Covering the Uncovered
While Washington drags its collective feet on health reform, the states are moving ahead
Last year, when the Massachusetts law was signed, Peter Brook told reporters he was skeptical that the plan would work for everyone. The 46-year-old carpenter, who was diagnosed with diabetes at age 14 and needs insulin shots up to five times a day, had been uninsured for six years and used the emergency room when he needed to see a doctor. Under his new plan, his diabetes needles and test strips are all covered, and he's got a team of health professionals-an endocrinologist, a dietitian, a nurse practitioner-with whom he meets regularly. There's no deductible, no premium, and doctor visits are free. Now, Brook is skeptical for a different reason: "They're signing people up like gangbusters," he says. "How are we going to pay for all this?"
Indeed, long-term financing is a potential stumbling block in every state, given that healthcare costs continue to rise faster than income. "We anticipate there will be a wall that we hit," says John McDonough, executive director of Health Care for All, a Boston-based advocacy group. "We don't know how high it will be, but we do expect financial pressures and the need to identify revenue to sustain this long term." In Massachusetts, the plan relies primarily on federal Medicaid matching funds and on bringing costs down by moving people into managed, coordinated care. Since May began and new help lines went live, the service has been handling about 2,500 customer service calls a day. The push is on.