By Allison Scharmann '21
“There seems to be a problem with your insurance. Do you have another card?”
I froze. I had just gotten out of my first appointment at HUHS this November, and needed to pick up a prescription. Without thinking, I reached for the MassHealth card in my pocket and held it out to the pharmacy worker.
“I’m sorry, we don’t accept MassHealth,” she said in a sympathetic tone.
I began to panic, silently. I felt my throat start to choke up with anxiety. I needed the prescription. How much is it going to cost?...is the question I wanted to ask. I didn’t know the first thing about pharmaceutical prices, just the vague generalization that without insurance they can be very high. Instead, voice shaking, I said:
“I’ll pay for it.”
“It’s going to be twelve dollars.”
Relief washed over me as I handed over my debit card. I chalked the situation up to an an error. There was no reason for there to be any problem with my insurance, a plan backed by MassHealth. That is, until I received an eighty-six dollar bill in the mail.
How could this have happened?
MassHealth, Massachusetts’ Medicaid and Children’s Health Insurance programs, according to a 2017 report, serves almost 1.9 million people, over one in four residents of the Commonwealth of Massachusetts. 44% of members, myself included, have plans with private organizations that contract with MassHealth. It is part of the reason that over 96% of the Massachusetts population has health insurance. The drawback? It is far from easy to organize, and to navigate, a system that provides coverage to the amount of people MassHealth does.
When I called to ask the organization why my health insurance had been rejected, I was told my plan was no longer being offered. They told me I had been reached out to in order to select a new one, which never happened, and that I had been auto-enrolled in a new plan, despite my not receiving any other information. The organization attributed the confusion to a “computer error.” I requested information about my new plan and, in the meantime, paid the bill. I had two options: pay it myself, or trust MassHealth to cover it before the deadline. I decided it would be better to sacrifice the money and hope for a refund than risk hurting my credit score before I even had a credit card.
This new plan, part of an overhaul in the MassHealth system, assigned me to a doctor near my home in Western Massachusetts. The overhaul, which launched on March 1st, placed around 800,000 MassHealth enrollees in plans within Accountable Care Organizations (ACOs), or groups of doctors and hospitals which collaborate in order to serve patients. It is intended to streamline care and help curb the system’s over $16 billion annual budget. Those who did not choose a plan ahead of time were automatically enrolled in a plan. Considering I attend college in Cambridge for the better part of each year, a plan that only allowed me to see doctors two and a half hours away was not going to work.
After hours of dialing phones and being put on hold, a team effort between myself and my father, I was able to switch to a plan that gives me freedom to change my primary care provider whenever necessary and pick up prescriptions after HUHS visits covered by Harvard’s Student Health Fee. The process was difficult and lengthy but I was lucky. I had the support of my father and I have minimal healthcare needs outside of primary care. Others, in the wake of this new rollout, may not be so lucky in navigating the complicated system.
Information and instructions regarding the new system are inaccessible and difficult to understand, as evidenced by the Greenfield Recorder’s reporting of the 40,000 phone calls MassHealth received March 1st when the changes went into effect. Beyond the information gap there are issues with the new coverage itself. For those who require more specialized care, the ACOs may restrict their access to doctors and hospitals outside of their assigned, or chosen, network. Members have until June 1st to change providers and plans, after which they’ll be locked in for nine months.
A potential cure for many concerns not only with the MassHealth system, but with health insurance in the Commonwealth more broadly, is under consideration by the Massachusetts State Legislature. State Senate Bill 619, which the Harvard College Democrats will lobby for later this Spring, would establish a Massachusetts Health Care Trust to “cover all Massachusetts residents in a single payer health care financing system.” The move from the Affordable Care Act to a single payer system, oft debated at the federal level, hits close to home in Massachusetts. The Commonwealth’s own healthcare system was the inspiration for Obama’s sweeping healthcare policy. Ideally the system would curb costs while expanding both health insurance attainment and services covered in the Commonwealth. The bill is in committee awaiting an April 28th reporting deadline.
In the meantime, myself and 1.9 million other MassHealth consumers are left not only to puzzle out what changes in our healthcare have just occured, but also watch for those to come. On the bright side, I finally got my refund check!