October 2017

October 31, 2017

With Halloween upon us, we are enjoying the playfulness of costumes and trick or treating. As we are passing out sweets to all the cute ghosts and dinosaurs, we should be concerned that families are wondering whether the Children’s Health Insurance Program (CHIP) will be available to their children in the coming months and years.

As of September 30, Congress allowed funding for CHIP to expire. This puts at risk health insurance coverage for nearly 9 million children, which is scary. In early October, committees in each chamber of Congress made some progress by passing similar legislative language extending CHIP funding for five years. This is an example of the longstanding bipartisan support for CHIP and is certainly something to celebrate. However, the House version of the legislation contains other policy proposals and worrisome methods of covering the costs of CHIP funding. This means that House and Senate leadership are still negotiating how to pay for CHIP, and there are clear signals that they still have not come to an agreement.

Unfortunately—despite Congress’ progress—the urgency of refunding the program is only increasing. Last week, the Georgetown Center on Children and Families released a report outlining the consequences of Congress’ delayed action. As the report notes, the children most at risk of losing coverage live in states with CHIP programs that are running out of funds more quickly. Some states like Minnesota might run out of funds as early as November while other states could run out of funds by December or early January. Arizona, California, Florida, Texas and the District of Columbia are among the states slated to run out most quickly. This means that kids could lose coverage, including a disproportionate proportion of children of color because those states enroll some of the highest percentages of children of color.

Meanwhile, making changes to CHIP takes time and states cannot complete the necessary steps moments before they exhaust their funds. Even states that estimate their funding will stretch a bit farther into 2018 have already started taking action to wind down their program. Colorado, Texas, Virginia and Washington all plan to send notices to families in December alerting them that their coverage is ending. Utah has taken an even more significant step by submitting a plan to the Centers for Medicare and Medicaid Services (CMS) to close their program once they exhaust their funds.

Children, families and states need swift action to address the uncertainty around CHIP funding. Despite ongoing efforts to reach consensus on how to pay for CHIP, Majority Leader Kevin McCarthy announced that he would hold a floor vote on the House’s version of the CHIP funding legislation this week. This House vote threatens the bipartisan support that CHIP has had for more than 20 years. As the House moves forward with a vote, Democratic leadership argues Republicans are pushing ahead on partisan terms rather than working together to identify ways to pay for CHIP funding that would not harm other people.

It’s not a Halloween trick; it’s true: Without Congressional reauthorization, Massachusetts will exhaust its federal Children’s Health Insurance Program (CHIP) funds by March 2018. Here in the Commonwealth, CHIP is a part of MassHealth, along with Medicaid. Losing CHIP would be scary for the 160,000 Massachusetts children who depend on it for their health care. CHIP enables Massachusetts to provide health care coverage to children whose family incomes exceed the Medicaid eligibility standards but may not be high enough to afford private health insurance. In Massachusetts, 10% of children depend on CHIP for their health care, and 25% of children in the MassHealth program are covered by CHIP. In addition, CHIP currently provides health insurance to 7,000 expectant mothers who are not eligible for Medicaid. Without CHIP reauthorization, these mothers would lose access to prenatal care.

We must be loud and clear that Congress should pass a five-year extension of CHIP funding with bipartisan agreement on both policy and funding. Our little ghosts and goblins deserve it.

This post was written in concert with Community Catalyst

October 26, 2017

This Monday, Health Care For All testified before the Special Senate Committee on Health Care Cost Containment and Reform during a public hearing on the Senate health package (An Act furthering health empowerment and affordability by leveraging transformative health care) released the previous week. This major legislation affects a wide range of topics throughout the health care system. In our testimony, Health Care For All touched on a few of the provisions we think will impact consumers.

Major Items Highlighted by Health Care For All:

Prescription Drugs

Health Care For All supports the provision in this bill which authorizes an evidence-based education program for drug prescribers. To best prescribe to patients, doctors must keep up with a constantly evolving drug market and new clinical research. Meanwhile, the pharmaceutical industry spends billions of dollars in marketing directly to doctors, promoting new, high cost drugs even if these drugs don’t improve outcomes. This education program can help providers prescribe based on clinical data instead of promotional information.

HCFA also supports the introduction of transparency measures for prescription drug pricing. The rapidly rising cost of prescription drugs places major burdens on consumers and the state budget. However, Health Care For All urges for stronger transparency than is currently in the legislation. We believe that any information the state gathers on prices should be made available to the public, and that a substantial penalty should be levelled against any drug company that withholds pricing information.

Dental Therapists

Health Care For All strongly supports the authorization of dental therapists in this legislation. Dental therapists are mid-level providers who are trained to provide basic but vital services, including preventive dental care and basic restorative care such as filling cavities. Authorization for dental therapists will help expand these important services which too many Massachusetts residents are currently unable to access.

