Vineyarders pressed by health costs

While President Obama leaves behind the tense health care debate in Washington for a week’s respite on Martha’s Vineyard, many here say the sweeping health insurance law Massachusetts enacted three years ago has not made their medical care more affordable or accessible. The state’s venture toward universal health coverage requires nearly everyone to buy health insurance or pay a hefty tax penalty, and it is seen as a model for the president’s ambitious health care overhaul.

Consider Heather Thurber, 36, a West Tisbury organic farmer and special education teacher, who spends $424.50 monthly for health insurance for herself, her husband, and their two sons.

“I can’t even imagine what it would cost if the school district didn’t already pay 75 percent of the total,’’ she said.

Thurber, licensed as a preschool teacher, said she grabbed a high school position six years ago in special education, largely because it came with health and dental insurance benefits. For years before that, she said, her husband had no health insurance, and she and the boys were covered by Medicaid because their family income was so low.

Her advice to Obama, should the first family stroll through the farmers’ market?

“Figure out how to make health insurance less expensive,’’ Thurber said. “It’s a huge cut out of my paycheck.’’

A report released last week by the Commonwealth Fund, a New York-based think tank, shows that Massachusetts residents shoulder the most expensive health insurance premiums in the country, with the average annual family premium costing $13,788 in 2008. And that does not include the tab for prescriptions and copayments.

Over the past five years, the cost of a family premium has risen 40 percent, higher than the national increase of 33 percent, the report concluded.

While the percentage of uninsured in Massachusetts is now the lowest in the nation, about 3 percent, some islanders said they resent being forced to buy coverage.

“I think it’s good that everyone should have health insurance, but to pay a penalty [for not having insurance] doesn’t seem right,’’ is the opinion Michael Hartzband would share with the vacationer in chief, if he should stop by Hartzband’s new Oak Bluffs General Store on Kennebec Avenue.

Still, the genial shopkeeper admits that the mandate he so detests has been effective.

Hartzband, 31, is among the state’s newly insured, solely, he said, because of the requirement. The former construction worker skipped coverage for years - “I was rarely sick,’’ he said - but finally signed up this year when the maximum tax penalty for not having coverage topped $1,000.

For Tina Marinelli, who calls the mandate “un-American,’’ the primary problem is not just affordability but access to care. The part-time Oak Bluffs elementary school chef and salon nail technician is single with two teenage sons. She pays $500 monthly for health insurance, but can’t get an appointment with her family doctor without a long wait; he’s too busy.

That’s a common complaint among the island’s 15,000 year-round residents, where waits to see physicians were long even before the 2006 overhaul added more than 400,000 newly insured statewide.

At Martha’s Vineyard Hospital, chief executive Tim Walsh said his staff has been “on a tear’’ trying to recruit more primary care physicians, a tough task, given the island’s high cost of living.

Walsh was skeptical about the state’s overhaul before it started. He now says it has been more successful than he predicted for connecting newly insured patients to primary care physicians and easing their reliance on hospital emergency rooms for routine care.

Since 2006, he said, the hospital has recorded a 40 percent drop in the number of uninsured patients who formerly received free care because they were too poor to pay. Many of them are receiving state-subsidized health insurance.

Walsh grades the state a C+ on its overhaul so far, saying leaders still have a lot of work to do on controlling costs and tackling the prickly issue of health care for illegal immigrants. Walsh estimates that this population accounts for about 3 percent of the hospital’s free care, which is subsidized by the state.

Among some locals, frustration and resentment is palpable on the issue of free health care for illegal immigrants, though few are comfortable being quoted on the topic. Why, they ask, should they be forced to face a tax penalty for not having health insurance, while others receive government-subsidized emergency care for free?

A wave of immigration over the past decade, largely from Brazil, has created an underground island economy, where 16 of every 100 jobs is estimated to be held by undocumented workers, according to a 2008 analysis for the Martha’s Vineyard Commission.

Massachusetts’s overhaul did not tackle the issue of health care for illegal immigrants, who continue to receive limited care under a government-funded Medicaid program similar to those in other states. As recently as Saturday, Obama reiterated that the health care overhaul he envisions would not extend full care to illegal immigrants.

Kay Lazar can be reached at klazar@globe.com.

Correction: Because of incorrect information provided to the Globe, a story in Tuesday's Metro section about health insurance concerns on Martha's Vineyard incorrectly stated the insurance premium paid by Heather Thurber. She pays $424.50 a month.