20% of VIM’s target patient population is uninsured for at least part of the year; 5% all year. Even here in Massachusetts, where “universal” coverage was enacted in 2006 under the Commonwealth Care program, there are still huge gaps. The Blue Cross Blue Shield Foundation of Massachusetts, in conjunction with The Urban Institute, has conducted periodic surveys to determine the effectiveness of the commonwealth’s program.  Although we are among the best in the nation in total coverage, there are significant gaps among key segments of the population.  The most recent survey found more than 20% of non-elderly adults (19-64) with incomes under 300% of the Federal Poverty Guideline (VIM’s patient profile) were without health insurance for at least part of the year and about 5% had no coverage at all during the previous year.  As recently as last summer, the Gallup Organization conducted a similar phone survey with similar results.

 

There is a critical shortage of primary care physicians in Berkshire County. The Massachusetts Medical Society’s Annual Workforce Study found a “critical” shortage of primary care physicians in Berkshire County.  This has been an ongoing problem and shows no sign of significant easing in the near future.  So, even if you have insurance it can be very difficult to find a doctor who is taking on new patients.  And if that insurance is Medicaid (MassHealth), you will find even fewer practices that will accept it. Even those with good employer provided insurance or Medicare often have to wait many months to see a doctor.

Omit Finally More than Half

Many VIM services are not covered under the Affordable Care Act. Finally, more than half our patient visits are for healthcare services that are not even covered under the ACA. Adult dental services, which constitute more than 1/3 of our patient visits, are not covered. Nor are acupuncture, therapeutic massage or nutrition counseling which, together, add almost 20% more visits for uncovered services..

Omit About half our medical

About half our medical visits are with patients who are only temporarily without insurance. To begin with, there are those who are temporarily without insurance – the difference between the 20% and 5% cited above. They may have recently lost a job or missed a premium payment and been dropped from the system. We address the patients’ health care issues and work with them to get reinstated. This can take as much as three to six months, or even more, once they can afford it. These patients may account for as many as half of our medical visits at any given time. The balance of our medical patients are among the 5% who have no coverage at all; we are their medical home.

Many people are exempted from the “individual mandate” for financial reasons. There are many patients who cannot afford coverage, even with subsidies.  There are nearly twenty categories of exemptions from the individual mandate, most of them financial in nature.  For example, if you have had a bankruptcy or a bill turned over for collection or simply an unpaid medical bill in the previous six months, you qualify for an exemption from the mandate.

Under the Affordable Care Act there will still be a similar number without insurance.

The provisions of the Affordable Care Act won’t be fully implemented until 2019. Even then, the “goal” of the ACA is to provide coverage for up to 30 million of the 50+ million uninsured in the US.  That still leaves 20+ million uninsured, or about 400,000+ people in Massachusetts.

Although 5.5 million people in MA have at least some health insurance, nearly 500,000 are without coverage for at least part of the year. 

The oft quoted 98% of Massachusetts residents that have health insurance includes those with only high deductible, catastrophic type plans that do not provide coverage for primary, preventative, episodic or chronic care – the underinsured – who still need help to access these essential services.  It also does not include an estimated 130,000 uninsured, 220,000 undocumented, and, according to the most recent data, an almost equal number that are without coverage for some part of the year.  Berkshire County has a disproportionate share of all of these groups.