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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

April 25, 2017

Yesterday, the full House began the FY 2018 budget deliberation process on Beacon Hill. As the amendment process moves forward, we at HCFA are working with lawmakers, advocates, providers, faith groups, consumers, and other health stakeholders to protect funding for consumer based health care programs in the state budget and to protect MassHealth and other critical pieces of the Commonwealth’s health infrastructure.

[See our complete budget amendment fact sheet here]

HCFA Supports:

  • Investing an additional $5 million in the Children’s Medical Security Plan and directing EOHHS to plan for the lifting of caps on benefits for covered children (Amendment #1077/Rep. Barber)
  • Ensuring that MassHealth CarePlus enrollees continue to have access to non-emergency medical transportation (Amendment #100/Rep. Gentile)
  • Reinstating coverage for periodontal disease (a chronic bacterial infection of the gums and teeth) services for adult MassHealth enrollees (Amendment #439/Rep. Scibak)
  • Restoring full dental benefits for adult MassHealth enrollees (Amendment #419/Rep. Pignatelli)
  • Allocating $500,000 to fund academic detailing, a physician education program on cost-effective pain management medications (Amendment #797/Rep. Benson)
  • Increasing funding for the Department of Public Health’s Office of Oral Health (Amendment #117/Rep. Scibak)
  • Allocating $300,000 for the Forsyth Kids program, which provides school-based oral health care to 1,700 underserved children across the Commonwealth (Amendment #234/Rep. Crighton)
  • Establish the Prevention and Wellness Trust Fund as a permanent program with a dedicated revenue stream (Amendment #24/Rep. Vega)
  • Investing $301,500 to expand screening, brief intervention, and referral to treatment programs in schools targeted at addressing adolescent alcohol and drug use (Amendment #860/Rep. Khan)
  • Funding and maintaining the successful Mental Health Advocacy Program for Kids (MHAP) that helps children involved with the juvenile justice system (Amendment #351/Rep. Golden)
  • Creating a common application for SNAP and MassHealth benefits to close to SNAP Gap and expand access to benefits for low income residents (Amendment #31/Rep. Livingstone)

HCFA Opposes:

  • Creating a MassHealth Control Board charged with slashing MassHealth spending with no consideration for improving health outcomes for enrollees, no legislative oversight, and no MassHealth member/consumer representation (Amendment #876/Rep. Lyons)
  • Targeting low income residents by instituting MassHealth work requirements, charging premiums, and barring MassHealth eligible workers with employer sponsored insurance from enrolling in wrap around coverage (Amendment #878/Rep. Lyons)
  • Capping MassHealth spending at 30% of the total state budget, effectively forcing massive cuts in state Medicaid spending while only passing savings on to the federal government (Amendment #880/Rep. Lyons)

We encourage you to contact your state representative to express your support/opposition to the above amendments.

                                                                                                                                                                                                             Alec Lebovitz

April 17, 2017

The Blue Cross Blue Shield of Massachusetts Foundation has just released a detailed set of reports on uninsurance rates in the state, The Geography of Uninsurance in Massachusetts, 2011-2015. The report is based the five years of data from the census’ American Community Survey (ACS), which surveys 2 million households annually to identify uninsured residents.

Since the implementation of Chapter 58 our 2006 state health reform law, the insurance rate has increased dramatically. In 2015, 97.2% of the population had access to health care. However, “The Geography of Uninsurance, 2011-2015” highlights those areas in the state where the percentage of insured residents is much lower than the median. The wide variation is shown in this map:

Wide variation in insurance coverage in Massachusetts
The table below provides a list of municipalities ranked by the uninsurance rate (%) where HCFA has targeted our outreach and enrollment efforts:

Locations

Total Population (#)

Uninsured (#)

Uninsurance Rate (#)

