A Healthy Blog

Massachusetts health care – wonky with a dose of reality

November 20, 2017

Funding for the Children’s Health Insurance Program (CHIP) expired on September 30. CHIP provides health insurance for children and pregnant mothers who are low-income but are not eligible for Medicaid. States have a limited amount of funds left to maintain the program, but without federal reauthorization, these funds will soon run out. CHIP has been responsible for a massive decrease in the number of uninsured children throughout the country. When CHIP became law in 1997, 14 percent of people below the age of 18 were uninsured. By 2015, this number had decreased to less than 5 percent. In Massachusetts, CHIP covers about 160,000 children, including 7,000 expecting mothers. CHIP has helped the Commonwealth reach the incredible rate of 99 percent insurance coverage for children, which is the highest in the nation. According to updated estimates provided by MassHealth, without Congressional action, Massachusetts will exhaust its federal CHIP funding in mid-January.

Federal funding for community health centers expired on the same day. Community health centers are a vital part of the health care system, and a lack of federal funding will throw these health centers into a finical crisis, affecting a massive portion of the population. Many community health centers, uncertain when funding may reauthorized, are already experiencing considerable financial stress, which is hampering their ability to function effectively. In Massachusetts, community health centers provide primary care to one in seven state residents, or about 1 million people. Community health centers tend to serve large amounts of patients without private insurance, including those covered through Medicaid and those who are uninsured. The most vulnerable members of our society will be disproportionately affected if community health centers are forced to cut services due to a lack of federal funding.

Senator Elizabeth Warren recently posted a video calling for the reauthorization of funds for both CHIP and community health centers. Health Care For All commends Senator Warren for her commitment in fighting for these vital programs. HCFA calls on Congress to work together to forge a clean bipartisan agreement on funding of both CHIP and community health centers, two essential components of our health care system. 

November 17, 2017

Last week, the state Senate considered over 150 amendments proposed to their comprehensive health care cost control package, titled the HEALTH Act, for Health Empowerment and Affordability while Leveraging Transformative Health care (see our initial thoughts on the bill here). After spending two full days discussing and voting on amendments, the Senate approved the bill right at midnight on November 9. The final Senate bill, incorporating all the amendments, is expected to be numbered S. 2211, and so should be available online here.

The wide-ranging final bill includes over 150 sections, concerning many aspects of the state’s health care system. The bill now goes to the House. House leaders have said they will be reviewing the bill and preparing their version sometime in the new year.

HCFA was active during the amendment process, working on a number of proposed improvements to the bill. As you can see from the brief summaries below, among the many provisions are a number of long-standing HCFA priorities. Below is an outline of some of the key issues included in the bill; we apologize for the length, but this is a very large bill.

MassHealth reforms: We are thankful to the Senate for not including a package of proposed reforms to MassHealth that reduces eligibility for non-disabled adults which would limit benefits and impose barriers to keeping coverage and continuity of care. Most of these proposals also need federal approval; the Centers for Medicare and Medicaid Services is currently reviewing the 1115 waiver amendment Massachusetts submitted in September.

Oral Health: The bill allows dental therapists to practice in Massachusetts. Allowing dental therapists to work in Massachusetts would expand access to oral health. Low income children and families, older adults, people with disabilities and communities of color face the substantial barriers to accessing needed dental care. Dental therapists are licensed midlevel dental providers, working under a dentist’s supervision. As community-based providers who understand the history, culture, and language of their patients, they enable the dental team to deliver culturally competent, patient-centered care, mobilizing the strengths of underserved communities. Dental therapists could bring much needed care to underserved people and address oral health disparities.

Academic detailing: The Senate bill requires the Health Policy Commission to implement Academic Detailing, which is an evidence-based prescriber education program that focuses on the therapeutic and cost-effective utilization of prescription drugs. Academic Detailing supports prescribers to make informed decisions based on balanced research data rather than biased promotional information from drug companies. The Senate considered an amendment supported by HCFA that would have included an assessment on pharmaceutical companies to fund the program, but this amendment was not adopted.

Prevention: The Senate bill renews authorization for the Prevention and Wellness Trust Fund (PWTF) , which expired in June. PWTF is an innovative approach to address social determinants of health. It was set up as a pilot program in 2012, with the goal of reducing health costs by increasing access to community-based prevention. The pilot phase focused on hypertension, childhood asthma, elderly falls and tobacco use reduction, and operated in nine communities. PWTF is unique in addressing community factors that lead to poor health. HCFA worked with other public health advocates to add a funding mechanism to the provision, which originally had no source of funds. An amendment to the bill increases the tax on flavored cigars to fund the program.

