Proposed rules in Massachusetts that would require some residents seeking no-cost care at hospitals to contribute deductibles and copayments would weaken the state's health care safety net, according to testimony given on Wednesday at a public hearing on the rule, the Boston Globe reports (Dembner, Boston Globe, 8/23).

Under the proposed rules, set to take effect Oct. 1, uninsured residents with incomes between 150% and 200% of the federal poverty level would be required to pay a $35 monthly deductible. Those with incomes between 100% and 200% of the poverty level also would be required to contribute a $5 copay for office visits in a hospital and $50 for emergency department visits that do not result in an inpatient admission. People with incomes between 200% and 400% of the poverty level would pay a larger deductible based on income.

There would be no copays or deductibles for children or for care received at community health centers, except for a $3 copay per prescription. Under the state's health insurance law, hospitals and community health centers will not receive reimbursements for no-cost care provided to patients who are eligible for insurance through Medicaid, the state-subsidized Commonwealth Care or affordable employer-based coverage (Kaiser Daily Health Policy Report, 7/16).

Testimony
According to testimony from government officials, health care providers and advocates, the costs of the deductibles and copays might prevent some people from seeking care. In addition, eligibility requirements could leave health care providers to cover the cost of many patients who are unable to pay, opponents of the rules said. "The continuity of their health care will come at our expense," Joel Abrams, CEO of Dorchester House community health center, said at the hearing, adding, "I ask you to help avoid tearing apart ... the community-based, safety-net system." State Sen. Richard Moore (D), who sponsored the health reform law, said in written testimony that "what must be avoided is placing more of a burden on the hospitals and inadvertently discouraging patients from seeking medical care."

Sarah Iselin, the state commissioner of health care finance and policy, said, "We recognize, and the proposal reflects, our commitment that there will continue to be a strong safety net. But we need to align this with other state health programs, so people who have access to affordable coverage enroll." Iselin said state officials will consider the testimony before issuing final rules in mid-September, and once the new rules take effect, the state will monitor the impact on patients and health care providers (Boston Globe, 8/23).

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