Another panel also testified on the importance of dental therapists. Dr. Kerry Maguire of Forsyth Kids spoke on the importance of dental therapists to increase the number of providers that can fill cavities for children, saying that currently, “if every dentist in the state picked up a dental drill and never put it down, we would still not be able to treat all the cavities out there. The problem is simply too great.”

Katherine Soal, a dental hygienist and former president of the Massachusetts Dental Hygienist Association, spoke on how dental therapists could help treat problems before they become severe. She gave the example of a patient she knew with cerebral palsy who developed an extreme dental issue and needed hospitalization, and she said that the hospitalization could have been prevented by early treatment from a dental therapist.

Maura Sullivan of The ARC of Massachusetts spoke on the benefits dental therapists could have for people with developmental disabilities. She said she has worked with the state to ensure dental therapists will have training in providing oral health care to people with these disabilities. She spoke on the difficulty she has had in finding a dentist for her own children, and said that dental therapists with this training could benefit many patients who currently have trouble finding dentists who are willing to treat individuals with developmental disabilities.

MassHealth

Health Care For All was also pleased by the decision to not include damaging provisions in this legislation. Last summer, the Governor proposed a series of MassHealth cuts that would have reduced eligibility, limited benefits, and imposed barriers to keeping coverage and continuity of care. Many of these cuts required legislative authorization, and the Senate referred the issues to this Senate special committee. The committee did not include these provisions in this legislation, which shows their disapproval of the proposed cuts.

Prevention and Wellness Trust Fund

Health Care For All commended the Senate working group for including reauthorization of the Prevention and Wellness Trust Fund in this legislation. The PWTF is a successful pilot program which promotes public health through preventive care and promotion of healthy behaviors. Public health is an extremely important area of focus as it improves quality of life and cuts down on costs. It’s generally much cheaper to invest in keeping people healthy than paying for costly care when people become sick. Health Care For All urged the Senate to include a permanent source of funding for the program in this legislation.

Hospital Readmissions

October 19, 2017

The Massachusetts Senate issued its comprehensive health care reform bill this Tuesday, and Health Care For all participated in the release of the legislation. Health Care For All’s executive director, Amy Rosenthal, spoke during the event and highlighted some of the priorities of consumers in the current system. The bill contains over 150 sections, and many elements of the bill align with the needs of consumers.

Watch our executive director's full comments on the legislation here.

Public Health and Social Determinants of Health 

The bill was put together by a Senate working group, who spoke on different aspects of the bill. Senator Jason Lewis emphasized the importance of public health, saying that “the social determinants of health are absolutely critical in determining health outcomes and health disparities.” He pointed out that promoting health outcomes also helps to decrease health costs, as healthier populations require less care.

This legislation promotes public health in several ways. It reauthorizes the Prevention and Wellness Trust Fund, a successful pilot program which promotes community disease prevention by supporting healthy behavior and increasing preventative care.

The legislation also addresses housing as an important social determinant of health by establishing a housing security task force to investigate housing programs, including prioritizing shelter beds for homeless patients discharged from emergency rooms, and by allowing housing providers and health care plans to coordinate location-based care.

Amy Rosenthal also emphasized the importance of public health, saying “We focus too much on curing people when they’re sick, and not enough on prevention and keeping them healthy.”

Telemedicine

This legislation would help promote telemedicine services by permitting the coverage of telemedicine services through MassHealth and updating requirements for commercial health plans to provide coverage for telemedicine.

Telemedicine has been proposed as a way to help increase access to services for those with limited mobility and for those who live far away from medical professionals, particularly in rural areas. Behavioral health is often considered to be one field where telemedicine may be particularly effective.

Dental Therapists

Senate Majority Leader Harriette Chandler spoke on the importance of promoting dental health. “Dental health is just as important as any other health care pursuit, but so many people in this state lack access to this service.

This legislation aims to increase access to dental health by establishing a dental therapist certification. Dental therapists are mid-level providers who are trained to provide basic but vital services, such as preventive dental care and filling cavities. This bill would allow dental therapists to deliver care in community settings, such as schools and nursing homes, which would help ensure access to populations who may have a difficult time traveling to the dentist’s office. “With dental therapists,” said Senator Chandler, “dental health services are delivered directly to those in the most need.”

Dental therapists would also help to decrease health care costs. Because they are mid-level providers with a more restricted scope of practice than dentists, dental therapists generally charge less for services than dentists do. Increasing access to preventive dental care will also help lower costs by decreasing the number of patients who utilize the emergency department for oral health issues.

Amy Rosenthal also spoke on oral health, saying that “We need to get people the oral health care that they need, and get them out of emergency departments when that’s not where they should be.”

Prescription Drug Costs

Prescription drug costs are one of the main drivers of rising health care costs, and growth in prescription drug spending is one of the most rapidly increasing parts of health care spending.

