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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

July 27, 2020
Join Health Care For All in urging state representatives to ensure access to chronic disease and COVID-19 medications during the COVID-19 pandemic - please call and email your state representative TODAY and ask them to support and co-sponsor Representative Barber's COVID Medication Access Amendment #11 to House Bill 4888, an "Act to Promote Resilience in our Health Care System". 
The COVID-19 pandemic has made clearer the importance of access to affordable medications-from inhalers to insulin-to protect those with chronic conditions at highest risk for complications from the virus.
With many people struggling financially in the face of the pandemic, now more than ever we need to ensure prescription drugs, including those for COVID-19, are affordable without further burdening the state and the health care system.
Improving access to affordable medications for communities of color and low-income communities will support individuals and families that face disproportionate barriers accessing the care they need and are being hit hardest by the pandemic.
Representative Barber has proposed amendment #11 to House Bill 4888 titled, an "Act to Promote Resilience in our Health Care System" that would implement a temporary, 12-month program to reduce cost sharing for 15 drugs identified by the Department of Public Health that are used to treat five chronic disease conditions linked to COVID-19 complications as well as any FDA approved COVID-19 vaccines and treatments. 
It would also establish a review process for these drugs to ensure costs are not passed on to consumers through higher premiums. A fact sheet can be found here
Please call and email your state representative to ask them to support and co-sponsor the Barber COVID Medication Access Amendment #11 todayto make sure everyone is able to access and afford the lifesaving prescription drugs they need to stay safe during this pandemic
June 9, 2020

One of the important public health responses to COVID-19 here in Massachusetts and around the country was to keep people at home. That meant many doctor’s offices and other health care providers were limited to seeing only the most urgent cases in-person in their offices. Hospitals also limited non-urgent or elective surgeries and procedures to convert units and other resources to treating COVID-19 patients. These changes helped ensure our health care providers had the ability to respond to the pandemic and protected against the risk of transmission in health care settings during the peak of cases.

Starting this week, as numbers have started to improve, Governor Baker announced new rules to loosen the restrictions on in-person medical visits for non-urgent visits and what procedures can now be performed. This means people will have multiple options for seeing their health care providers going forward. Telehealth is still an option and is being encouraged when appropriate. In addition, it will now be possible to go to in-person visits at doctors’ offices for when that is more appropriate. Additionally, family members will begin to be able to visit loved ones in hospitals, nursing homes and other residential settings while adhering to the state’s safety guidelines.

We know that during the height of the pandemic, many people felt fear or anxiety about going to the doctor or getting health care treatment.[1] Unfortunately, that may have led some people to go without care they needed.[2] The first step for people getting care should still be to call your doctor or clinic to find out what they recommend. In-person visits are now a safe option, with doctors’ offices and clinics required to follow strict safety protocols. If you are someone who sees your doctor regularly to treat and manage a chronic condition, if you have children that should see their pediatrician, or if you or your children are due for immunizations, now is a good time to reach out to your doctor to find out the best way to get care!

For more information on the Governor’s plan to loosen restrictions on health care provider practices go to: https://www.mass.gov/doc/reopening-massachusetts-health-and-human-services-phase-2-one-pager/download.

April 1, 2020

Encouraging 327.2 million people to carry out even a single task is a seemingly impossible goal––despite being required by law, the challenge of ensuring that everyone in the United States completes the Census every ten years is made difficult by much more than the sheer number of people it must reach. Even with the best of intentions, Americans can be forgetful, busy, and stressed over other parts of their life that demand precedence. There are also those who are less willing, with many undocumented immigrants afraid to provide an official entity with their information out of concern for their families and their livelihoods. It goes without saying that in the most normal of years, reminding and motivating people to fill out their census forms is a herculean effort.

However, 2020 has not been a normal year, and the 2020 Census must overcome a new beast altogether. The spread of COVID-19 has left many in the U.S. with no idea how to pay their rent or afford food, potentially for months to come. Compared with the overwhelming need to survive, Census forms fall much farther down the list of priorities. In spite of the current circumstances, it is essential to encourage people to keep an eye on the future, one where the coronavirus outbreak will eventually come to an end and the 2020 Census results will be critical in determining policy and budget decisions. The funding that is allotted to public benefits and health programs, such as Medicaid and Medicare, directly determines the number of people who may benefit from that funding. In a time where the importance of public health practices cannot be overstated, it is key to demonstrate the link between the health of individuals and the health of the greater community. This means that everyone, including immigrants, need to be accounted for in the 2020 Census to expand access in the future to the health care they need and other public benefits that can support immigrants and their families through difficult times. It may not feel like a priority while a global pandemic spreads throughout the country, but the long-term impact of the data will be felt in the years to come as communities begin to recover from the economic damage of COVID-19.