Everett

43,714

4,413

10.1

Chelsea

37,110

3,605

9.7

Lawrence

78,108

6,216

8.0

Framingham

69,128

4,906

7.1

Brockton

93,441

4,800

5.1

Lowell

108,161

7,091

6.6

Lynn

91,294

5,575

6.1

Revere

52,858

3,248

6.1

Health Care For All’s HelpLine provides multilingual and culturally competent direct services as a navigator organization to improve access to health insurance and care for underserved communities such as the ones listed above. As part of this work, HCFA has deployed ethnic media campaigns and hosted successful enrollment events and sessions in towns with both high uninsurance rates and immigrant populations. We have also developed a partnership with the Edward M. Kennedy Community Health Center in Framingham to help residents navigate their health insurance options during Open Enrollment that will continue in 2017-2018, targeting Spanish and Portuguese speakers in the region.

If you know someone who is uninsured or needs help navigating the complicated healthcare system, please connect them to HCFA’s HelpLine at 1-800-272-4232.

April 13, 2017

The state House of Representatives released their draft budget this week. The budget funds the state's MassHealth and other health programs, and includes many provision supported by HCFA. Our friends at the Massachusetts Law Reform Institute released an outstanding summary of the provisions affecting low income residents, including MassHealth and other health concerns. House budget debate starts on April 24.

Net state spending for MassHealth is just 14% of state budget

We want to offer an important correction to a misleading fact often cited in the press. It is claimed that MassHealth, our Medicaid program, consumes 40% or more of the total state budget, leading policymakers to decry out of control spending for Medicaid. Yet this statistic ignores the fact that that the vast majority of that spending comes from the federal government, and doesn't come out of state revenue. It's just a pass-through.

The real numbers are that Medicaid costs make up just 14% of state spending from state revenue. The rest is all federal money, that comes into Massachusetts, and is then spent in our economy, benefiting Mass residents. See the graphs on this presentation from the Blue Cross Foundation, chart 5, reproduced above. So, claiming that Medicaid costs us 40% of the budget is very misleading

HCFA is pleased that the House budget proposal includes a reinstatment of the state's employer responsibilty law. This will assess a fee on large employers who do not provide health insurance coverage to their workers. A similar fee was included in chapter 58, the 2006 health reform passed under Governor Romney, and was also part of the Affordable Care Act. The state fee was repealed several years ago, and with the ACA fee in danger of being repealed, or nor enforced, it's important for the state to step in and make sure that employers are prompted to provide coverage.

HCFA is supporting a number of important amendments to improve the budget. Please, call your state Representative, and urge him or her to support HCFA's budget priorities. Here's our list:

Improve Children's Health Coverage

Thousands of children who are not eligible for MassHealth and do not have access to private health insurance through their parents can get basic coverage through the Children's Medical Security Plan (CMSP). However, CMSP benefits have strict limits on coverage that are inadequate to keep a child healthy; for example, a $200 limit on prescription drugs and a 13-visit limit on mental health services. The FY2018 budgets proposed thus far cut funding for CMSP from $17.4 million to $12.4 million. Please support Rep. Barber's amendment to restore $5 million in funding for CMSP and to direct EOHHS to develop a plan to improve the scope of benefits (adding language and $5 million to line item 4000-0990).

Ensure Access to Transportation for Medical Appointments

Non-emergency medical transportation provides access to and from medical appointments for MassHealth enrollees who do not have other means of transportation. EOHHS has indicated it plans to seek a waiver to eliminate this benefit except for travel to substance use disorder (SUD) treatment services for MassHealth CarePlus (Medicaid expansion) enrollees. About 13,000 MassHealth CarePlus enrollees used non-emergency medical transportation for non-substance use disorders (SUD) services last year. Please support Rep. Gentile's amendment (#100) to ensure that MassHealth CarePlus enrollees continue to receive appropriate transportation to all necessary medical appointments (adding language to line item 4000-0940).

Restore Periodontal Treatment Coverage for Adult MassHealth Enrollees

Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss leading to eventual tooth loss and also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth. Therefore, coverage for the treatment of periodontal disease is critical to improving the oral and general health of the adult population. Please support Rep. Scibak’s amendment to restore coverage for periodontal services for adult MassHealth enrollees (adding language and $10 million to line item 4000-0700).

