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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

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: 

March 10, 2017

"Dentists still drill and fill teeth and physicians still look at the body from the tonsils south."

Julie Beck from The Atlantic just wrote an article that highlights the importance of dentists working alongside physicians. Read the article here.
At Health Care For All, our Oral Health Integration Project (OHIP) promotes the health of all Massachusetts residents by building a broad-based coalition advocating for the integration of dental and medical care. 
Our current objectives are to include oral health and dental services as a requirement of new state standards for Medicaid and commercial Accountable Care Organizations (ACOs). Given ACOs’ focus on whole-person health, the inclusion of oral health is critical to fully realize the potential of integrated care. For more information on OHIP, click here.
March 1, 2017

HCFA Policy Director Brian Rosman speaking at MPHA event 3-1-2017

HCFA was proud to play a leading role in today's big State House Campaign Kick-Off in support of Prevention and Wellness Trust Fund. PWTF is a unique Massachusetts program that works in partnership with community organizations to keep people safe and healthy. Almost one million people benefit from the program, which is currently active in nine regions, and focuses on four priority health conditions: pediatric asthma, hypertension, tobacco, and falls among older adults.

The rally was in support of legislation to extend and expand the program. Without legislative action, the program expires this June. HCFA, in collaboration with a coalition led by the Massachusetts Public Health Association, and including hospitals, community health centers, health care workers, faith organizations, and mayors across the state support S. 643, An Act to Promote Public Health through the Prevention and Wellness Trust Fund and a companion House bill. These bills will ensure continued funding for the fund, make available new revenue, and enhance the scope and depth of preventive care programs offered across the Commonwealth. We are particularly pleased to note that 112 state legislators have signed on to the bills as cosponsors; over half of the legislature!

Preventive care interventions supported by the fund are thorough and comprehensive, bringing community health centers, schools, housing authorities, and other entities together to address environmental causes of illness. The goal is to take a broader view, and promote healthy behaviors and community-clinical linkages.  The result is effective interventions that leads to improved health outcomes for patients and a significant return on investment for our health care system.

We are dedicated to expanding access to quality and affordable health care for all Massachusetts residents. But the truth is, we would rather not need health care; we would rather people stayed healthy to begin with. In this spirit, we believe that investing in preventive care is vital for Massachusetts. Preventative care prevents future illnesses and hospitalizations, improves health outcomes, and offers financial relief for our health care system. For these reasons, it is critical that Massachusetts lawmakers continue to invest in preventive care by extending funding for the Prevention and Wellness Trust Fund.

                                                                                                                                                                 - Alec Lebovitz

 

February 28, 2017

The Boston Globe ran two opinion pieces yesterday on employer responsibility in health care and the need for increased transparency in prescription drug pricing, both of which Health Care For All supports

An editorial expressed support for the concept put forth in Governor Baker’s budget proposal to require a contribution for  employers that provide inadequate health insurance coverage to employees, or do not provide coverage at all. Specifically, the Governor’s proposal would require employers with at least eleven full time employees (FTEs) to cover at least 80% of their workers or to pay a penalty of $2,000 per FTE. This assessment would be calculated on a sliding scale, meaning that the closer employers get to the 80% coverage benchmark, the less they would pay. HCFA agrees with the new employer contribution proposal. Governor Baker’s suggestion closely resembles the employer responsibility law that was originally included in Massachusetts’s 2006 health reform law. The state requirement  was repealed in 2013 in preparation for implementation of the Affordable Care Act (ACA)’s employer responsibility provisions. However, especially with the ACA in jeopardy, it is critical that health coverage remains a shared responsibility between employers, employees, insurers, payers, and providers, and that Massachusetts employers continue to pay their fair share.  

