Name: margalit
Location: Massachusetts, United States Professional writer, educational advocate, opinionated ultra liberal mother of 18 year old twins, living life in the slow lane due to hypertrophic cardiomyopathy, congestive heart failure, and diabetes.

email: margalitc at yahoo dot com

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Thursday, May 11, 2006

Mass Health just plain sucks lemons

I'm scared to death of the new Health Insurance mandate passed by the state legislature and ballyhoed by our jerk of a governor, Mitt Romney. For those not in the loop, MA residents are going to be required to have health insurance coverage. There isn't a choice, it's a mandate. If you are under the poverty level, you can get Mass Health for free. Since nobody could possibly live in MA under the poverty level, that means pretty much everyone is going to be required to be covered at work or to purchase MassHealth for themselves.

Now I know most people outside of MA see this as a step towards universal health care and consider it a positive step. However, this program has serious flaws, especially if you're not financially able to pay for your own health care. Small employers must put a tiny amount towards health coverage, but the basic responsibility is on you, the user. If you have free care from a hospital now, you're going to lose that excellent coverage and will have to get half assed MassHealth coverage instead. If you're living paycheck to paycheck because you pay a ridiculous rent or mortgage, adding several hundred dollars a month to your budget has just become mandates without any additional funds coming to you. Aren't you lucky?

Why does this matter? Because MassHealth refuses to cover a huge variety of items, mostly prescriptions. So not only do you lose good care that covers pretty much everything if you have had free care, you are now required to pay high prices for crappy care and to fight for every prescription your doctor orders for you.

I'm not talking about weird medications. I'm talking about pretty much EVERY allergy medication, many asthma medications, blood pressure medications, GERD medications, sleep aids, antidepressants, cholesterol medications, and birth control pills. Yup, the state gets to tell you what kind of birth control you can use, and they will not pay for other prescriptions ordered by your doctor, even if the bc pills they do cover don't work for you.

Today I took the Girl to see a specialist at Children's Hospital. After the examination, the doctor wrote two prescriptions for her, and she wrote extremely detailed directions for the labeling, just because she has had such trouble with MassHealth. Off we went to CVS to fill the prescriptions. MassHealth denied them both. Not just one, both. Now we have to have the doctor file an appeal, and the thing will take at least a month to solve. The doctor wouldn't have written the prescriptions if she didn't think the Girl needed the medications, and yet the state's mandated formulary is so bad that we couldn't get either of the meds she needs.

Aren't you all looking forward to dealing with this agency? You'll just love them. One month, back when I had MassHealth, I had to appeal 7 different medications because they changed their formulary without any patient notification, and when I went to refill my scripts, they were no longer covered. This meant contacting 3 different doctors to have them write appeal letters to MassHealth and then waiting impatiently for almost 2 months for the appeals to be decided. While I didn't have my medications my doctor scrounged up free samples for me to use.

This isn't health care coverage, it's a sham program that denies, denies, denies. Aren't the people of MA fortunate to have such groovy coverage? Um, I'm pretty worried myself.
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Blogger Croila said...

Oh what a shame - that sounds absolutely terrible! I know we complain about the National Health Service here in the UK, but oh boy, compared to this Mass Health thing, ours is a dream. So sorry to hear you have these terrible hassles - it must be horrendous for you :-(

11/5/06 4:54 PM  
Blogger Aurelius said...

Interesting. I havn't been keeping up on the whole thing.

11/5/06 8:38 PM  
Blogger jane said...

Sounds like more ways to take your money. Beureacratic (sp) BS.

12/5/06 8:10 PM  
Blogger srp said...

Like most problems, the issue of health care is extremely complex. Childhood eating habits and fast foods and modern convenience and smoking and a host of things have made us more susceptible to disease. Prevention should be covered by health insurance even more so than the fix. It is cheaper to prevent than cure. I don't know if a national health insurance is the answer. It will take a lot of personal choice out of health care. There will likely have to be some kind of compromise plan.
I hope things sort themselves out.
Here from Michele.

12/5/06 8:22 PM  
Blogger Paul Sveda said...

I dunno what to say, up here in Canada we have universal health care thats not all its cracked up to be either.



Michele says hi...

12/5/06 8:50 PM  
Blogger Grins said...

I had only heard the broad strokes of this and that was an interview with your governor. Your more detailed explaination sheds a different light. I'm betting the money that some are paying for the insurance that doesn't cover scripts could be going to pay for scripts they need to function. What a mess. Here via Michele.

12/5/06 8:51 PM  
Blogger Robin said...

This really IS a scary prospect. You are right about the "living under the poverty level" The average 'poverty level' determinations are B*llsh*t and totally irrelevant in Massachusetts. Here from Michele's, this evening and heading your way for work in a few minutes :)

12/5/06 9:03 PM  
Blogger Karen said...

Wow, this is pretty scary! This sounds like the worst solution possible. Hope "Girl" gets her prescriptions sorted out soon.

Here via Michele's. Hi from Wisconsin! *waves*

12/5/06 9:50 PM  
Blogger Leslie Shelor said...

I hadn't heard of this, but I have no doubt that if it will cause more expense for the average person, it's the thing that will be voted in. Frustrating and sad.

Here from Michele's, hello!

12/5/06 9:56 PM  
Blogger Canadian Dude said...

Health care is a mess no matter where you are.

Michele sent me.

12/5/06 10:13 PM  
Blogger Mocha said...

I'm not from Michele's. In fact, I'm not sure who she is. ;-)

This post is awfully scary and doesn't make me feel good about health care, but I'm more worried about WHO is in charge of decisions regarding it. Scary.

13/5/06 11:00 AM  
Blogger Tracy said...

This is so scary... I and kids have had Masshealth since 1997... email me please and explain... I need to get more in the loop...I will email my adress to you..

I am meaning to email you anyway soon....

13/5/06 8:06 PM  

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