December 21, 2001

For Newly Jobless, Insurance Options Are Few, Costly
By Melody Simmons, The Washington Post, 12/18/01

[Extracts] -- Like most accidents, it happened fast. The coffee pot fell off
the shelf at the Williams-Sonoma store where clerk Annie Brown worked,
cutting her face and severely bruising her eye.

"It was one of those instances where my first reaction was to think: I don't
have health insurance," said the Baltimore woman. "I got a shiner, and I was
afraid to go to the emergency room."

Brown and family had no such worries until Nov. 5, when her husband, Doug,
got pink-slipped by technology publisher Ziff Davis Media. Their
company-sponsored health benefits ended two weeks later. "Now," says Brown,
34, "I feel so vulnerable."

With the nation's unemployment rate at 5.7 percent -- the highest level in
six years -- hundreds of thousands of Americans are struggling to maintain
health care coverage or entering an uncertain world without it.

A Dec. 4 report by Families USA, a nonprofit health care advocacy group,
showed that in the last three months, 529,320 individuals nationwide lost
health care coverage, most of them as the result of layoffs. Reach back
further, to when the recession purportedly began in March, and that number
rises to more than 911,680.

The newly unemployed face a tough marketplace for health insurance, in which
the policies available to them often share several unattractive features:
steep premiums, exclusions of coverage for preexisting medical conditions or
certain kinds of treatment, high deductibles and numerous caveats.

State workers face higher prescription costs
By Associated Press, 12/17/01

PROVIDENCE, R.I. -- State employees will face some increases in prescription
drug copayments under a contract approved last week by the Almond
administration and Blue Cross & Blue Shield of Rhode Island.

Prescription copayments will increase from no cost to $5 for generic drugs;
from $5 to $10 for brand-name drugs; and from $10 to $20 for so-called
"non-preferred" drugs such as Viagra, according to Jeanne Peloquin, the
state's chief of employee benefits.

The three-year contract with Blue Cross will cover the state's 15,495 current
employees and 9,534 retired employees, The Providence Journal reported.

The state pays 100 percent of premiums for current employees and pays a
portion of retirees' premiums, based on how many years they worked for the
state.

"Blue Cross worked with the state to develop a plan that provides a
continuity of benefits at a cost reasonable to both the state and all
enrollees," Gov. Lincoln Almond said in a statement.

The contract takes effect Jan. 1 and runs through December 2004. There will
be no increase in the state's costs for the first six months. The state's
costs will increase 8 percent in July 2002 and 16 percent in January 2003. In
July 2003, the state and Blue Cross will negotiate a rate to cover the rest
of the contract.

The big increases in state costs are slated to come after Almond leaves
office in January 2003.

300 face loss of prenatal services
By Cindy Rodríguez, Boston Globe, 12/20/01

[Extracts] -- About 300 pregnant women who are at risk for premature labor
and other complications may be kicked out of a state prenatal care program
due to state budget cuts.

Healthy Start last year helped more than 3,500 low-income women who earn too
much to qualify for Medicare and too little to buy health insurance.
Lawmakers approved a $7.5 million budget for the program this year, which is
about $1 million less than last year. Program administrators had sought $9.3
million.

They say if these pregnant women don't get the services they need, it could
lead to many problems, including neonatal intensive care for premature
babies, a cost that's exponentially higher.

"We're going to try to find them care, but there will be a lot of women who
won't have health care," said Sally Fogerty, assistant commissioner of the
state Bureau of Family and Community Health.

Healthy Start administrators are not giving up. They are working on a
last-ditch effort to persuade lawmakers to restore funding in a supplemental
budget that may be voted on this week.

Healthy Start administrators say these women face other problems if they
don't get needed services. They may wind up going to emergency rooms to
deliver their babies, a more costly option where doctors may find
complications that could have been avoided with preventative care.

Laurie Stillman, executive director of the Massachusetts Public Health
Association, said the women are primarily Latina, with the next largest group
being white women. They have to meet income guidelines. They cannot make more
than $17,184 a year, or $23,220 for a family of two.

Tufts Health raises concerns on 'premium practice' by doctors
By Liz Kowalczyk, Boston Globe, 12/20/01

[Extracts] -- Last week two Boston doctors said they were quitting their jobs
at Beth Israel Deaconess Medical Center to open a controversial,
concierge-style practice for patients willing to pay a $4,000 annual fee.

Yesterday, executives at Tufts Health Plan said they have concerns about the
practice, and are asking state officials to determine whether it complies
with insurance laws.

The physicians, Dr. Steven Flier and Dr. Jordan Busch, said they don't have
enough time to spend with their patients. Their new practice will be far
smaller - 300 patients each instead of several thousand -- and will offer
amenities such as 24-hour access to them by cellphone.

Dozens of doctors across the country have begun opening these types of
"premium practices." But the fee, which many patients won't be able to
afford, has upset a number of doctors and health care executives in Boston
who believe such practices unfairly deny care to all but the well-off.

And executives at Tufts, which contracts with Flier and Busch to treat 900 of
the plan's members, said it may hurt Tufts enrollees.

"I am concerned that this new fee represents an access fee which most of our
members simply cannot afford and which is inconsistent with our commitment at
the Tufts Health Plan to make quality health care affordable," Dr. Philip
Boulter, Tufts chief medical officer, wrote the doctors Tuesday.

In their new practice, Flier and Busch still will charge patients' insurance
companies for covered services, such as physical exams, lab tests, and
surgery. The $4,000 fee will pay for extras, such as the doctors accompanying
patients on visits to specialists. But Boulter said that if the fee is a
prerequisite for access to covered Tufts services, it may violate Tufts's
contract with the doctors.

Boulter is worried about arrangements made for patients who cannot pay the
fee and will have to find new doctors but who have "serious, ongoing, or
terminal diseases." He also said the plan simply has philosophical objections
to what Flier and Busch are doing. He has asked the doctors to meet with him.

The new practice "is a response to the chaotic financial environment we
have in health care right now, but it just adds another financial burden
on patients and on the system," Boulter said. Tufts is not considering
terminating their contract with the doctors at this point, executives
said.

Michael Blau, the lawyer for the two doctors, said he does not believe the
plan's concerns have legal merit. The $4,000 fee, he said, is not an access
fee because the doctors have the discretion to waive the fee for patients who
cannot afford it. And Busch said he is helping to find new doctors for
patients who can't or don't want to sign up for the new practice, which won't
open until April.