Cape Cod

On Island, Health Care Coverage Gaps Are Common

By Sean Corcoran   |   Monday, May 21, 2012
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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.

'Tourist Train' Status: Delayed

By Sean Corcoran   |   Thursday, April 26, 2012
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April 27, 2012

hyannis train station

Planners believe a summer weekend train from Boston to Hyannis would run in the black. (Sean Corcoran/WGBH)

HYANNIS, Mass. — Summer on the Cape means beaches, boating and sun. It's a boon for Cape businesses — but a hassle for everyone getting there, with traffic from Braintree to Bourne and beyond. An influx of tourists each summer doubles the Cape's population to 215,000.
Transportation officials expected to launch a new weekend train service from Boston to the Cape this summer to help ease that congestion. But with the MBTA facing its most significant budget crises in its history, the service is now on hold — and not because it would cost the MBTA money. It wouldn't. But with fare hikes and budget cuts on the table, launching a new train service to the Cape could be a political blunder.

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Barnstable DA: Killer Will Be Brought to Justice

By Sean Corcoran   |   Tuesday, April 24, 2012
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April 24, 2012

Trudie Hall
Trudie Hall disappeared in 2010. (Facebook)

WOODS HOLE, Mass. — Law enforcement officials on Cape Cod have identified a body found in a remote area of woods in Falmouth on April 19 as Trudie Hall, a Nantucket resident who went missing in July 2010.

Officials are giving few details surrounding the investigation and the condition of Hall's body, beyond saying she was shot multiple times. Barnstable County District Attorney Michael O'Keefe said a person walking their dog found the body in woods adjacent to Falmouth Country Club and the Crane Wildlife Area — an area police had not previously searched.
"Last Thursday, skeletal remains were found in the town of Falmouth, and we indicated those remains would be analyzed by experts at the office of the medical examiner, including a forensic anthropologist and a forensic dentist," he said. "The medical examiners' office late yesterday, has identified the remains as Trudie Hall."
Hall, 23, was reported missing in July 2010 by her mother after Hall had traveled from Nantucket to Cape Cod, where she spent the night in a Yarmouth motel and rented a car. The car later was found in a commuter lot, with blood and bullet casings inside.
O'Keefe would not identify any suspects, but investigators had previously interviewed a Centerville man with a criminal record and seized some of his property during the investigation. That man has not been charged. O'Keefe indicated that anyone involved in the crime should step up now, saying, "There may be a possibility that someone knowingly or unknowingly aided the killer of Trudie after the fact, and we want that person to contact us."
Hall was approximately four months pregnant at the time of her disappearance, and O'Keefe said it was unclear whether a second murder charge for the unborn baby would be appropriate. He also would not confirm multiple media reports that Hall was married to more than one person at the time of her death, and may have been involved in an immigration scam.
"Some of the things that you have reported about Trudie that may or may not be true with respect to these immigration issues, not withstanding all that, she was a 23-year-old woman who had a family that loved her very much," he said.
While providing few details, O'Keefe said the location and condition of Hall's body provides law enforcement officials with some key information, and officials are confident that whomever was involved in her murder will be brought to justice.

State Aims to Slow Nuclear Plant Relicensing

By Jordan Weinstein   |   Friday, April 6, 2012
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April 6, 2012

pilgrim nuclear

The Pilgrim Nuclear Power Plant's current license expires this year. (Courtesy of Entergy)

BOSTON — Attorney General Martha Coakley has filed an appeal challenging the Nuclear Regulatory Commission's decision to go ahead with hearings to grant a new 20-year license extension for the Pilgrim Nuclear Power Plant in Plymouth.
> > WGBH NEWS SPECIAL COVERAGE: Power Struggle: The Fight over Pilgrim Nuclear
Coakley said an independent expert has concluded that the risks of operating Pilgrim are greater than originally thought and that certain improvements should be made to the plant before a new license is granted. “There should be better and longer backup power systems, or there should be instrumentation to verify the cooling systems are functioning properly. Or to make sure there are improved valves and containment to reduce pressure on the reactor,” she said.
The goal, Coakley said, is to guarantee that the NRC considers the environmental and public safety implications of the 2011 Fukushima accident while allowing a meaningful opportunity for public comment.
State Sen. Dan Wolf (D-Harwich) agreed, saying that lessons learned from Fukushima should be explored in an open, public process and applied to the Pilgrim relicensing process, particularly in regards to on-site storage of spent nuclear fuel rods.
The appeal was filed on April 4 in the 1st U.S. Circuit Court of Appeals.

> > READ: More from Coakley's office on Pilgrim

A Local Perspective on Global Warming: Complete Series

By Heather Goldstone   |   Tuesday, February 28, 2012
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A Brookings study released this week found that the public's belief in global warming is on the rise. Scientists say it's clear: temperatures are increasing, weather is getting more erratic and sea levels are going up. The question is ... what should we do about it? WCAI's Heather Goldstone looked at the ramifications of environmental change for the Massachusetts coast in a four-part series.

Reporter Heather Goldstone talks about the series to host Bob Seay.

> > Are you concerned about climate change? Comment on this story, let us know on Facebook or tweet @wgbhnews with the hashtag #climatide.

Part One: Warm Winter, Big Questions

early daffodils

Scientists predict that Massachusetts could have the climate of the Carolinas by late this century if global warming continues unabated. With temperatures several degrees above average, this winter has brought a taste of what may be to come. And some wonder if that’s really such a bad thing. In the first installment of our four-part series, we explore the disparity between the scientific consensus and public opinion on climate change.

Web Extra: The psychological impacts of climate change

Part Two: Fisheries in Hot Water


Lobstermen in the Gulf of Maine have posted record harvests in recent years. But in the waters just south of Cape Cod, the situation is dramatically different. Lobster populations there crashed a decade ago and have not recovered, leaving lobstermen to face the potential closure of their fishery. We take a look at one of the most dramatic examples of how climate change is affecting New England’s fisheries.

Web Extra: A warming world? See for yourself

Part Three: The Rising Seas


In part three of this week's series on climate change, we look at the threat rising ocean levels pose to the state's coastline — and to the policymakers who will be forced to face tough questions. But does it have to be bad news?

Multimedia: A three-dimensional animation of sea level rise.
Web Extra: Cape Cod's disappearing dunes

Part Four: Mitigation and Adaptation — the Birds' Lessons for Us


In the final installment of our series, we take a look at state officials' attempts to find the right balance between stopping climate change and preparing for it, with guidance from the avian kingdom.

Web Extra: With global warming, new birds in our skies
Massachusetts' clean energy and climate plan for 2020 (pdf)

Warm Winter, Big Questions

By Heather Goldstone   |   Sunday, February 26, 2012
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About the Authors
Jordan Weinstein Jordan Weinstein
Jordan Weinstein is a news anchor for NPR's All Things Considered on WGBH, 89.7 FM in Boston.
Heather Goldstone Heather Goldstone
Heather Goldstone is the science editor at WCAI, the Cape and Islands NPR Station. She holds a Ph.D. in ocean science from M.I.T. and Woods Hole Oceanographic Institution, and spent a decade as an active researcher before leaving the lab to become a writer. In her nine years with the Cape and Islands NPR Station, Goldstone has reported on Woods Hole’s unique scientific community and key environmental issues on Cape Cod. Her reporting has appeared in venues ranging from NPR and PBS News Hour, to Cape Cod Times and Commercial Fishery News. Most recently, Goldstone hosted the blog Climatide – an exploration of how climate change is impacting coastal life in the region. 


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