Plan for Full Restoration of MassHealth Adult Dental Benefits

More than 1 million people, including 149,000 seniors and 245,000 people with disabilities, are without access to dental care beyond cleanings, fillings, extractions, and full dentures. Without access to appropriate dental care, many people living with chronic illnesses such as diabetes or hypertension see their conditions worsen. Those with oral health issues that may have been easily resolved with a simple procedure may require far more invasive and costly treatments. Please support Rep. Pignatelli’s amendment directing EOHHS to develop a plan to fully restore dental benefits for adult MassHealth enrollees (adding language to line item 4000-0700).

March 26, 2017

As was noted in the Globe article on Saturday, there were smiles and high-fives at Health Care For All, as we joined together with our partners at Community Catalyst and Health Law Advocates to watch Speaker Ryan declare that the effort to repeal the Affordable Care Act was not going forward. 

We were going all out in the last few days, contacting voters in key districts outside Massachusetts, urging them to call their Representatives. The bill that was pulled would have been devastating to Massachusetts, likely leading to some 600,000 Bay Staters losing coverage over the next 8 years.

A few quick observations, looking back and forwards:

1. Huge thanks to all the members of the state's House Congressional delegation, who unanimously, steadfastly opposed this harmful bill. Congressman Steven Lynch spoke passionately before the vote, saying, “This bill would actually do away with Medicaid as we know it…. It takes all the opioid money that we’re using; we have a major crisis going on in this country, especially in Massachusetts.” Congressmen Richard Neal and Jim McGovern each spoke in opposition during the abortive House debate (we also loved Congressman McGovern's comment on the proposal to axe essential health benefits: “It’s so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night”). Strong statements also came from Representatives Katherine Clark, Bill Keating, and Niki Tsongas, Earlier, Representatives Mike Capuano and Seth Moulton also registered their strong opposition

Following the vote, Congressman Joe Kennedy III spoke at an impromptu celebration outside the Capitol, saying:

This fight is not over…There are still hundreds and thousands and millions of Americans out there that need access to affordable, quality care everywhere for their loved ones. Yes, we had a victory today, but this does not end when you pull a bill. This ends when every single American can wake up in the morning…knowing that our society is there for them…Because I know, uniquely in healthcare, that there will be some point in my life when I will need to draw on that very same safety net that I hope is there for you. And I hope that you are willing to make that same investment in me.

That is what this fight is about, not about actuaries and spreadsheets and numbers, but about the commitment that we make to each other that goes to the very heart of what I believe this nation great, the promise we make to our neighbors and our friends. We had an incredible day today because of the thousands of people who stood up over the past several weeks and told their members that this was a bad bill. It was going to hurt people. And today, America, we won. And tomorrow, we fight on.

Watch:

Thanks also to Governor Baker and his team, who showed true leadership by letting analysis, not partisanship, guide their approach. We understand he was an effective mostly behind-the-scenes force pushing against the rush to take away MassHealth funds and care from Massachusetts.

2. Much credit goes to the public activism. While the hard-right "Freedom Caucus" grabbed most of the attention, as their demands kept getting met, more and more Republican moderates began peeling away, leading to the bill's demise. Vox dubbed this group the "Coverage Caucus," and they worried about people losing coverage because people in their districts were loudly letting them know how important the ACA was. Many were from states that expanded Medicaid. They were made acutely aware of the political risks of voting for Ryan's bill, starting in the loud town hall meeting protests earlier this year. The stunning growth of explosive grass-roots energy, guided by projects such as the Indivisible movement, and many others, made a real difference. 

3. It's far from over. The Trump administration still has many ways to sabotage the operations of the ACA, particularly for the marketplaces, like our Health Connector. Last week Politico reported on a number of already-moving actions:

March 23, 2017

   

 

A new report details the positive impact the Affordable Care Act (ACA) has had in Massachusetts. The report (read it here), issued by Senator Elizabeth Warren along with Senator Ed Markey and almost all of the state's Congressional delegation, provides example after example of people whose lives were directly affected by the help offered through the ACA.

