This morning we sat in on an ACT! Coalition meeting at the Healthcare For All headquarters.  Much like our meeting at the Family Health Center Worcester (FHCW), I was surprised by what I understood to be some of the unintended consequences of the 2006 health care reform legislation (Chapter 58).  While the number of uninsured residents in MA has been dropping, the organizations that provide medical care to the traditionally underserved populations have been losing money.
After listening to Medicaid director, Tom Dehner, discuss the most recent Medicaid waiver, the representatives from BMC and Cambridge Health Alliance spoke up.  These hospitals have been losing money since the passage of Chapter 58.  The problem is very similar to that of FHCW - the health safety net pool and payments are slowly being cut back, and the expected insurance payments are not filling the gap.  In some cases the problem is caused by the bureaucracy of gaining accreditation on a new health plan.  As physicians await the necessary accreditation for the new CommCare plans (1-9 month process) they still treat patients and the hospitals cannot be reimbursed for these services.  Additionally the problem of churn seems to be another big contributor.  Many individuals that are newly enrolled in CommCare plans drop out quickly because they either get lost in all the paperwork (some could never read it to begin with) or they miss a payment due to a mini-financial crisis (like they need to buy their children a new pair of shoes).  Once a patient gets dropped from CommCare, they rarely get themselves reenrolled and so their next healthcare interaction is not reimbursed.  Are these big problems?  It would appear so given that BMC and Cambridge Health Alliance are running a deficit this year and are worried about insolvency by 2012 if these problems don't get addressed.
While the Chapter 58 reform has been very beneficial to the patients living without access to a safety net hospital, it is hard to see this piece of reform legislation as the "great success" many have described when the very providers that care for the underserved and uninsured are struggling as a result of it.