Health & wellness

OCT. 23, 2008

Medical costs still burden many despite insurance

Mass. survey finds people in debt, skimping on care

Although far more Massachusetts residents have health insurance coverage than residents nationwide, a significant portion of Bay Staters are still struggling to pay for needed healthcare, a new survey shows.

Some are postponing treatments, and others are not filling prescriptions, because of high costs or an inability to pay bills from earlier procedures, according to the survey by The Boston Globe and the Blue Cross Blue Shield of Massachusetts Foundation.

A third of those surveyed said the cost of care is their biggest health concern, and 39 percent ranked it among their top two health concerns. No other concern came close.


Thirteen percent of residents with insurance said they were unable to pay for some health services in the past year. The same percentage of insured people said they did not fill at least one prescription because it was too expensive or their insurance copayment was too high. The numbers rise to 14 percent if both insured and uninsured residents are considered.

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Two years into the state’s pioneering healthcare experiment to insure nearly everyone, coverage is almost universal, with 97 percent of Massachusetts adults reporting they have some sort of insurance, according to the survey. Yet for some that did not translate into getting needed care.

“Basic things, like getting Flonase, [a sinus medicine] are a luxury,” said Diane Schilder, a 44-year-old Arlington mom and adjunct college professor of education who has two children, a doctorate, health insurance, dental insurance, and about $800 of medical debt on her credit card.

Schilder is one of 506 adults surveyed in the telephone poll conducted Oct. 12 to 17 by the University of New Hampshire Survey Center. The margin of error is plus or minus 4.4 percentage points. Schilder is divorced, but still covered under her former husband’s insurance, which carries a $500 family deductible for prescriptions and then covers only 50 percent of the costs for many drugs, she said.

Such insurance coverage is not unusual. “Many of the policies out there have such huge copayments and deductibles that people can’t afford care,” said Dr. David Himmelstein, associate professor of medicine at Harvard Medical School and a primary care doctor at Cambridge Health Alliance.


Himmelstein is cofounder of Physicians for a National Health Program, an organization that pushes for national health insurance. He studied personal bankruptcies nationwide in 2001 and found that about half of them were linked to a medical issue, and in three-quarters of those cases, the debtor was insured.

While medical debt is burdening a sizable number of Massachusetts residents, the pain is greater nationally, where the percent of uninsured is about five times greater, according to the latest US Census.

A national poll released this week by the Kaiser Family Foundation, a California-based nonprofit that researches health policy, found that about a third of Americans surveyed reported that their family had problems paying medical bills in the past year and that almost one in five said they had medical bills of more than $1,000.

Healthcare leaders say the state’s first-in-the-nation law, which requires nearly everyone to have health insurance or face a tax penalty, has mitigated some cost concerns for consumers.

“It may be that while you are seeing those problems in Massachusetts, they are not as high as what we are seeing nationally because in Massachusetts people do have access to healthcare,” said Drew Altman, Kaiser president and chief executive officer.


Dr. JudyAnn Bigby, Massachusetts secretary of health and human services, said prescription costs can be prohibitive, especially for low-income residents who have chronic health problems and need several medications. She said the state is considering eliminating or greatly reducing the $1 copayments for thousands of residents on Medicaid who need medications to treat diabetes or high blood pressure or cholesterol.

“It would make it more affordable for people with chronic medical conditions to take multiple medications and ... manage their conditions better,” she said.

Still, she said, fewer residents overall are struggling with medical bills since Massachusetts overhauled its healthcare laws two years ago. She cited a recent survey by the Urban Institute, which found that the share of people with skimpy health insurance that left them with huge medical bills has dropped two percentage points since the state’s new law started.

It also found that such inadequate insurance is a problem for three times the number of people nationally, compared with Massachusetts. Starting in January, the insurance coverage mandated by the state will have to include prescription drugs.

The Globe-Blue Cross survey found that income has a direct correlation to a household’s ability to afford care. People with household incomes less than 300 percent of the federal poverty level, roughly $31,200 for a single person, were more than twice as likely to report problems affording prescriptions or other care. People who are divorced or who never went beyond high school were also more likely to report healthcare cost problems.

Among those reporting difficulty was Harvard University graduate student Justin Vincent, 26, a brain researcher who was stuck with a $3,000 bill last year after breaking his leg because his health insurance did not cover the physical therapists recommended by his doctor.

“After the leg surgery, I generally refuse medical care because they don’t tell you what the prices are,” he said. “It’s not like Walmart, where they tell you what the prices are.”

The Globe/Blue Cross survey found that 8 percent of people with insurance and 9 percent overall reported avoiding or postponing medical treatment because they already owed money for health services.

In Blackstone, Robert Ravenelle, 20, a private security guard who makes about $10 an hour, said he is still paying off a $1,400 emergency room bill from last year for a knee injury because he doesn’t have health insurance. Ravenelle said he has received warnings from the state about facing a tax penalty for not having coverage, but has decided paying the penalty is less expensive than buying insurance.

“Unless they want me to live on the street,” he said, “I can’t do it.”

The Blue Cross Blue Shield Foundation recently launched a project studying how state residents get care.

Kay Lazar can be reached at