A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 5, 2005

Word spread quickly today that MA Health & Human Services Secretary Ron Preston will be stepping down sometime this summer. I wasn't going to mention it here until I got a call from a Boston Globe reporter for a quote. So witness the first HCFA Blog news scoop -- and let's take a moment for some reflection.

First, Ron had his share of critics, and HCFA had our share of beefs with him. Here's my large assessment. Ron facilitated the most significant reorganization of EOHHS in its 34 year history, transforming the Secretary from a powerless figurehead to the immensively powerful manager of half of state government. The reorg has good and not so good points, yet give Ron credit for pulling off an amazing achievement, and leaving a transformed H&HS landscape behind. Second, he surrounded himself with a cast of first rate commissioners and managers who do great work with insufficient resources -- not their fault. Third, he put health reform on Gov. Romney's agenda and kept it there -- not the way we (or he!) would have preferred; still the Governor's active engagement is a key reason something big may happen in the next 18 months. So Ron, here's a tip of the hat for your energetic leadership, your passion, and your dedication to doing the right thing.

Now, the future! Omigosh! The State has an urgent need to develop a new plan to use $1.3 billion in federal dollars to create a new "Safety Net Care" program for the uninsured. Ron has been the point person in this effort -- we've yet to see a bill that will require extensive legislative and federal review, with an implementation deadline of July 1, 2006. The new level of uncertainty concerning the Secretary's position puts a lot on the line and a lot in jeopardy. We hope the Governor finds someone exceptional to fill Ron's shoes.

May 4, 2005

In early 2003, with the state in the midst of a fiscal crisis, dental services for MassHealth adults were eliminated, except when teeth become so rotten, they need to be pulled. After that, tough luck because the state also stopped paying for dentures. About 550,000 adults -- 180,000 of them poor seniors -- are affected. The cost to restore coverage -- about $58 million ($29 million of which would be federally reimbursed). With state revenues now about $1 billion over estimate, we can think of three good reasons to restore coverage:

First, poor adults are experiencing incredible suffering and pain because they can't obtain medically needed services. Second, the state is wasting millions providing acute medical services that are preventable with adequate dental care. (One Holyoke man spent ten days in intensive care directly related to untreated gum disease.) Third, low-income parents on public assistance are unable to obtain jobs because of the condition of their mouths.

HCFA's incredible Oral Health Advocacy Task Force is getting ready to make their first major policy push to convince the Senate to restore coverage in their upcoming FY06 budget plan. What do you think? Worth the effort? Are you ready to help? Use the form on the right to let us know your reactions and thoughts.

May 3, 2005

Last Friday, the MA House finished work on its version of the FY06 budget, to start July 1. It was a conservative document with no new initiatives, and conservative estimates on taxes and spending. Their treatment of health issues was illustrative.

Governor Romney proposed cutting funding for the Free Care Pool by $120 million from this year's amount -- despite rising numbers of uninsured. Hospital leaders were caught off guard when House Ways and Means accepted the Governor's number and worked furiously to restore funding to the FY05 level. On Friday, House leaders put back $85 of the $120 million, though not before cutting $18 million to fix the "20 day withhold" problem. Back in 2003, the State stopped paying for any Medicaid patient who stays in a hospital longer than 20 days (imagine the reaction if Blue Cross or Harvard Pilgrim pulled this trick?). After putting in $18 million to fix this mini-disgrace in the Ways and Means version, House leaders pulled back this money as they reinserted $85 of the $120 million Pool funding.

On access, the House increased funding for MassHealth outreach from $250,000 to $500,000, removed objectionable language relating to health services for legal immigrants, and restored funding for public health programs. They refused to: 1) Remove enrollment caps that will keep thousands of needy low income persons out of MassHealth next year, 2) Restore essential benefits such as adult dental services, 3) Lessen high premiums for the Children's Medical Security Plan, and 4) Permit open enrollment in the Prescription Advantage program.

Special thanks to Reps. Debbie Blumer, Kathy Teahan, Steve LeDuc, John Scibak, Jim Marzilli and others for their tireless efforts in behalf of health care access. It's still early in the tenure of the new House leadership team. These discouraging signs leave us hoping there will be more encouraging news later this year.

May 2, 2005

Here's a good summary of the federal Medicaid budget fight by Families USA's Ron Pollack:

The Medicaid Fight: What Happened?