More than 100 hospitals, community health centers, behavioral health organizations, insurers, patient advocates, health care providers, and individuals share their perspectives, including Health Care For All and our legal affiliate, Health Law Advocates. Their stories reveal the importance of high-quality, affordable insurance coverage and how the ACA has improved health care and access to health care in Massachusetts. In the report, voices from across the health system in Massachusetts speak of the need to maintain the protections and coverage provided by the ACA. Hospitals, insurers, and health care providers from across the Commonwealth explain what it means to them to participate in a health system that provides near-universal coverage, and the difference it has made to them or to the individuals they cover, care for, advocate with, or work with to have access to the ACA’s protections. These voices also highlight the unique and innovative ways that Massachusetts has been able to provide services and programs that have improved the health and wellbeing of its residents and communities.

The Health Care For All contribution focuses on our HelpLine, and on a mother who called us because her daughter had pulmonary hypertension. Their daughter was able to get all the care she needed through the law's forbidding of lifetime caps on insurance coverage.

HCFA congratulates Senator Warren on the amazing resource, and hopes its message will be spread far as the debate continues on the ACA.

March 22, 2017

Three brand new resources to help people understand the impact of the House-proposed Republican bill to repeal and replace the Affordable Care Act - an infographic summary of coverage losses; a 1-page summary of the impact on Medicaid (MassHealth); and a more comprehensive chart we prepared comparing the ACA with the Republican AHCA, and the impact on Massachusetts.

The Medicaid summary is here, you can download the chart here, and see the infographic below:

 

March 17, 2017

Notice of TerminationOn Monday, the Congressional Budget Office (CBO), the legislative branch’s nonpartisan policy analysis arm, released its analysis of the Republican health plan put forward to replace Obamacare. As expected, the CBO report showed that the Republican’s American Health Care Act (AHCA) would result in drastically reduced health coverage, rising health care costs, and disproportionate harm to the old, the poor, and the sick. Specifically, the report found that 24 million Americans would lose coverage by 2026 and that nationally, premiums would rise anywhere from 15% - 20% in 2018 and 2019.

This authoritative data fueled further analysis that looked at the state-by-state impact of the proposal. We naturally looked at the forecasts for Massachusetts.

One study, by the Center for American Progress (CAP) looked at the impact of the proposed changes in help available through ACA insurance marketplaces, like our Massachusetts Health Connector. The bill would end the ACA's system of sliding scale assistance based on income, and instead substitute flat subsidies based solely on age. In addition, the bill would eliminate help for the co-pays and deductibles in these plans.

The CAP study found that the impact of these changes would be particularly harsh on vulnerable residents of Massachusetts getting help through the Connector. Here’s the projected increase in total costs for Massachusetts, compared to the ACA:

            In 2020:           Low-income individuals: $1,404 increase
                                      Low income families: $3,172 increase

           Older individuals (age 55-64): $1,267 increase
           Older families: $1,705 increase

            In 2026:           Low-income individuals: $2,367 increase
                                      Low income families: $5,629 increase

           Older individuals (age 55-64): $2,354 increase
           Older families: $3,668 increase

CAP also estimated the impact on coverage, looking at each Congressional District in the country. For Massachusetts, they projected a decline of 539,800 non-elderly people with coverage in 2026, including 87,800 fewer children, and 55,200 fewer people with disabilities with MassHealth coverage. In addition, some 50,000 seniors will lose their MassHealth coverage as well.

Another report from the Democratic staff of the Congressional Joint Economic Committee looked at the impact on private premiums, private coverage and hospital uncompensated care. Combining CBO data with other key data, they found that private premiums would increase in Massachusetts next year an additional $445 to $593 if the proposal was passed. They project an additional 147,616 Bay Staters losing coverage, and an eye-popping increase in hospital uncompensated care in Massachusetts of $132,854,730.  