This legislation takes several steps to address these costs. The legislation increases transparency for providers and consumers. It would establish an academic detailing program to educate prescribers on drug outcomes based on medical evidence and not pharmaceutical advertisements. It would also require pharmacists to inform a consumer if the amount they are paying for a drug through insurance is higher than the direct retail rate that they would pay without insurance, which is sometimes the case due to the complex and hidden factors in drug pricing. If the price with insurance is higher, the consumer would be able to buy the drug at the lower retail rate.

The legislation would also create reports on the impact and potential cost saving of the state engaging in prescription drug bulk purchase consortiums.

Surprise Out-of-Network Billing

Amy Rosenthal said that “We need to… shut down surprise medical bills.” Surprise out-of-network billing refers to a situation where a patient is receiving care in a hospital that is in their insurance network, but is treated by a specific doctor who does not accept that insurance, resulting in an unexpected and large fee for the patient. This is a major financial stress for consumers. This legislation would guarantee that the patient would not have to pay an additional copay or deductible when this happens.

- Sean Connolly 

October 6, 2017

On Monday and Tuesday this week, the Massachusetts Health Policy Commission (HPC) held its 5th annual Health Care Cost Trends hearing. Government officials, health care providers, insurers, and advocates came together to provide testimony and answer questions from the HPC commissioners on strategies to contain health care costs.

Below are some of the major themes from the hearing, a number of which were also reflected in Health Care For All’s testimony to the HPC. You can read our full testimony here.

Massachusetts is below the state benchmark for spending growth, but there is more work to be done:

Massachusetts successfully remained under the state benchmark for health care spending growth in 2016. As of 2014, Massachusetts health care spending growth was the fourth lowest in the nation. In 2015 and 2016, Massachusetts remained below the US average in health care spending growth.

However, major problems remain in our health care spending. In 2014, Massachusetts still spent the second most in the country on health care per person, exceeded only by Alaska. It is estimated that about 26% of an average Massachusetts family’s wages go towards health care costs. Families with a greater number of health issues tend to pay even more, and often have a difficult time affording care.

Commissioners emphasized that, while lowering growth rates to below the benchmark has been a success, much more work is needed to lower costs. Commissioners also made it clear that cost cutting measures shouldn’t impact access to care for Massachusetts residents.

Unnecessary Hospital Use and Readmissions:

One cost containment method identified repeatedly at the hearing was reducing unnecessary hospital use, particularly hospital readmissions. A readmission is when a patient returns to a hospital within 30 days of being discharged from a previous hospital stay. Data presented at the hearing showed that Massachusetts readmission rates grew between 2015 and 2016.

While decreasing readmissions would help to decrease overall spending, several panelists at the hearing pointed out the challenges of preventing readmissions. Particularly for patients with chronic conditions, readmissions may be a result of the illness and do not necessarily indicate errors on the part of the hospital. The question was also raised if reducing readmissions is the best strategy to support vulnerable populations. Some panelists cautioned against any strategies that would financially penalize patients who make multiple hospital visits within a short time period, as this could end up preventing these patients from accessing needed care.

Those suffering from addiction and those with behavioral health conditions were identified as groups more likely to have a readmission. Because of this, improving treatment for addiction and behavioral health was identified as one way to help lower readmission rates. One panelist commented that, when a patient is in the hospital for an overdose, they can be provided detox services, “but where do they go after?” Without adequate resources invested in treatment and recovery programs, people suffering from addiction may repeatedly return to the hospital. Commissioners also identified improved care coordination and engaging patients more actively in their care as a way to decrease unnecessary readmissions.

Social Determinants of Health:

Both commissioners and panelists identified social determinants of health as a key contributing factor to high health care costs.. Several commissioners noted that there has not yet been enough done to invest in programs that focus on these social determinants.  

The importance of ensuring that communities have access to necessities such as nutritious food, transportation, housing and infrastructure was repeatedly stressed during the hearing. These resources allow communities to maintain better health overall and to access health care services when needed. One community health center CEO mentioned that a lack of transportation and infrastructure are major issues for patients, and that the health center provides transportation services to some patients to ensure they are able to access care. While a number of panelists and commissioners agreed that providers and payers should be doing more to invest in addressing unmet social needs, they also expressed concerns about how to do this without adding more money to the system.

One specific program mentioned during the hearing was the Prevention and Wellness Trust Fund. This fund promotes healthy behaviors, which helps to prevent illness and hospitalizations and improve health outcomes. The fund’s authorization expired this summer, and it has not been reauthorized in the current state budget. Health Care For All believes that allowing funding to lapse for this program is a shortsighted approach to containing cost, as the program will reduces overall cost in the long term by creating a healthier population which has less need for costly medical care.

Keeping Care in the Community: