Medical debt a continuing problem, report says

The state's landmark healthcare law is pulling people onto the insurance rolls through new mandates and insurance offerings, but some Massachusetts citizens are still struggling with medical debt, a report released today says.

According to The Access Project, a national health research and advocacy group based in Boston, about 40 percent of the people who came to them for help with their medical debt over the last two years had insurance, but were still unable to pay their bills. Many were unaware of programs put in place to assist them or had difficulty navigating them, said Andrew Cohen, coordinator of the project's Medical Debt Resolution program and co-author of the report.

"This really is a silent tragedy in Massachusetts," he said in an interview. "It's really about medical bills being transformed into medical debt."

The report focuses on 187 people who came for help between September 2006, before the law requiring near-universal coverage was implemented, and April 2008, after it took effect. Most of the people seeking assistance had low incomes; those who qualified were helped to obtain coverage through state-subsidized Commonwealth Care. Others enrolled in non-subsidized insurance plans had trouble paying both insurance premiums and co-payments while dealing with previous medical debt.

While many of the programs' clients weren't aware of programs designed to help them pay their bills, they weren't alone, the report says. People working at hospitals and other healthcare settings contacted by the program didn't always know about them either, the report said.

"While Massachusetts strives to achieve universal coverage, a robust safety net must remain in place to assist people who have unaffordable medical expenses, whether they are uninsured or have inadequate insurance coverage," the report says.

The report recommends awareness programs to better inform individuals and healthcare providers about resources such as the Health Safety Net, the Office of Patient Protection, and charity care.

It also suggests allowing college students who meet income eligibility requirements to receive Commonwealth Care coverage.

Bob Carey, director of planning and development at the Commonwealth Health Insurance Connector Authority, said if even 10 percent of the students attending college in Massachusetts were enrolled, that could mean adding 45,000 people to a program that now insures 170,000 people. Adding that significant extra cost might not make sense if the problems lie in the current student insurance program.

"There are certain pressures on Massachusetts health reform and we need to be mindful of that," he said.

While praising The Access Project and its Medical Debt Resolution program for helping people navigate a confusing system, Carey also said its report should be viewed with caution. Its sample is small, representing neither the state as a whole nor the time frame in which the healthcare law was in full effect.

"This is not pre- and post-reform. It's pre-reform and the beginning of reform," he said. "You can't draw conclusions about the general population based on the 200 people who were unfortunate enough to run up medical bills. These guys do good work and they're very helpful to the community, but drawing conclusions from a limited population can be dangerous."