Even though Congress passed a budget resolution that includes $10 billion in cuts to Medicaid, the budget doesn't specify any policy requirements for achieving those cuts. In other words, the budget doesn't say what will be cut within Medicaid. Those decisions will be made by the Senate Finance and House Energy and Commerce committees during the reconciliation process, which we expect will be completed by or before mid-September. Our staff has produced a table that shows how much cuts of this magnitude could cost each state, and how many kids and seniors could be covered with that amount of money in one year. Click here for the document.

During the budget negotiations, there was much discussion about the creation of a Medicaid commission that would be charged with recommending Medicaid cuts to the congressional committees. At this point there's no decision about the framework, composition, scope and timeline of this commission, but it's an issue we're watching closely. The commission may issue some recommendations as early as September. It may be a very partisan, sham commission, but that is not yet clear.

Where We Go From Here

While it's hard to feel good about a budget that is balanced on the backs of the poor while adding to the fortunes of the wealthy, it's important to take a step back and look at the big picture as well. Yes, we are all disappointed; this budget will undoubtedly hurt millions of the most vulnerable among us. However, from the perspective of where we started last December (when we expected enormous structural changes in Medicaid and tens, if not hundreds, of billions of dollars in program cuts), the approximately $10 billion in Medicaid budget cuts is a far cry from what we feared. Because of your hard work and dedication, together we have prevented enormous and irreparable harm to millions of people who would otherwise have become uninsured and lost their health care.

We have a lot of work ahead of us in the coming months, but one thing remains clear: we are an extremely powerful voice when we work together. Make no mistake: your calls, e-mails and other efforts made a real difference during this fight. During the coming months we'll keep you informed about the latest developments in this fight, and will continue to ask for your help. I look forward to our work together in the coming months.

Sincerely,
Ron Pollack, Executive Director, Families USA

April 30, 2005

The National Academy of State Health Policy observes that for 25 years states have served as laboratories for health care reform efforts. In examining the impact and effectiveness of state funded health insurance programs they observe:

"State demonstrations have shown that, in order to provide coverage to significant numbers of the uninsured in a voluntary market, benefits must be comprehensive and affordable, carefully marketed, and offered through a simplified, accessible, eligibility process. They have also demonstrate that the cost of coverage poses a significant barrier to accessing coverage. To achieve affordability, plans must be offered to low-income families with premiums not to exceed one percent to three percent of family income."

If the outcome vision of the three major health care bills being considered in the state legislature is to decrease the numbers of uninsured , they need to learn from the research of NASHP. As these plans develope, it is crucial to design them so they are truly affordable for lower-income families.

This was taken from an op-ed column written by HCFA Board President Chip Joffe-Halpern in the April 28th edition of the North Adams Transcript. To view the entire piece, click here.

April 29, 2005

Last night, both houses of Congress voted along partisan lines to cut $10 billion in Medicaid spending nationally over the next five years as part of the FY06 budget resolution. This same budget plan cuts taxes on everyone making more than $1 million annually by $32 billion. Rarely has the connection been so clear between the needs of working and lower income Americans versus the wealthy.

Sen. Dick Durbin, last night on C-SPAN, recalled last week's event in Illinois to dedicate the new Lincoln Library, an event attended by President Bush. On the roadway to the event, the Senator recalled, one bystander held a sign President Bush could not have missed. The sign asked: "Whose taxes would Jesus cut?" We might add ... and whose health care benefits would Jesus cut?

April 28, 2005

A great new Robert Wood Johnson study provides state by state estimates on numbers of uninsured adults and uninsured adults with jobs. Among uninsured adults, best states were Minnesota (8.3%), Hawaii (9.8% -- love that employer mandate!), and Deleware (10.2%). Worst states -- Texas (30.7% -- helloooo Mr. President), Louisiana, 26.4%) and New Mexico (26%). Uninsured among adults with jobs -- same order, but look -- MN 6.9, HW 8.5, NM 22.6, LA 22.6, TX 26.6. Across the board, more than 80 percent of uninsured, state by state, are folks who work every day and pay taxes.

And how do we do in Massachusetts? We have the 4th best rate of uninsured adults at 11.2%, ditto for uninsured adults with jobs, 10.3%. Here's some data to chew on... uninsured whites in Massachusetts, 8.5%; uninsured blacks, 20.8%, and uninsured Hispanics, 32.8%.

