A Healthy Blog

Massachusetts health care – wonky with a dose of reality

January 13, 2017

Congressman Jim McGovern of Worcester spoke this morning as the U.S. House opened debate on the repeal of the Affordable Care Act. He spoke eloquently in defense of health care as a right:

“It is a cruel thing to do to take away people’s health care. We believe that health care ought to be a right, I know you don’t. We believe health care protections ought to be in law, you believe they ought to be up to the insurance companies. But this is a lousy thing to do. We’re gonna fight you on this. This is a fight worth having. Protecting people’s health care is something we should all be dedicated to and we’re going to fight you on this.”

Watch his speech, and the full text is below:

Full Text of Congressman McGovern’s Floor Speech:

“For nearly seven years my Republican friends have railed against the Affordable Care Act. Their well-funded allies have spent billions of dollars distorting the ACA and lying to the American people about what it actually does. And for nearly seven years, there has not been a single comprehensive health care bill brought to the floor by Republicans as a replacement for the Affordable Care Act. Not one!

“We have voted over 60 times to repeal the ACA on the House Floor! I’d be the first to admit the ACA is not perfect. But rather than work together to tweak it, to make it better, all we get from them are repeal bills, repeal bills, repeal bills. And let me again point out – not once, not once was a replacement bill offered.

“Not only do Republicans not have a plan to replace the Affordable Care Act and protect access to health care for more than 20 million Americans who gained coverage, they can’t even agree on a timeline for when they’ll pass their replacement.

  •          President-elect Trump says repeal and replace will be done on the same day and he wants it to happen now.
  •          Rep. Steve Scalise said Republicans will replace the ACA over the course of the next few months.
  •          Sen. John Thune said it could take two or three years for the replacement to be implemented.
  •          Rep. Chris Collins said Republicans have six months to work out the replacement plan. 
  •          Sen. Mitch McConnell refused to even give a timeline, just saying it would happen.

“While Republicans fight for each other over timelines, I think it’s appropriate to ask: If they did have a replacement, what would that replacement be?

“And what, specifically, would they replace the ACA with?

“Well, President-elect Donald Trump has the answer! When asked what we should replace Obamacare with he said, and I quote, “Something terrific.” When pressed for details and more specificity, he said “Something that people will really, really, really like.”

“You can’t make this stuff up! It would be laughable if it weren’t so tragic.

“It’s tragic because what Republicans are trying to do is take health care protections away from millions and millions of families.

“No one in Congress has to worry about health care if the Affordable Care Act is repealed. And the Donald Trumps of the world certainly don’t have to worry about health care if the Affordable Care Act is repealed. If someone in their family gets really sick – they’ll just sell some stocks or close down another American factory, or not pay their workers – as our President-elect has been known to do on many, many occasions.

“But for millions of Americans it will be a different story. Repealing the ACA would mean over 30 million Americans would lose coverage, including nearly 4 million children; more than 52 million individuals with pre-existing conditions could have coverage rescinded or see their premiums dramatically increased; millions of young adults would be unable to stay on their parents’ plans until they are 26; over 14 million individuals enrolled in Medicaid under the expansion would lose coverage; and nearly 140 million individuals with private insurance would lose access to preventive services without co-pays or deductibles.

“And millions of seniors would see their prescription drug prices increase because it would re-open the so-called doughnut hole that the ACA has begun to close.

“Republicans want to slash Medicaid, a health care program that does a lot of good and enables mothers to work their way out of poverty by providing affordable coverage for their children.

“And as someone who represents Massachusetts, this is especially personal because Medicaid is one of the best tools we have in the fight against opioid addiction, providing real care for the addiction and the underlying conditions that drive the opioid epidemic in our communities. Repealing Medicaid expansion under the ACA would rip coverage away from an estimated 1.6 million newly insured individuals with substance use disorders.

“That’s what’s at stake – and that’s what my Republican colleagues are so happy, so giddy, and so excited to do. It is sad. It is pathetic.

“But – they’re moving forward anyway – with no replacement in sight. I suppose they can roll out their oldies but goodies – like health savings accounts or their other healthcare prescription – take two tax breaks and call me in the morning.

“But that doesn’t do it.

“We have a complicated health care system, no doubt. I wish it were simpler. That’s why I’ve always favored a single-payer system and that is why I favor a public option.

January 13, 2017

National trends mean the rising cost of prescription drugs remain a driving factor of rising medical costs. In the preliminary findings of the annual Cost Trends and Market Performance report released by the Health Policy Commission (HPC), it is made apparent that a significant portion of growing medical expenditures in Massachusetts can be attributed to increased spending on prescription drugs.

