On Island, Health Care Coverage Gaps Are Common

By Sean Corcoran

May 22, 2012

John Clarkson Nantucket
John Clarkson sits in his apartment in Nantucket. (Sean Corcoran/WGBH)

NANTUCKET, Mass. — Nantucket is getting ready for summer — a busy time not just for vacationers but for the island's labor force. But there's a serious side to island living, especially for those residents who aren't employed all year round: a gap in health insurance that leaves some people without crucial coverage.
A $500 gap
The refrigerator in John Clarkson's small, one-bedroom apartment is adorned with magnets and to-do lists, while the cupboard above it is a virtual medicine cabinet.
"I got five different pill medications; my insulin, which is Atlantis; and another one for high sugar level; it lowers it real quick," Clarkson said. "That I don't have to take very often. I can't pronounce these names of the pills, but there are five different ones."
Even if he can't pronounce the names, Clarkson knows how much they cost — just under $500 a month. And that's a lot of money for a man who was out of work for nearly 2 years. When he got a job last December, Clarkson paid for his medicines out-of-pocket as he moved off unemployment insurance and on to the state's Commonwealth Care program.
"My biggest concern was my medication," he said. "I need my medication to stay alive."
Clarkson is 56 years old, and he grew up on Nantucket. He worked as a nurse's aide and then 5 years at a lumberyard before being laid off when construction slowed down. Clarkson put aside some money for retirement when he was making 19 dollars an hour at the lumberyard. But he said he can't afford too many more $500-a-month gaps in insurance coverage. 
"As I said, I was a year and 10 months looking for a job and I couldn't find one. I couldn't find one. I finally had to settle for working at Stop and Shop. Which is, it's work I guess. But I still don't have enough to pay rent. I still have to fall back on my savings," he said.
On Nantucket, where the labor force more than doubles from winter to summer, folks are going several weeks — and in some cases months — without health insurance as they switch from one government program to another.
The application process — and delay
Kathy Butterworth and Alex Rosenberg are health care advocates at Nantucket Cottage Hospital. They assist islanders as they navigate the various state and federally sponsored health insurance programs. They say the state is failing to live up to its goal of "health care for all," as coverage gaps of weeks or even months are common when people move from unemployment insurance to the state's Commonwealth Care programs.
"Oftentimes what happens is, people who are on unemployment, say they get a job. That unemployment insurance, that medical employment insurance plan, runs out like that. Snap. It just is gone," Butterworth said. "And suddenly the person is like, 'oh my goodness, I have no health insurance.' They come in to do an application. Those applications have taken as many as 68 days this year to be processed. They're a little bit quicker now, but over the winter, the time frame was somewhere between 60 and 68 days for many of our applications."
If coverage is approved, applicants like Clarkson must then meet strict deadlines or face more weeks of delay.
"Now you have to make a phone call that says, 'Yes, I do want that insurance.' You have to send in a payment. That takes another month, maybe two, depending upon how quickly you do that," Butterworth said.
The government perspective
Stephanie Chrobak is the director of program management at the Health Connector, the agency responsible for state-sponsored health insurance programs. Chrobak said she isn't surprised there are gaps in coverage. What surprised Chrobak was the length of time Nantucketers reportedly are without coverage.
"To me, the times you quoted seem to be much, much longer than I expect," she said. "Have I heard in general that there are these times when a member may be caught with a gap? Yes, I have. And certainly we currently try to minimize that, and I think the most important thing to know, as we move forward with federal reform — as we plan for federal reform in 2014 — there's a lot of work there to eliminate those gaps."
It's hard to say just how many Nantucket residents are experiencing month-long delays in insurance coverage. Unemployment ebbs and flows with the seasons on Nantucket, swinging from a low of about 3.4 percent in July to nearly 15 percent in the winter. Butterworth said it's often the same clients experiencing the same types of delays over and over again.
"This week we've probably both gotten at least 60 phone calls so far," she said. "At least. And we're busy. And part of the reason we're so busy is because we live in a community where people's jobs come and go constantly."
Months on insurance, months off
Miriam Lemus is a Nantucket mother of two young children, and she works 8 months of the year at a landscape company. She said she is constantly submitting pay stubs and paperwork, making phone calls and waiting for coverage to start.
"In December, I had to fight with them that they don't take it off, but they took it off," she said. "And now I have to do it again. I have to fight again for them to give it back to me. It's kind of hard for me, you know. Right now I think it's like 3 months already without insurance."
Rosenberg said she was helpless as she watched Lemus and other clients follow the state's procedures and do everything they can to get back on the Commonwealth Care program, but still experience months of costly delay.
"I sort of describe it as like they are both pointing at each other — so that when you're receiving benefits from one place to the other, they are both saying, 'Oh, no, sorry, I can't cover you. There are other federal or government or state-based funds that are supposed to cover you at this time period,'" Rosenberg said. "It seems to me you could combine them into one area that is health insurance and cover people who don't have other options for health care."
State officials said short coverage gaps as people move from unemployment insurance to the Commonwealth Care plan was a problem across the Commonwealth. But federal changes coming in 2014, they said, offer another opportunity to address coverage gaps and ensure continuous health care for all.

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