Today,  April 1, is Census Day. The Census collects household information as of this specific day in 2020, a designation which also serves as a reminder of the efforts that must still be made to record the most accurate data possible. Responses are due by mid-May and can be filled out online or by phone in English and twelve other languages, or on paper in English and Spanish. It is important to remember that the responses collected in the Census every ten years cannot be held against anyone by any court or government agency.  The data is well-protected, with federal laws strictly limiting the ways that it can be used. It is crucial that everyone makes the decision to be accounted for––in Massachusetts alone, $16 billion, or $2,372 per person, is allocated based on Census data to provide funding for schools, hospitals, roads, affordable housing, and other programs. This data is also key to create fair and equitable political representation in Congress and the state legislature. In other words, filling out the Census form is a great way to make your voice heard and support more investment in your community. Coronavirus may be overshadowing the country now, but the years of recovery can only be made easier through the Census results if everyone is fairly represented. To respond now or find more information, go to: https://2020census.gov.

March 19, 2020

We are faced with a once in a century public health crisis that has bought society to a halt, that threatens to overwhelm health systems and that may yet bring economies to their knees. Over the last few weeks, the unthinkable - that a virus affecting one city in one country would have a similar impact everywhere else in the world -- became thinkable and now inevitable. 

As cases of Coronavirus infection rise exponentially and testing remains thin on the ground, it is difficult to intuitively understand how bad this crisis can get. Simple back of the envelope calculations project a ten-fold increase in cases every 16 days. As of March 19, 2020, there have been approximately 7,000 cases reported to the CDC. This number is widely acknowledged to be a significant underestimate.  If it is assumed (for ease of illustration) that there are ten thousand current cases, then in approximately two weeks there will be one hundred thousand cases, in one month one million cases, and in two months one hundred million cases - a staggering 1/3 of the US population. 

Of course there is plenty that can be done to “flatten the curve” and buy time. The radical social distancing and hygiene measures that have been recommended are of urgent importance for everyone. However, even with these measures these are sobering numbers. The rough calculus is that the more people have Coronavirus, the greater the chance that those most vulnerable will be exposed which increases the number who will need ICU care which will rapidly be overwhelmed with inevitable consequences. 

Those already marginalized in society - immigrants, the homeless and those with long-term mental health conditions are at particular risk from serious complications. These populations, as ever, have been largely forgotten in the broader discourse around Coronavirus. Many people in these populations have difficulty accessing health care and have low levels of trust in the health care system. It is these people who more than ever need our support. 

That’s why we are asking everyone to do their part by practicing social distancing until the crisis recedes. We need to adopt all the measures provided by health authorities to “flatten the curve”: wash your hands and use hand sanitizer often; avoid touching your face; limit social interaction keeping a safe distance between others; and most importantly, we need to stay home if it’s possible for us to do so. It may sound drastic, but these are unprecedented circumstances that require unprecedented actions. 

If you or someone in your family is experiencing symptoms or suspects being infected by COVID-19, you can call 2-1-1. This resource has been made available for Massachusetts residents who have questions about the virus or need a referral, and the services are being provided in multiple languages. And if you need help enrolling in health insurance, please know Health Care For All’s HelpLine is still taking calls in English, Spanish and Portuguese and is there to help you.

- Trishan Panch, MD, MPH, Chief Medical Officer at Wellframe, and Health Care For All’s board member

March 13, 2020

Due to the situation created by COVID-19 (also known as the Coronavirus) and following guidance from the Baker Administration, HCFA's physical office will be closed from Monday, March 16, 2020 until further notice but the entire staff will be working remotely. We will be available during regular hours via email and phone and will be using video-conferencing capabilities when appropriate. We are monitoring the situation and we will resume our regular operations at One Federal Street in Boston (MA), based upon recommendations from federal and state agencies. You can contact our team via email or phone through the staff directory.  

In the meantime, the HelpLine will remain operational for those who need to apply for coverage or have questions about their health insurance benefits. Please call 1-800-272-4232 if you need to contact one of our counselors. Remember that our team can assist you in English, Spanish, and Portuguese. Our HelpLine is referring individuals who have questions about COVID-19 to the resources made available by the Massachusetts Department of Public Health: https://www.mass.gov/resource/information-on-the-outbreak-of-coronavirus-disease-2019-covid-19

January 23, 2020

The Massachusetts Health Connector Open Enrollment period officially closes on January 23, 2020. However, this does not mean enrollment is “closed” for everyone. The Open Enrollment period is the annual time for Health Connector members to change their plan for any reason, and for new applicants to shop for health insurance without a “qualifying life event.”