The HPC found that spending on prescription drugs increased by 8.8% from 2014 through 2015. Additionally, prescription drugs now constitute 17.2% of commercial healthcare spending in the Commonwealth, more than total spending on hospital inpatient care.

However, for consumers, the news is not all bad; the HPC report also indicates that several key components of President Obama’s Affordable Care Act (ACA) have insulated consumers from the worst impact of rising drug costs. According to HPC analysis of data collected from the Massachusetts All-Payer Claims Database, at the same time drug costs have been on the rise in Massachusetts, cost-sharing has been on the decline.

HPC Chart: Out of pocket drug costs down in MA

Due to protections included in the ACA which prevent payers from imposing coinsurance or copayments on many preventative drugs, including contraception, Massachusetts has seen a 6% decrease in average cost sharing for generic drugs and a 13% decrease in average cost sharing for branded drugs. So while total spending on prescription drugs has increased, the average out-of-pocket price for Massachusetts residents has been on the decline, thanks to the ACA.

Another success of the ACA, correcting gender inequities in the health care system, can be observed in the HPC report. The mandate included in the ACA that requires insurers to cover many contraceptive methods has led to lower out-of-pocket payments for many women in Massachusetts and across the country.

Mass HPC Chart: Copay differential by gender

Specifically, the HPC report finds that from 2012 to 2014, the percent of prescription drug claims with zero cost sharing for women increased by 10.2%. Over this same period, average annual cost sharing for Massachusetts women fell 14%, from $205 to $176. This effect also benefits Massachusetts men, who saw a decline in average cost sharing of 4% over the same period.

Even though drug costs continue to plague the healthcare system, the good news is that the ACA has proven to be an effective shield protecting Massachusetts consumers from soaring out-of-pocket costs. Combined with the progress on correcting gender inequity in our health care system, the data makes it clear that the ACA has worked for Massachusetts consumers, something lawmakers should consider prior to hasty efforts to repeal the law.

                                                                                                                                                                                    -- Alec Lebovitz

January 12, 2017

Donald Trump and the Republican leadership are marshaling their forces to destroy health care in America. It’s up to us to fight back.

This Sunday, January 15th, a national day of rallies are scheduled to save health care. Senator Elizabeth Warren, along with Senator Edward Markey and members of the Massachusetts congressional delegation, will be hosting a rally at Faneuil Hall with hundreds of people. Join the HCFA contingent!

Send us an email at organizing@hcfama.org

Event will begin at 1:00 PM. Doors open at 12:00 Noon (first come, first served).

Time: Sunday, January 15, 2017 12:00 PM - 3:00 PM EST
Host: Senator Elizabeth Warren, Senator Ed Markey, Mayor Marty Walsh, and members of the MA Congressional Delegation
Location:
Faneuil Hall (Boston, MA)
1 Faneuil Hall Sq
BostonMA 02109
Directions: Please take public transportation if possible. T stations for the Red, Orange, Green and Blue lines are nearby: http://www.mbta.com/
January 10, 2017

On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act, which repeals major provisions of the Affordable Care Act (ACA) and makes severe cuts to the Medicaid program. If enacted into law, this bill would be devastating to health care in Massachusetts and throughout the country. Nationally, this bill would result in 23 million people losing coverage, up to 445,000 in Massachusetts alone.

Please contact your friends and family who live in the states listed below, and ask them to call their Senators!

Tell them what is at stake if this bill passes, and direct them to www.savemycare.org

There they just have to click the "Call Your Senator" box, enter their zip code and phone number. The system connects them directly to their Senators' offices, and provides them with instructions and suggested talking points. Or, they can call (866) 426-2631 directly and ask to be connected to their Senator(s).

  • Alaska: Lisa Murkowski
  • Arkansas: Tom Cotton
  • Arizona: Jeff Flake
  • Colorado: Cory Gardner
  • Louisiana: Bill Cassidy
  • Maine: Susan Collins
  • Nevada: Dean Heller
  • Ohio: Rob Portman
  • Pennsylvania: Pat Toomey
  • West Virginia: Shelly Moore Capito

You can also use the system yourself to thank Massachusetts Senators Elizabeth Warren and Ed Markey for their support. 

For more information about Health Care For All and the Massachusetts Protect Our Care, please visit: www.hcfama.org.

