The victims of the Boston Marathon bombing have endured pain and injury but they may be spared further insult in the form of huge medical bills, thanks to Massachusetts' unique health care system.
Owing to a 2006 health care reform law enacted by then-Gov. Mitt Romney (R), just 4 percent of Massachusetts residents were uninsured in 2011, according to census data. And many of those bombing victims who lack health insurance, including those visiting Boston from out of state, may qualify for financial assistance from a "Romneycare" safety-net program.
"When I was watching the events and hearing from my colleagues what was happening at the hospitals I said, 'Well, thank God we have near-universal coverage in Massachusetts' because those people almost certainly would be covered," said JudyAnn Bigby, who was secretary of the Massachusetts Executive Office of Health and Human Services under Gov. Deval Patrick (D) from 2007 to 2012.
Boston's emergency services and its hospitals have been praised for the speed and effectiveness of the medical response to the bombing last Monday. More than 280 injured marathon participants and spectators passed through the doors of Boston hospitals and clinics over the last week, but none have died beyond the first three fatalities and just two victims remained in critical condition as of Monday.
But all that medical care costs money. Trauma care, surgery, hospital services, recovery and rehabilitation charges can quickly mount. Compared to other states with higher rates of uninsured people and weaker safety nets, the Massachusetts health care system is built to minimize the likelihood that huge debts will follow major injuries and illnesses.
Massachusetts enforces an individual mandate that nearly every state resident obtain some form of health coverage, and it also provides subsidized coverage via Medicaid or private health insurance to low- and middle-income people who don't receive health benefits at work. This system served as a model for President Barack Obama's health care reform law, known as the Affordable Care Act.
In addition to providing for health insurance coverage, Massachusetts runs a program called Health Safety Net. This benefit allows patients who have no health insurance or inadequate coverage to apply to have the state pay their hospital bills, even if they aren't residents, Bigby said. Generally, the only people who qualify are those who make up to 400 percent of the federal poverty level, which is $45,690 for a single person this year -- but exceptions are made for severe illness and injuries, according to Bigby. The Health Safety Net benefit is largely financed by assessments on hospitals and health insurance companies.
Federal law requires hospitals to accept and stabilize everyone in need of emergency medical care regardless of their ability to pay. In Massachusetts, however, broader insurance coverage and a safety net program for uninsured people's hospital bills not only alleviates some worry about high costs, but also diminishes the chances a patient will be sent out of the hospital as soon as they are out of mortal danger, Bigby said.
"In some of those places, people would be seen and stabilized and hospitals would try to ship them somewhere else, to a public hospital or somewhere where people without insurance generally are sent," Bigby said.
Yet, given the extensive nature of some patients' injuries, including lost limbs, there will be ongoing medical and rehabilitative costs that may not be covered by health insurance or by the Massachusetts safety net program. "The breadth of coverage could leave some people with some uncovered expenses given the severity of some of the potential injuries," Bigby said. The Health Safety Net Program is limited to hospital costs.
Patients' costs will vary, Bigby said, depending on the care they receive and the level of coverage their health insurance plans provide. In Massachusetts, some less expensive insurance requires patients to cover 20 percent of their hospital bills and pay deductibles as high as $5,000, she said.
That's one reason why some bombing victims are raising money online and why Gov. Patrick and Boston Mayor Tom Menino (D) have backed the creation of the One Boston Fund. The fund will benefit those injured in the blasts and the families of the three killed at the marathon site and the police officer killed in Cambridge Thursday. Massachusetts and the federal government also have crime victims' compensation funds available.
Additionally, hospitals have charity care programs that can waive some charges, said Tim Gens, general counsel for the Burlington-based Massachusetts Hospital Association. "Massachusetts has a very strong and extensive safety net," Gens said.
At Beth Israel Deaconess Medical Center in Boston, which treated victims as well as the two bombing suspects, billing questions will wait until a later date, spokesman Jerry Berger wrote in e-mails to The Huffington Post. "We just aren't focusing on that yet. It's a question that will be addressed when everyone is discharged," Berger wrote. "We have been focusing on providing care."
The most severely injured bombing victims likely will suffer lifelong health problems or disabilities as a result of their injuries, and Massachusetts law guarantees residents of the state will remain insured, said Donald Berwick, a former acting administrator of the U.S. Centers for Medicare and Medicaid Services under Obama and a possible 2014 gubernatorial candidate in Massachusetts.
In other states, those would qualify as pre-existing conditions that would enable health insurance companies to refuse future coverage for the victims, he said. That will change when the health insurance market reforms under Obama's health care reform law are enforced next year, Berwick noted.
"Massachusetts is the only state, until the Affordable Care Act comes into effect, in which they have to issue insurance," he said.
CORRECTION: A previous version of this story misstated Boston Mayor Tom Menino's political affiliation. He is in fact a Democrat.