Quick followup notes:

The Mass. House may be wrapping up its budget debate as early as today. Thus far, news for health care access has not been encouraging. Hospital leaders are distracted trying to restore $120 million in cuts to the Free Care Pool, and there's a dearth of money and political will to address access needs thus far. If you haven't done so, please visit our site to send an email to your legislator.

In Tennessee, Gov. Bredesen is now proposing to cut 226,000 from TennCare instead of 323,000. All enrollees would be limited to five prescriptions per month, only two of which could be brand name.

Meanwhile, health reform talk in Vermont is boiling. The House passed a plan last week 86 to 58 calling for a state run health insurance program by 2007, with an assured veto from the governor. The Senate is working on a plan that could attract some Republican support, and is proposing a 3% payroll tax on employers who don't cover their workers. Check out recent coverage by clicking here.

April 26, 2005

Just about a year ago, HCFA's Consumer Helpline began answering online requests for assistance. If you know anyone in need of free advice about their health coverage options, feel welcome to refer them to our Helpline -- phone or email. Meanwhile, here is a small sample of email requests for help our great HelpLine counselors answer every day:

"I am 64 and work full time but have no insurance. Company I work for does not offer it. According to MassHealth, I do not quality for their coverage."

"I am a Home Health Care Aide. We have insurance but it is too high for us girls. They want $75 a week and we only clear about $300 every two weeks. The state places to go to are filled up or a 4 month waiting list. I am on HTC for high blood pressurre and have had to cut back on medication because I can't afford it, and I haven't been to a doctor in over a year. We need your help."

"I work two part time jobs which equals to 40 hours a week. I do not qualify for insurance at one because I don't work enough hours. I do qualify at my other job but they take $150 our of EVERY paycheck which is biweekly. That is more than I can afford. I recently had to spend the night in the hospital and now I have significant medical bills as a result. While I qualify for partial free care, I am one of those people who doesn't make enough to get insurance but makes too much to qualify for state help."

"Currently I have a condition that the doctors can't diagnose without an ultrasound, but the cost to me and my family would be prohibitive. The urologist guessed the condition would resolve itself (though he wanted the ultrasound to make sure). I didn't schedule one because of the costs involved, so I've waited two months. The condition hasn't improved so I really need an ultrasound and a correct diagnosis. I simply can't obtain this procedure without assistance."

"Married senior citizens with combined income of $2400/month. We are paying 1/3 of our gross income for supplemental health insurance...are we eligible for help?"

"My employer is deducting health insurance from my paycheck every week. I have not had health insurance for seven months. I keep asking my employer and he has a different story every month. I am 57. What are my options?"

And what are our options to fix this immoral and inhumane system that places individuals and families in these circumstances? At HCFA, we're doing our best -- check out our Reform home page. Please get involved today!

April 25, 2005

Beginning today, the Mass. House of Representatives begins its annual budget debate. It usually goes on for most of the week, and the key decisions on health issue occur later in the week. HCFA and our allies are working on amendments to fix important health access programs, and we would appreciate your help. Go to our homepage and click to send an instant email message to your state representative.

Our issues include: removing enrollment caps from programs such as MassHealth Essential and CommonHealth, restoring adult dental services, restoring coverage for legal immigrants, and much more. And thanks...

April 23, 2005

At HCFA, we regularly get daily doses of reality. Here are two recent examples:

"I currently have no health insurance, its a god dam ripoff. Been paying $4000 a year for $5000 deductable. No claims for ten years, just $40,000 out the window. Finally had a $6000 operation, they agreed to pay 80% of costs minus $5000 deductable. So they paid nothing, and billed me another $4000 for another year with worse deductable. Out $10,000 for the year and they pay nothing? Screw them. I've switched my health plan to Dr. Kavorkian's jail house phone number outside Detroit. He'll tell me what kind of anti-freeze to drink when the bad one comes, and a lot cheaper than those 3-martini health insurance execs. Health insurance should have nothing to do with employment or employers. Its dragging down hiring and profits. Everyone is in and out of jobs or unemployed."

And here's a brief case synopsis from our HelpLine director, Michele Lee:

"I spoke with a woman who has been caretaker for her now adult disabled son. She just lost MassHealth because social security puts her over-income. She has cataracts and has lost sight in one eye. Now that she can’t see the doctor who has been treating her, she fears the state will find her unfit to care for her son and separate them. It is unlikely this will happen, but that’s her fear and nothing I say can allay it. HLA has put her case on the docket; we’re hoping for a mini-miracle."

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