 

January 9, 2017

Both Massachusetts U.S. Senators Warren and Markey took to the Senate floor on Monday night, as the Senate began debate on a budget resolution designed to set the stage for the repeal of the Affordable Care Act.

Both cited in detail the success of Massachusetts' 2006 health reform law in setting the blueprint for the ACA, and how our efforts have led to the lowest uninsurance rate in the country. Senator Markey also focused on the role health coverage, particularly Medicaid coverage, plays in helping people with opioid addiction, and the support under the law for community health centers. He also spoke later in the debate about the value of the Prevention Trust Fund, established by the ACA.

Senator Warren spoke passionatey about how support for affordable coverage in Massachusetts brought together Democrats, Republicans, business leaders, hospitals, insurers, doctors, consumers and advocates to find a solution. She decried how the first item on the agenda of the new Congress is the repeal of health reform:

The first thing, rip health insurance out of the hands of millions of Americans who need it. The first thing, massively raise the cost of health insurance for everyone who has it. The first thing, create chaos for hospitals, clinics and insurance companies and send their costs spiraling out of control. The first thing, abandon the people they were elected to represent. The first thing, repeal and run away.

She concluded that, "Repeal and run is for cowards!" 

Watch them both here:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

January 6, 2017

Protect Our Care - Join Our Campaign

Sign up for our campaign to stay informed and find out how you can help: www.hcfama.org/get-involved

Please share this widely.

January 3, 2017

Massachusetts pioneered health reform when we passed our “Chapter 58” law under Governor Mitt Romney in 2006. The result was a dramatic increase in insurance coverage and financial security, as well improvements in overall health, increases in preventive care, and dramatic reductions in racial and ethnic disparities in coverage.  These gains were most significant for the lowest income individuals.

President Obama’s Affordable Care Act (ACA) increased coverage further, and provided additional support to Massachusetts’ health care system. With the looming repeal of the ACA being proposed by President-elect Trump and the Republican Congress, it’s critical to understand how the ACA improved and strengthened Massachusetts health reform, and what the impact of repeal would be on the state.

Massachusetts Uninsurance Rates 2002 - 2015

1. What are the similarities and differences between the ACA and the 2006 Massachusetts Health Reform Law (Chapter 58)?

The success of health reform in Massachusetts provided the template for the Affordable Care Act. Both laws are built upon the same policy blueprint:

  1. Expansion of the MassHealth Medicaid program.
  2. Sliding-scale subsidies to make private coverage affordable for moderate-income people.
  3. Insurance protections that ban insurers from taking into account pre-existing conditions and from gender discrimination and that require all insurance plans to cover a list of essential health care services.
  4. Creation of an insurance exchange (here called the Health Connector) that allows people to easily compare and purchase private coverage plans.   
  5. An individual mandate that requires everyone to have coverage if an affordable plan is available.
  6. An employer responsibility requirement that requires large employers to offer coverage to their workers.

But as a federal law, the ACA in some areas went further and provided more coverage and more protections than the Massachusetts statute. Here are some of the major ways the ACA improved on our reforms:

  1. Medicaid: The federal Medicaid expansion covers more people than the Massachusetts law, allowing many to switch from Connector coverage to more comprehensive MassHealth. Currently, some 300,000 adults are covered by MassHealth due to the ACA’s Medicaid provision.
  2. Subsidies: The federal tax credits provided under the ACA go to families with incomes up to 4 times the federal poverty level, while under Chapter 58 the state provided help to those with incomes up to 3 times the poverty level. In addition the federal tax credits reduced the state cost for providing subsidies through the Connector. Over 190,000 people in Massachusetts receive federal tax credits to help them afford their insurance.
  3. Insurance Protections: The state’s insurance protections could not legally apply to most people with employer-offered coverage, which is under federal jurisdiction. In addition, the ACA includes provisions not in state law, like prohibiting copays and deductibles for preventive care, including reproductive health. These protections affect 2.5 million people with private coverage in Massachusetts.
  4. Employers: The ACA includes a tax credit to help small businesses with the cost of providing health care to their workers.
  5. Medicare: The ACA is closing the Medicare prescription drug “donut hole,” which is saving 83,000 seniors and people with disabilities an annual average of $1,039 in drug costs.

The ACA also included numerous provisions that go beyond coverage, including support for public health prevention programs, community health center grants, patient-focused medical research, workforce training, and increased transparency.

