12/21/2016 by Share Your Story

Massachusetts: Patients can keep their doctor — for a price


Massachusetts hit with 21 percent health insurance rate hike

Patients in Massachusetts are discovering that keeping their doctor comes at a price.

This month, thousands of patients shopping for health insurance are now realizing that they’ll pay, on average, 21 percent more for health insurance in 2017 “if they want to keep the only plan that gives them access to certain prestigious Boston hospitals.”

Back in September, the Boston Globe first reported that insurer Neighborhood Health Plan was hiking rates for patients enrolled through Massachusetts Health Connector, the state agency that serves people who don’t get insurance from an employer.

Nearly a quarter of a million Massachusetts residents obtain health insurance through the Connector program. For those patients, Neighborhood Health is the only insurance company that provides network coverage at Massachusetts General Hospital and Brigham and Women’s Hospital.

These Massachusetts health insurance rate hikes leave patients with a difficult choice: pay more for health insurance, or find a new doctor.

“This proposal is going to be massively disruptive for members, for the Connector, and for health plans,” Connector board member Nancy Turnbull told the Globe.

Patients Rising’s Perspective: Increase insurance transparency

What’s driving the increases in Massachusetts health insurance rates? It depends whom you ask.

Neighborhood Health Plan blamed the hikes on “industrywide” increases associated with the Affordable Care Act.

“With regard to the merged market overall, including products offered through the Connector, rates are being driven up industry-wide by increased medical costs and utilization as well as structural changes in the Affordable Care Act,” Neighborhood Health said in a statement, according to WWLP News.

That excuse is hard to verify, given the lack of transparency in health insurance. Other health insurance plans, which would be affected by the same “industrywide” pressures, posted minimal increases or even LOWERED their premiums. One plan, offered by BMC Healthnet, is lowering its premiums by 8 percent, according to the Boston Globe.

“Insurers should be held accountable for these decisions and they must act with transparency,” explains Jonathan Wilcox, co-founder and policy director at Patients Rising. “Advocates and patients must stand up for their rights and lawmakers and regulators must listen and develop realistic solutions.”

He adds, “The real tragedy here is that this twisted system has effectively turned patients into expenditures on a spreadsheet and shrouded by the fact that many patients forgo the fight for the medications prescribed by their doctor and submit to insurer decision in favor of a less-expensive, often less-effective medication.”

Patients in Massachusetts want lower co-pays, premiums

Overall, Bay Staters say their top health care priorities for politicians and government officials should be managing premium increases, lowering co-pays and deductibles and holding insurance companies accountable.

A recent nationwide study by the Partnership to Fight Chronic Disease found that:

  • 87 percent of patients in Massachusetts say it’s somewhat or very important for health plans to disclose how often and why they decide to deny coverage of doctor-prescribed treatments
  • 18 percent of patients in Massachusetts say the treatment their doctor recommended was not covered by insurance
  • 21 percent of patients in Massachusetts say the treatment of someone they know was not covered by insurance
  • 26 percent of patients in Massachusetts say their health insurance coverage is getting worse
  • 39 percent of patients in Massachusetts have seen their costs increase

Massachusetts lawmakers study other state’s success stories

To their credit, state lawmakers are actively searching for ways to address patients’ concerns.

The Boston Globe reports that a group of state lawmakers recently completed a fact-finding trip to Minnesota to research new ideas for Massachusetts.

“We actually lag behind many other states when it comes to our use of hospitals,” David Seltz, executive director of the Massachusetts Health Policy Commission, told the Globe. “We’re one of the worst-performing states when it comes to readmissions. Minnesota has implemented a number of reforms and policies to try to reduce the rate of preventable readmissions.”

Minnesota has earned plaudits from non-profits that analyze health care issues for reducing costs without compromising care.  Among the topic areas Massachusetts lawmakers researched: “Minnesota’s evolving Medicaid program, how the state is deploying paramedics in new ways to provide care, and how one pilot program, Hennepin Health, reduced hospital visits by better managing patients’ care at home.”

“The two states share some common values on prioritizing health and well-being and access to excellent health care,” Seltz said. “They have, from a policy perspective, a willingness to experiment with new ideas.”


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