Medicare Savings Programs: The Senate considered an amendment filed by Senator L’Italien that would leverage federal and existing state funds to expand eligibility to Medicare Savings Programs (MSPs), which help lower costs for Medicare beneficiaries with limited incomes. In the end, the Senate approved a redrafted amendment that directs the Executive Office of Elder Affairs and the Executive Office of Health and Human Services to develop plans to utilize Prescription Advantage program funding and expand MSPs, respectively, by September 2018.

Prescription Drug Price Transparency: The Senate bill includes a number of provisions to increase transparency of prescription drug pricing. The bill requires the Center for Health Information and Analysis to collect pricing information from pharmaceutical manufacturers and pharmacy benefit managers, including research and development costs, marketing and advertising costs and annual profits. The bill also requires these entities to take part in the Health Policy Commission’s annual health cost trends hearings where the Commission can solicit sworn testimony from the industry on factors driving drug price increases. An amendment supported by HCFA strengthened the reporting requirements and allows the Attorney General to compel pricing information from industry officials, subject to a financial penalty and other legal action for noncompliance.

November 16, 2017

The Massachusetts legislature recently passed legislation, called the Contraceptive ACCESS bill, to ensure access to birth control in Massachusetts. The bill now needs the signature of the Governor to become law.

The Affordable Care Act mandates coverage of birth control without copayments. However, the Trump administration recently moved to roll back this requirement by allowing employers to request exemptions from this requirement based on religious or moral beliefs. This could result in some employers choosing to no longer cover birth control in the insurance plans they offer to workers.

The ACCESS bill ensures that, even with this action on the federal level, employers in Massachusetts will continue to provide employees with coverage for birth control without copayments.

This bill also increases access to birth control in several other ways. It allows women to receive a 12- month supply of oral contraceptives at once, instead of requiring women to repeatedly return to the pharmacy to renew their prescription throughout the year.

This legislation further allows for women to access emergency contraception without a copayment or new prescription, which is vital to ensure timely access. Before this legislation, a woman would need to get a prescription to receive emergency contraception without a copayment. Emergency contraception is meant to be taken immediately, so being forced to wait for a prescription could undermine the effectiveness of the medication.

Access to contraception is critical to the health and wellbeing of women and their families. Health Care For All believes birth control should be available to all who need it, regardless of economic status. HCFA supports this legislation as a measure to increase access to birth control in Massachusetts and to protect against attacks on access to affordable birth control from the federal level.  

(Image courtesy of NARAL Pro-Choice Massachusetts

November 14, 2017

Despite being completely preventable, dental disease is a major cause of illness in the US. Millions suffer from painful untreated dental issues due to an inability to access dental care, which impacts their ability to eat, talk, gain or retain employment and maintain good overall health. Low income children and families, older adults, people with disabilities and communities of color face the greatest barriers to accessing care.

Dental access is a severe problem in Massachusetts. A 2016 Massachusetts Health Policy Commission study highlighted the severe access problem for low-income people. It found that only 56% of low-income adults saw a dentist in the past year, compared to 82% of high-income adults.

The lack of access to dental care is also evidenced by the large number of ER visits for preventable dental issues. In Massachusetts, for example, ER use by children covered by Medicaid for preventable oral health conditions was 3.4 times that for kids with commercial coverage. For non-elderly adults, the rate of ER visits by Medicaid members was a stunning 16.6 times that of those with commercial coverage.

These disparities affect many – adults of color, people with disabilities and older adult communities face significant social, structural, cultural, economic and geographic barriers in accessing care and have high rates of oral health problems.  The current dental delivery system is not overcoming these barriers. This is why health care advocates across the country keep pushing to add dental therapists, licensed midlevel dental providers to the dental team. Dental therapists could immediately bring care to millions of underserved people nationwide and address oral health disparities.  In Massachusetts, the Senate’s recently passed health care bill includes authorization for dental therapists.

Dental therapists work with the dental team similar to the way physician assistants work on the medical team—they are early intervention and prevention dental professionals who are trained to provide a limited scope of services under the supervision of a dentist. They have been working worldwide since the 1920s and have been part of the US dental team for over a decade. Specifically designed to work in underserved areas, dental therapists are practicing safely, effectively and increasing access to care in Alaska, Minnesota, and the Swinomish Indian Tribal Community in Washington, and were also recently authorized in Vermont and Maine.