2. If the ACA is repealed, could Massachusetts just go back to the Romney-era plan established under Chapter 58?

While it depends on the precise legislative details and the timing of any repeal law, repeal of the ACA would likely result in a substantial reversal of the gains we have made due to the federal law. Moreover, it would probably be very difficult to even go back to where we were before.

First, the original Connector insurance subsidies and Medicaid expansion under Chapter 58 were substantially funded by the federal government, using special Medicaid funds authorized under a waiver negotiated with Washington. Federal policymakers encouraged Massachusetts to pilot our unique health policies, and they provided funding to test our approach. Last November, the waiver was renewed for another 5 years. But it includes provisions allowing the incoming Trump administration to alter its terms. Trump and Republican congressional leaders are planning to greatly reduce Medicaid spending in addition to repealing the ACA. With much tighter budgets, it is very doubtful that they would allow Massachusetts to continue operating its own version of Obamacare using federal Medicaid funds.

Second, Republican Congressional leaders have said that their repeal law might prohibit states from enacting the strong insurance protections required as part of the ACA. Also, their proposal would likely allow for the sale of insurance across state lines, meaning out-of-state insurance could be offered that wouldn’t have to comply with our standards.  In any case, under federal law, states cannot regulate coverage offered by self-insuring employers. Thus Massachusetts could not regulate coverage offered to workers in those employer plans.

Bottom Line: Repeal of the ACA would be very damaging to health care in Massachusetts.

December 20, 2016

Jon Kingsdale can rightfully hold the title of senior implementor of health reform in the country, As the first Executive Director of the Massachusetts Health Connector, Jon had to figure out from scratch how to set up our health care marketplace in way that would be affordable, efficient, and would rely on competition among private insurers to offer coverage.

Today, Jon published a thoughtful article that builds on the wisdom he gained from years of experience. Titled, "Republicans are about to learn just how much Americans hate health care changes, he makes the bold forecast that the best days of the ACA may still be ahead of us. He identifies the central dilemma of the repeal effort - while the ACA as a concept is not that popular, many of its features have broad support, and tens of millions of people rely on it for affordable coverage. And nobody likes changes to their health care:

While it may be unlovable, the ACA is firmly established — written into the costly software and strategic plans of hundreds of insurers, thousands of hospitals, and the 32 states that expanded Medicaid. If Republicans upend those apple carts, they’ll make a lot of Americans very nervous.

Republicans will struggle mightily over how to replace the ACA’s budget-balanced, market-oriented reforms with something far less regulated and subsidized that doesn’t throw millions of Americans off coverage. Then they must persuade at least eight Democratic senators to support their alternative. If bipartisan reform were easy, it would have happened decades ago, when the country was far less divided, or in 2009 when Senate Democrats last tried.

So, where does that leave the ACA? Pretty darn hard to repeal and replace. But doing nothing seems equally untenable: Either the Republicans fund the ACA, leading Tea Partiers to call for their heads — and everyone else to wonder how they can support a law they revile — or they preside over an insurance crisis. If they defund it, Americans will see just how much they really had to lose. And Republicans will no longer have Obama to blame.

Alongside Jon's appeal to practicality, there's also politics and policy, On the politics side, Noam Levey of the LA Times reported last week on the dwindling constiuency for repeal: 

As they race to repeal large parts of the Affordable Care Act, President-elect Donald Trump and congressional Republicans are leaving behind nearly everyone but their base voters and a handful of conservative activists.

Not a single major organization representing patients, physicians, hospitals or others who work in the nation’s healthcare system backs the GOP’s Obamacare strategy.

New polls also show far more Americans would like to expand or keep the healthcare law, rather than repeal it.

Even many conservative health policy experts caution that the emerging Republican plan, which calls for a vote in January to roll back insurance coverage followed by a lengthy period to develop a replacement, could be disastrous.

That potential disaster is explained well in Sunday's New York Times economics column by Robert Frank, "Want to Get Rid of Obamacare? Be Careful What You Wish For." Frank explains that Republican policy thinkers object most to the individual mandate, and to the sliding scale tax credit subsidies that allow moderate income people to afford coverage. But, as the Massachusetts experience shows, both are essential:

The same logic explains why private/government hybrid programs — like Obamacare, and its predecessor in Massachusetts, Romneycare — include an individual mandate. Opponents of the mandate argue that it limits individual freedom, which of course it does. But traffic lights and homicide laws also limit individual freedom; everyone celebrates liberty, but sometimes we must choose among competing freedoms. Failure to include a mandate would eliminate the freedom of citizens to purchase affordable health insurance. In such cases, we must decide which of the competing freedoms is more important.