The second Globe article, an op-ed by Eric Schultz, the president and CEO of Harvard Pilgrim Health Care, lays out a compelling case for increased transparency for prescription drug prices. As Schultz points out in the article, prescription drug prices continue to grow at a furious pace and the United States continues to pay disproportionately high prices for both name brand and generic drugs. As an example, Schultz cites Harvoni, a drug used to cure hepatitis C, which costs $94,500 for a twelve week regimen in the United States, while it would cost essentially half that amount in the United Kingdom and only $900 in India. Schultz points out that it would be cheaper for Harvard Pilgrim to fly a member with hepatitis C (along with a guest) back and forth from the Cayman Islands twice, pay for the member to purchase Harvoni through a Cayman medical facility and receive follow-up testing and screenings, and treat the member to a nine day all-expenses paid vacation on the Cayman beaches– than it would to treat the member here in Massachusetts.

Clearly there is a problem with the way prescription drugs are priced in Massachusetts and across the United States. This is largely due to a lack of transparency. Health insurers routinely negotiate discounts and rebates with drug companies, yet insurers are not allowed to disclose publically the cost of those discounts. In addition, drug manufacturers do not disclose the amounts spent on administrative overhead, marketing, and research and development, all of which remain hidden from public scrutiny.

Health care costs continue to rise in Massachusetts, and a leading driver of cost growth is the rising cost of prescription drugs. From insulin to epipens, life-saving drugs have caught headlines and public attention for massive price increases (insulin prices have more than tripled since 2003, while epipen prices have increased six fold in the past decade). That is why HCFA is supporting a pair of bills recently introduced in the State House, H. 1228 and S. 652. Both bills would empower state agencies to collect information on costs of production from drug manufacturers and ensure that the Commonwealth is paying a fair price for prescription drugs. These legislative proposals are an important first step towards ensuring that Massachusetts consumers can afford critical medications, and that insurers won’t have to pay the equivalent of a Caribbean vacation to provide access to life-saving treatments here in the Commonwealth.   

                                                                                                                                                       - Alec Lebovitz                                                                                                                                           

February 28, 2017

We urge you today to read the following articles that were recently published on the Boston Globe.

  1. Lawmakers' bill tops dentists' proposal in expanding access to care
    The Globe published a letter to the editor submitted by Health Care for All's Executive Director Stephen Rosenfeld favoring legislation that would create a new class of oral health providers, called dental therapists. This bill would allow them to meet the needs of vulnerable populations who might not have access to oral health care in traditional settings (see this fact sheet for more details). 

  2. Groups urge Baker to oppose possible Medicaid cuts
    As part of a national effort to ask governors in to oppose Medicaid cuts in the form of block grants or per capita caps, HCFA circulated a sign-on letter to Governor Baker urging him to continue to support full funding for Medicaid. The letter was signed by 28 Massachusetts hospitals, consumer groups, labor unions, religious coalitions and other organizations. Together we ask for Governor Baker to "oppose any federal policy changes that could threaten Medicaid coverage for thousands of poor and disabled people across the state."

  3. The Lifesaving Care Act
    This column highlights the story of Jen Fox, an intern for Massachusetts Congressman Joe Kennedy who got access to health insurance and treatment that saved her life thanks to the Affordable Care Act.

 

February 17, 2017

Join Health Care For All's contingent at the "We will Persist"- Boston Rally

As the Massachusetts Congressional delegation gets ready to go back to D.C., let's join together, stand with our allies in Congress and continue to send a clear message to Washington: We will continue to fight. Our voices will not be silenced. We will persist. We need to speak up and take action to protect our communities and to protect health care access for millions of residents.

Tuesday, February 21
2 PM - 3 PM
Irish Famine Memorial
294 Washington St, Boston, MA 02108

Speakers:
U.S. Representative Joe P. Kennedy
U.S. Senator Ed Markey                             

Sponsors:
32BJ SEIU
1199 SEIU
SEIU 888
Health Care For All
Mass Senior Action Council

 

You want to help save health care but cannot make it to the rally? No problem! You can participate on the phone banks that HCFA will be co-hosting next week with 1199 SEIU. We will be calling voters in Maine to ask senators in that state to vote against repeal of the Affordable care Act. 

 

 
February 17, 2017

Today, the Massachusetts Budget and Policy Center released a report highlighting the major federal funding sources received by the state to provide access to affordable health care, help children thrive, assist low-income families, and care for veterans.