The results are in, and the Republican plan, simply put, would cover fewer people and cost all Americans more for health care. Additionally, low income people, seniors, people living with disabilities, and other vulnerable populations would be singled out for the greatest harm.

Health Care for All’s Director of Policy and Government Relations, Brian Rosman, discussed the impact of the proposed health plan on Boston Neighborhood Network News on Wednesday:

 

                                                                                                                               - Alec Lebovitz

March 13, 2017

Impact of ACA repeal bill on Massachusetts Medicaid

The Republican ACA legislation being moved through the House contains Medicaid provisions that, if passed, would fundamentally alter the program that provides health care for over 70 million vulnerable Americans.  National estimates are that millions of Medicaid recipients would lose coverage under the proposal.

In Massachusetts, the impact would be particularly devastating. This was the conclusion of a recent presentation issued by the Blue Cross of Massachusetts Foundation, based on research done by the national law/consulting firm, Manatt.

Their presentation (linked here) analyzes the various Medicaid-related provisions of the proposal that would impact Massachusetts. The proposal freezes enrollment in the Medicaid expansion starting in 2020. The expansion provides comprehensive coverage to around 300,000 adults here. In 2017, Massachusetts received some $1.7 billion in federal matching funds for the expansion population. The bill also freezes a scheduled increase in our federal matching rate for this population, costing Massachusetts an additional millions over the next two years.

Congressional Republicans also propose to restructure Medicaid payments to states by imposing “per capita” caps. Currently, states spend what is necessary to provide medical care to people eligible for Medicaid, which include low income adults and children, pregnant women, seniors, and people with disabilities. If per capita caps are implemented, the federal government would give each state a fixed quantity for Medicaid spending annually, based on state Medicaid costs in previous years.

The goal is to cut federal Medicaid spending, at the expense of state budgets and the health of our most vulnerable populations. The Republican proposal uses 2016 as the base year for determining how much to appropriate each state and that amount would only be adjusted each year according to the Consumer Price Index for medical care (CPI-Med). However, in a high-cost health care state such as Massachusetts, CPI-Med will not adequately capture the rising cost of healthcare. The result is a compounding effect, in which every year the gap widens between the funds Massachusetts needs to maintain basic Medicaid coverage and benefits for residents and the funds it receives. Over time, the state would lose billions, at an accelerating rate.

In addition, by capping Medicaid this way, states would be left helpless in the face of major health care crises, such as a major flu breakout, or an economic downturn that pushes more people onto the Medicaid rolls.

Although the wording is not completely clear, it appears the Republican language would also preclude the state from receiving funds under the MassHealth Waiver agreement with the federal government, finalized last year. The waiver supports the restructuring of MassHealth, the state’s Medicaid program, to promote integrated behavioral and long-term care, and innovative support for focusing on the social factors that keep patients healthy. The waiver also addresses the opioid addiction crisis by expanded access to recovery-oriented substance abuse services. This could mean loss of hundreds of millions of dollars for Massachusetts health care.

In addition to installing per capita caps, the Republican proposal includes other provision designed to weaken Medicaid. Essential health benefits for Medicaid recipients codified under the ACA would be revoked, making it easier to cut benefits. Legal immigrants and naturalized citizens would lose an up to 90-day coverage period allowing them time to submit citizenship or immigration documents. And finally, the Medicaid expansion authorized under the ACA would be rolled back starting in 2020, jeopardizing coverage for millions of Americans and over 300,000 Massachusetts residents.

