinic in western Massachusetts, founded to help the uninsured population, has been taking Commonwealth Care members who can’t find a primary care physician. One of the board members wrote a letter that was published in the local newspaper stating that remediation of this problem is long-term, and that the quick implementation of Commonwealth Care did even consider this. He also pointed out that as our nation moves forward with trying to cover the uninsured, there must be careful review of physician availability by region as well as a structure to provide quality transitional care to the newly insured. It is important to note that in the case of this clinic, the service it is providing is at no cost to taxpayers because it is privately supported, therefore, the designers of any large-scale health care reform must provide for what this clinic is currently doing. 

We agree wholeheartedly. Three years into mandated health insurance, and neither the Connector or the Massachusetts legislators have even made a dent regarding this issue.

Massachusetts taxpayers were told this law was put into place so people would have access to preventative care. What we have described in this section is a definite barrier to care. I doubt this issue has been thoroughly considered for the national plan either. Just get ‘em covered as fast as possible; we’ll worry about making it work later. Health care reform can’t wait. 

The HMO managed-care scheme is supposed to be more efficient and save money but in reality is complicated, bureaucratic and prone to reduce patient care to numbers and paperwork rather than actual hands-on care. This system benefits the insurer at the expense of the patient.

The Connector "Seal of Approval" provides a near monopoly - all Commonwealth health insurance plans are HMO-based organizations. It is well understood by both the healthcare-consuming public and medical providers that the HMO business model's objective is to restrict rather than enable care.

» Read the next "What the Law Says" topic
  » See the Law Topic Index 

The Individual Mandate explained  /  The Connector Authority  /  Affordability  /  The Appeals Process 

Religious Exemption  /  Income estimation  /  Tax enforcement and Criminal penalties  /  Data Gathering

Estate Recovery  /  Insurance plan "lock-in"  /  State as health insurance  /  Primary Care Shortage