So what happens on Health Care For All’s HelpLine and with all the enrollment assisters across the state on January 24th? The answer is (drum roll, please): a lot. Consumer assistance programs that help people enroll into health insurance are not limited to aiding people with their applications during the Open Enrollment period. They do so much more. Enrollment assisters continue to be busy post-Open Enrollment because many people can apply for health insurance after that day, or because they may experience life changes that require updating their coverage. People who qualify for MassHealth, the Health Safety Net, Children’s Medical Security Plan and people who would be newly determined eligible for ConnectorCare, can apply at any time throughout the year. Other people may be eligible for what is known as a Special Enrollment Period. This allows them to go through the Health Connector to shop for private insurance if they experience qualifying life events such as moving, employment or income changes, marriage, divorce, birth, change in household dependents, and loss of health insurance. Also, if an individual is member of a federally recognized tribe or Alaska Native shareholder, they are able to apply for health insurance at any time.

On December 9, 2019, The Boston Globe published a piece that I wrote about what it is like to work on the HelpLine and the importance of consumer assistance. This piece paints a picture of the broad range of issues handled on the HelpLine throughout the year.

The HelpLine troubleshoots health insurance issues that can happen at any point in the year in English, Spanish and Portuguese. HelpLine counselors regularly make conference calls with clients and MassHealth or the Health Connector to diagnose problems and resolve coverage issues. Those calls do not stop once enrollment is completed. Callers want to know how to use their coverage, how to understand the out of pockets costs associated with their plan, and if they can get any other assistance with their health care expenses. In addition, people already on coverage need help updating their applications through the Health Connector and MassHealth throughout the year when they experience a change.

Successful consumer assistance is provided by community organizations understanding how to reach the communities they work with, and providing culturally competent aid in the languages most spoken in the area(s) they serve. Consumer assistance for health insurance is needed year round and this important work should get the financial support that it requires and deserves. Health Care For All is advocating for additional funding for programs like the HCFA HelpLine to continue the crucial work being done day in and day out. Consumer assistance is pivotal in keeping Massachusetts as the #1 in coverage rates, and making sure consumers have access to affordable health care when they need it. 

- Hannah Frigand, Director, Education and Enrollment Services at Health Care For All

January 23, 2020

Last week, the Protecting Immigrant Families (PIF) campaign released the report, Navigating Public Charge: Best Practices in Community Based Organizations to Mitigate the Harm for the Immigrant Community, a compilation of the best practices for community based organizations (CBOs) to reduce the risk posed by the current environment to immigrant communities. The results were gathered in collaboration with immigrant-serving organizations from across the country, who contributed their experiences and expertise to provide insight for the report. Health Care For All was one of the twenty-seven advocacy and immigrant-serving agencies who were acknowledged in the document.

The report serves as a roadmap for CBOs, narrowing down the most effective approaches to support immigrant communities. Some of these practices include: building coalitions to oppose changes to the “public charge” rule and develop education and outreach strategies, offering trainings that are culturally sensitive, and incorporating feedback and leadership to and from the community. The report also emphasizes the importance of coordination with legal support and points out that education funds can be utilized to inform immigrant communities and their leaders about public charge.

HCFA shared some of the key strategies implemented in Massachusetts to address the fear and uncertainty impacting immigrant communities. One of the immigration policies coming from the federal administration that is causing great concern is the new “public charge” rule. This is an attempt to broaden the factors taken into account to determine if an immigrant applying for a green card is a public charge. Being deemed a public charge may prevent them from adjusting their immigration status. That’s why many organizations such as HCFA have focused their efforts on educating the community on the rule and what it means for them.

Maria R. González Albuixech, Director of Communications and Immigrant Health at HCFA, is quoted in the report discussing several tactics implemented in the Commonwealth. One of the strategies highlighted is the combination of Affordable Care Act (ACA) enrollment efforts with education about public charge, immigration, and use of benefits in general: “We brought 4-5 pro bono immigration lawyers and enrollment assisters to the same event. We could advise on public charge at the same time.” At such events, HCFA and partners do not only help people apply for health insurance, but also provide answers to their immigration questions and dispel concerns regarding the use of benefits they are entitled to. “Health Care For All Massachusetts monitored ACA health insurance enrollment numbers after a significant outreach campaign targeting the immigrant community and including public charge education. Their intention to reduce the impact of public charge fears on ACA enrollment is measured by the overall enrollment rates in the immigrant community.”