                                                                                                                                                                                       -- Alec Lebovitz

March 10, 2017

Yesterday, HCFA, along with dozens of advocates, providers, faith leaders, and consumers gathered in Boston’s historic Old South Church to protest the proposed Republican plan to dismantle Medicaid and the Affordable Care Act (ACA). Speakers included:

  • Rev. John Edgerton, Associate Minister, Old South Church of Boston; Member, Greater Boston Interfaith Organization
  • Hannah Frigand, Associate Director, HelpLine, Enrollment and Education, Health Care For All
  • Sheila Belin, Health Care Worker at Boston Medical Center, 1199SEIU Member
  • Eric Fleegler, MD, MPH, Boston Children’s Hospital
  • Kathy Paul, Massachusetts Senior Action Council
  • James S. Gessner, MD,  President, Massachusetts Medical Society
  • Nassira Nicola, Boston Center for Independent Living
  • Elizabeth Mooney, Southeast and Metrowest Regional Coordinator for the Massachusetts Organization for Addiction Recovery (MOAR)
  • Dennis Heaphy, Disability Policy Consortium
  • Jennifer Childs-Roshak, MD, MBA, President and CEO of Planned Parenthood League of Massachusetts

You can read highlights of their remarks here.

Both in Massachusetts and across the nation, a broad coalition of stakeholders has emerged in fierce opposition to the Republican plan, entitled the American Health Care Act (AHCA). The opposition includes health insurers, hospitals, nurses, doctors, patients, consumer advocates, community organizations, faith organizations, groups representing people with disabilities, senior groups, and even an executive from the Center for Medicare and Medicaid Services. The unanimous opposition of all these groups, which represent the full spectrum of health care stakeholders, is stunning – and telling.

The fact is that the AHCA would have devastating consequences across the entire nation, and Massachusetts would be particularly hard hit.  The provisions in the Republican legislation would decrease coverage and increase health care costs for consumers and the Commonwealth. The AHCA reduces federal assistance to low and middle income people for purchasing health insurance, eliminates cost-sharing protections included in the ACA, and rolls back the state’s Medicaid expansion, threatening coverage for over 300,000 Massachusetts residents.

Additionally, the Republican plan calls for capping Medicaid funds, which would result in the loss of billions of federal dollars used by the state to offer health coverage to the state’s most vulnerable residents. This radical change to Medicaid would place an enormous financial burden on Massachusetts and directly threaten benefits and coverage for 650,000 Massachusetts children, 170,000 seniors and 280,000 people with disabilities.

Much of what is contained in the Republican proposal is outrageous, but there is no doubt that most egregious of all is the theft of health care from the poorest Americans to line the pockets of the very richest among us. Reverend John Edgerton, an Associate Minister at Old South Church, a Greater Boston Interfaith Organization member, put it best yesterday, “This plan disregards the right of poor people to access care they can afford, while slanderously claiming that if they lose coverage it will be because of irresponsible spending. If this plan is passed, it will ruin people financially. But worse than that, people who might have remained healthy will get sick. People who might have survived will die."

Every voice counts in this fight to defend Medicaid and the ACA. We urge Massachusetts residents to call Governor Baker, Senators Markey and Warren, and your Representative in Congress. Thank them for all they have done to protect health coverage for the people of Massachusetts. Click here for more ways to get involved.

March 10, 2017

HCFA testified before the Health Policy Commission in support of lowering the state's "Cost Growth Benchmark." The hearing was held on March 8, 2017. The benchmark sets a goal for the limit of overall growth in medical spending in the state. Entities such as insurers or hospitals that exceed the benchmark may be subject to specific sanctions under the state's health care cost containment law (summary).

In our testimony, HCFA supported allowing the benchmark - the goal for the maximum allowable increase in health costs - to go down to 3.1%, from its current 3.6% annual rate.

"We think it's important to signal to the health care community on all sides that our job of reducing health care cost growth has to be strengthened and intensified, and therefore we support allowing the benchmark to go down," Health Care For All policy director Brian Rosman said.

HCFA also urged the Commission to support concrete steps to reduce health care cost growth, such as:

  • renewal of the Prevention and Wellness Trust Fund
  • integration of oral health
  • supporting Value-Based Insurance Design
  • bring transparency to pharmaceutical prices

Read the full testimony:

Link to Resource: 

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