Several dental therapy programs are recruiting providers directly from the communities where oral health needs are the greatest. Utilizing community-based providers who understand the history, culture, and language of their patients enables the dental team to deliver culturally competent, patient-centered care and mobilizes the strengths of underserved communities.

In addition to delivering patient centered care, dental therapists are proving to relieve the financial burden on dental practices who have limited resources for oral health services for vulnerable and underserved populations. Since dental therapists are less expensive to hire, dental practices are able to provide care for more Medicaid patients, even with lower reimbursement rates, and still be profitable. These are critical components to being able to remove some of the systemic barriers that prevent underserved communities from accessing dental services, and building the community’s health care delivery capacity to improve oral health outcomes.

Access to dental services and good oral health should not be treated as novelties reserved for those lucky enough to live near a dentist, have dental insurance and afford to receive treatment. These are critical components to overall good health, and it is imperative that we address the structural barriers that cause oral health disparities. Dental therapists can address these disparities by expanding and bolstering the current dental delivery system to serve these underserved communities. Dental therapy is an evidenced-based solution that has increased access to care in Alaska and Minnesota, especially for hard-to-reach populations, and can do the same in Massachusetts.

                                                                                                                                       -- Kristen McGlaston, Community Catalyst

October 31, 2017

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

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

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

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

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

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

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

This post was written in concert with Community Catalyst

October 26, 2017

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

Major Items Highlighted by Health Care For All:

Prescription Drugs

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

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

Dental Therapists

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

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

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

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

MassHealth

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

Prevention and Wellness Trust Fund

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

Hospital Readmissions

October 19, 2017

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

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

Public Health and Social Determinants of Health 

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

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

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

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

Telemedicine

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

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

Dental Therapists

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

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

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

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

Prescription Drug Costs

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

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

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

Surprise Out-of-Network Billing

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

- Sean Connolly 

October 6, 2017

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

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

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

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

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

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

Unnecessary Hospital Use and Readmissions:

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

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

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

Social Determinants of Health:

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

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

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

Keeping Care in the Community:

September 26, 2017

The Graham-Casidy proposal to repeal the Affordable Care Act seems to have stalled, with Republican senators expressing public opposition, but the defeat of repeal isn't guaranteed

Public pressure needs to be maintained to keep these senators accountable and to pressure other senators to join in opposing the Graham-Cassidy plan. 

As part of an ongoing effort to prevent the passage of this damaging bill, on Monday, September 25, Health Care For All submitted comments to the Senate Committee on Finance detailing why this bill would be harmful for health care consumers in Massachusetts and throughout the country. The bill would undermine protections for people with pre-existing conditions, lead to millions of people becoming uninsured, and greatly reduce federal funding for health care. The proposal would be particularly damaging for states such as Massachusetts that have expanded Medicaid, as these states would see large cuts to federal funding, placing massive financial strain on state budgets.

The Oral Health Advocacy Task Force which HCFA leads also submitted a letter focusing on the alarming oral health aspects of the Graham-Cassidy bill. That letter is available here.

Read our full letter below

 


Dear Chairman Hatch and Ranking Member Wyden:

On behalf of Health Care For All (HCFA), thank you for the opportunity to submit comments on the Graham-Cassidy-Heller-Johnson health care proposal. HCFA is a Massachusetts nonprofit advocacy organization working to create a health care system that provides comprehensive, affordable, accessible, and culturally competent care to everyone, especially the most vulnerable among us. We achieve this as leaders in public policy, advocacy, education and service to consumers in Massachusetts.

We write to voice our extreme opposition to the Graham-Cassidy-Heller-Johnson proposal. We are very discouraged that instead of continuing down a bipartisan path and working on issues to improve the strength and stability of the Affordable Care Act’s (ACA) marketplaces, the sponsors of this legislation have put forward a proposal that will:

  •  Eliminate the financial assistance that helps low- and moderate-income families purchase health care coverage;
  •  End expanded Medicaid coverage that helps millions of low-income adults;
  • Gut Medicaid through deep, permanent cuts that would grow over time and threaten care for millions of low-income seniors, children, and people living with disabilities and shift massive costs and risks to states;
  • Jeopardize access to life-saving and effective treatments for addiction and weaken states’ efforts to address the current crisis of drug overdose deaths
  • Undermine essential protections for people with pre-existing conditions; and 
  • Resurrect - and worsen - the devastating cuts in coverage and benefits that the American public and the majority of Congress have already rejected.