According to the report, federal revenue currently accounts for approximately 25% of the Massachusetts state budget, totaling about $11 billion in state fiscal year 2017. Of that $11 billion, $9.44 billion comes in the form of reimbursement for state spending on Medicaid.  Federal funding for the Children’s Health Insurance Program brings in an additional $534 million. MassHealth, the state’s combined Medicaid and Children’s Health Insurance Program (CHIP), provides health insurance to 1.9 million Bay State residents, including over 645,000 children and hundreds of thousands of seniors and people with disabilities

A number of proposals expected to be debated by Congress in the coming months will certainly impact state budgets across the country, including Massachusetts.  The state’s MassHealth budget in particular faces three major threats:  repeal of the Affordable Care Act (ACA), major restructuring of the Medicaid program, and funding for CHIP.

The ACA contains a provision that expands Medicaid coverage to adults earning up to 133% of the Federal Poverty Level and increases the federal reimbursement rate for state spending on this population. The state will spend and expected $2.096 billion on the expansion population in 2017, with the federal government picking up 86% of the cost, or $1.824 billion (as opposed to 50% for most of the remaining Medicaid spending). The ACA also included a 23% enhanced matching rate for CHIP spending – increasing Massachusetts’ rate from 65% to 88%. If the ACA is repealed, Massachusetts could lose some or all of the $776 million in enhanced Medicaid funding, or even all of the $1.824 billion in federal reimbursement for the expansion population, in addition to the $139.6 million in increased CHIP reimbursement.

Congressional Republicans are also moving towards transforming federal Medicaid funding into a block grant or per-capita caps. If they are successful, rather than state’s receiving reimbursement for Medicaid spending, each state will instead receive a set amount each year – resulting in up to 25% in reductions to federal Medicaid funding for Massachusetts. These proposals simply shift health care costs from the federal government to state governments, forcing state policymakers to make difficult decisions, such as slashing eligibility, benefits and provider rates. In addition, MassHealth’s progress toward innovation – investing in keeping people health and changing the payment system to promote value – could also be constrained with the move to block grants or per-capita caps.

In addition, federal funding for the CHIP program expires in September, 2017. If Congress does not act to reauthorize and fund the program, the Commonwealth will be faced with the choice of picking up the state would have to pick up the full costs of this program, or reduce the number of children covered and the benefits they receive.

The MassBudget report drives home the point that all states, including Massachusetts, depend on a partnership with the federal government to share in the cost of providing health care to needy children, people living with disabilities, seniors, veterans, and low income and working families. If the ACA is repealed, if CHIP is not funded, or if Medicaid is gutted, Massachusetts will face significant budget challenges and difficult choices that could have devastating impacts on the ability of low-income individuals and families, children, seniors and people with disabilities to access health care services.

February 14, 2017

As the Trump administration and congressional Republicans rush to take healthcare away from 30 million Americans, increase our healthcare costs, endanger the care we deliver and threaten our jobs, our Massachusetts Congressional Delegation has been leading the charge to fight back. Our members of Congress know we deserve better, and our patients and communities do, too.

Send your thanks to our Members of Congress as part of 1199 SEIU's Valentine's Day campaign!

 

Write your own email and tell your member of Congress:

"I am a voter in your district and a healthcare worker. I am writing to thank you for fighting to protect the healthcare that my family and so many Massachusetts residents depend on. The Affordable Care Act must not be repealed without a plan to keep and improve the healthcare of our patients and consumers. Please continue fighting for a plan that protects care for 30 million hardworking Americans, preserves coverage for patients with pre-existing conditions, and maintains Medicaid funding for seniors, children and people with disabilities.Thank you again for fighting to protect quality, affordable healthcare - keep it up!"

You can also use your Facebook, Twitter and Instagram accounts to thank your member of Congress:

"My name is [name], I am a voter in [hometown] and a healthcare worker at [facility]. I want to thank our entire Massachusetts Congressional Delegation for fighting to protect the healthcare that my family and so many Massachusetts residents depend on. The Affordable Care Act must not be repealed without a plan to keep and improve our healthcare. We care for Massachusetts together, and I am proud to stand with you. Thank you again for fighting to protect quality, affordable healthcare - keep it up!"

 

Happy Valentine's Day from Health Care For All! 

 

 

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