The third feature of Obamacare (and Romneycare) is that both provide subsidies for low-income people. You simply cannot require people to buy something they cannot afford.

In short, it’s logically impossible to cobble together a private-insurer-based replacement for Obamacare that offers affordable coverage to people with pre-existing conditions without also including an individual mandate and subsidies. That’s why, despite scores of House votes to repeal it, no one has come forward with a coherent proposal to replace it. Hence the dilemma currently facing Republicans.

All three of these recent articles reach related, overlapping conclusions to some extent, and all are worth looking at. Massachusetts has a unique role in the upcoming debate. Because our 2.8% uninsurance rate is the best in the country, we are the prime example of how good implementation of health reform can work. And, because of that, in some sense we have the most to lose under repeal. We need you to join the effort to protect our care. Sign up here to join the campaign.

                                                                                                                                        -- Brian Rosman

 

December 8, 2016

White House Cabinet Room

The day after his inauguration, President Trump convenes his first cabinet meeting at the White House.

“As you all know, just an hour after yesterday’s swearing-in ceremony, I signed the bill to repeal Obamacare,” the President says with a broad smile. The cabinet explodes in applause, with hoots and hollers. “The American people will no longer be subject to that sad law, with its heavy-handed government mandates and taxes.”

“Now comes the hard part,” he explains. “We must come up with our replacement proposal. And I’ve said, I want our plan to meet just a few simple principles. It should not result in people losing their health coverage. We can’t afford millions of newly uninsured people angry at us. We also of course should not increase the growth rate of health care premiums. Oh, and we can’t increase the federal deficit with our plan.”

The President looks over at his new Secretary of Health and Human Services, Dr. Tom Price.

“So Tom, what’s your thinking? Is there a plan we can propose that meets these goals?”

“We’re beginning the process, Mr. President,” Price replies. We’re looking at options that meet your conditions. We also want to find a plan that is consistent with long-standing Republican principles. Our plan should promote individual responsibility, like the plan from the conservative Heritage Foundation. We should learn from states, so ideally we should forward a plan that was successful in some state. And as a doctor, I believe it’s critical that the plan not just provide coverage, but also improve the overall health of the people. And it would be good if the plan also improved people’s economic well-being, too.

“But so far, sir, we have not come up with the right plan.”

The President looks displeased, and makes a face. Everyone sits in silence.

Then, a hand is slowly raised from the far side of the table. It's the new Secretary of State.

“Gosh, Mr. President,” he says, “I have a swell plan that I think would work just fine.”

                                                                                                           -- Brian Rosman

December 8, 2016

It would be a disaster if the ACA were repealed, almost 370,000 Massachusetts residents would lose health coverage in 2019.

Chart from CBPP factsheetThat’s the stark conclusion of an analysis just released by the Urban Institute and the Center on Budget and Policy Priorities (CBPP). The report details the implications of a partial repeal of the Affordable Care Act through “reconciliation” – the process that allows the US Senate to approve budget-related bills with just 51 votes, avoiding a filibuster.  The report concludes that, “This scenario does not just move the country back to the situation before the ACA. It moves the country to a situation with higher uninsurance rates than was the case before the ACA’s reform.”

Here are some highlights from the report:

On the national level:

  • 29.8 million people nationwide would lose health insurance coverage. Of these 29.8 million, a majority of them would be working-class families and minorities.
  • Of the 29.8 million people newly uninsured, 22.5 million would become uninsured because they would no longer be eligible financial assistance.
  • Many, if not most, insurers are unlikely to participate in Marketplaces in 2018—even with tax credits and cost-sharing reductions still in place—if the individual mandate is not enforced starting in 2017.

But what about in Massachusetts? The CBPP looked specifically at the impact here.

  • The number of uninsured people would increase by 273%, to over half a million uninsured.
  • The health care system would be forced to absorb immense cuts, with hospitals and doctors facing huge increases in demand for uncompensated care.
  • Massachusetts would lose $1.4 billion in federal Medicaid funds for 2019, and $491 million in support for Health Connector plans.

Even if the ACA is replaced after reconciliation with programs designed to increase the insurance rate, the government would still need to raise taxes, cut spending, or increase the deficit. Reconciliation would also directly affect the most vulnerable populations in the US and across the Commonwealth, which is why it is so vital that we work to keep our health reforms in place.

Please add your voice to support affordable health care in Massachusetts and get involved today. 

-- Angela Swanson

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