The Graham-Cassidy-Heller-Johnson proposal threatens the health and financial security of millions of Americans including older adults, low-and moderate-income families, people living with disabilities, children, seniors, veterans and people with pre-existing conditions. It does nothing to improve affordability or availability of coverage for consumers and will likely result in approximately 665,000 Massachusetts residents losing coverage by 2027.1 This proposal will undermine the financial stability of our health care system and place additional fiscal strains on our state budget. We have come so far in Massachusetts, extending health coverage to 97.5% of our residents.2 To build support for the proposal, some have specifically singled out Massachusetts due to our state allegedly receiving a disproportionate amount of federal health care funds.3 Yet federal funds provided to Massachusetts mostly reflect the success we have had in our outreach and enrollment efforts, which have resulted in the lowest uninsurance rate nationally.

The Graham-Cassidy-Heller-Johnson proposal disproportionately impacts Massachusetts and other states that have expanded Medicaid. The bill would unravel this success in Massachusetts and devastate the lives of people in our state and across the country. Below we lay out in more detail our concerns with this proposal and the devastating impact it will have on consumers.

Eliminates programs that serve as a lifeline for low- and moderate-income families.

September 18, 2017

The effort to repeal the Affordable Care Act is back.

A legislative proposal introduced by Senators Lindsey Graham and Bill Cassidy to repeal Obamacare may go to a vote before the end of the month.

The Graham-Cassidy bill would end subsidies to help consumers pay for private insurance and would roll back the Medicaid expansion. States would receive lump-sum payments to put towards health care instead, but overall funding would greatly decrease. The effects of this bill would be similar to that of the other failed repeal attempts: millions would lose health insurance and health care costs would increase. This proposal would also remove important federal protections for consumers that require insurers to cover essential health benefits and to provide coverage regardless of preexisting conditions.

The bill has been picking up steam in the Senate. Senator Cassidy claims that there are already 48 Republican senators supporting it and Senate Majority Leader Mitch McConnell has reportedly announced that he will bring the bill to a vote if he believes that 50 senators back the effort.

However, there is an important timeline restriction. At the end of the month, the Senate can no longer use the reconciliation process to pass repeal; a process that currently allows the Senate Republicans to pass a bill with only 50 votes, assuming a tie-breaking vote by the Vice President. After this period, they would need 60 votes to avoid being blocked by a Democratic filibuster. 

The last repeal attempt hinged on a single vote. Putting enough pressure on key senators can completely change the outcome of repeal, so we need to apply as much pressure as possible before the end of the month. 

How you can help as a Massachusetts resident: 

Our congressional delegation is with us in the fight to protect the ACA. Senator Ed Markey and Senator Elizabeth Warren firmly oppose any attempts to repeal the ACA. You may wonder if there is anything you can do as a Massachusetts resident to block this new effort to take coverage away from millions of people nationwide. The good news is that you can still make a difference by joining our friends and family campaign!  We are urging residents in the Commonwealth to contact friends and relatives in other states and have them reach out to their own senators.

Below is a list of some of the major senators to target, and numbers to their D.C. offices. You can also tell friends and family in other states to use the dialer on https://www.savemycare.org/ They can just click on the box labeled “call your senators” and provide their zip code and phone number, and they’ll get a call that will connect them directly to their senator’s office. 

Important targets:
Alaska: Senator Lisa Murkowski: (202) 224-6665

Arizona: Senator John McCain: (202) 224-2235

Colorado: Senator Cory Gardner: (202) 224-5941

Kansas: Senator Jerry Moran (202) 224-6521

Maine: Senator Susan Collins (202) 224-2523

Nevada : Senator Dean Heller (202) 224-6244

North Carolina: Senator Thom Tillis (202) 224-6342

North Dakota: Senator John Hoeven (202) 224-2551

Ohio: Senator Rob Portman (202) 224-3353

West Virginia: Senator Shelley Moore Capito (202) 224-6472

You can also access this website www.trumpcareten.org and use the call scripts there as a guide to contact these and other senators. There is also a general call script for any senators for which the website does not have a specific script. 

We have blocked similar efforts before, and we can stop this new attempt to repeal the Affordable Care Act. Call Now!

Republican Governors can also play a major role in influencing Senators. People who live in two states in particular are urged to call their Governor's office and ask that they express their opposition to the Graham-Cassidy bill. They are:

Maryland: Governor Larry Hogan (410) 974-3901
Vermont: Governor Phil Scott (802) 828-3333

 

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