One of the biggest challenges to address the “chilling effect” that’s preventing immigrant communities from living productive and healthy lives under current circumstances is the lack of financial support for this specific line of work. A strategy suggested in the report is reframing ongoing work to bridge that gap: “Groups involved in ACA enrollment such as Health Care For All Massachusetts were able to secure funding from their state’s health insurance exchange to share public charge information as part of enrollment education.”

Through a collection and evaluation of the strategies implemented by organizations throughout the country to support immigrant communities, this report identifies the best path forward for CBOs so that they can provide effective assistance to immigrants who need to navigate public charge to develop long-term success.

If you would like to read more, you may access the links for the full report and executive summary.

- Jill Makin, Communications and Policy co-op at Health Care For All

December 11, 2019

Massachusetts continues to lead in children’s access to health care, however, many children and families continue to face barriers to coverage and care. Families, advocates, and policymakers recognize the need for additional improvements to ensure that all residents of the Commonwealth – particularly children and youth – can access the care they need. With this concern in mind, on July 29th Massachusetts Speaker Robert DeLeo introduced a bill known as An Act relative to children’s health and wellness (H. 4012). The bill included several policy proposals, two of which are Children’s Health Access Coalition (CHAC) priorities: ensuring continuous MassHealth coverage for former foster youth and requiring the Health Policy Commission (HPC) to study access to care for children with medical complexity, as well as a Health Care For All (HCFA) and Children’s Mental Health Campaign (CMHC) priority: improving the accuracy of provider directories, which the Senate had previously passed as stand-alone legislation this spring (S. 2295).

The Senate then introduced and passed their version of the legislation that included some variations on the provisions included in the House bill, along with several additional provisions related to the Department of Children and Families and other issues (S. 2368). A Conference Committee quickly worked out the differences and by November 20th, the legislature enacted the new version of the bill, H. 4210. Governor Baker signed the final version of An Act relative to children’s health and wellness on November 26th, making it a law in Massachusetts – Chapter 124 of the Acts of 2019.

This new law will have a positive impact on children, families, and individuals in communities across Massachusetts. Chapter 124 includes provisions similar to legislation filed by Representative Barber and Senator Lewis (H. 913/S. 610) to improve the accuracy of health insurance provider directories. Families and individuals seeking care in Massachusetts often face difficulties finding providers through their health plan’s provider directory because insurers may not regularly update their provider directories. As a result, insurance carriers appear to have adequate networks, however, upon closer inspection, a number of listed providers have moved, closed their practice, or no longer participate in a given plan – “ghost networks.” Even for providers who are still practicing and in-network, the provider directory often contains inaccurate information about the services they deliver, languages providers speak, and whether or not the provider is accepting new patients. These issues are particularly acute for families seeking behavioral health care. Chapter 124 would make short-term improvements to provider directories, including ensuring that provider directories are easily searchable, available to the public, and updated at least monthly, as well as establish a taskforce, chaired by the Division of Insurance, to make recommendations and develop regulations to make further improvements to provider directories. These provisions reflect the language agreed upon by advocates, health insurance carriers, and providers.

For some populations, the bill already had an impact even before being enacted by the legislature and signed into law. The Affordable Care Act included a provision to require states to provide Medicaid coverage to former foster youth until the age of 26, given that they were in foster care as of the age of 18, just like other young adults who are allowed to remain on their parent’s insurance until that age. However, given extensive challenges and the transient nature of former foster youth, many young adults who had “aged out” of care through the Department of Children and Families lost their MassHealth coverage for a period of time. Eligibility redetermination paperwork is sent to their last known address, at which these young adults may no longer reside causing delays or loss of coverage. If received, much of the form required them to fill out information on their income, despite being eligible for coverage under federal law regardless of income. The language included in Chapter 124 was based on legislative filed by Representative Gregoire and Senator DiDomenico requiring MassHealth to create a simplified redetermination process for former foster youth (H. 124/S. 35). In addition to the legislature, advocates are working with MassHealth to take steps to ensure uninterrupted coverage for former foster youth. Former foster youth between the ages of 18 and 26 will find it easier to maintain their MassHealth coverage by the end of 2019, due to a new system staff and leadership at MassHealth is putting into place to ensure continuous coverage for this population. The new system will protect MassHealth coverage for this population until their 26th birthday without the need to complete redetermination paperwork. This is a big step forward for former foster youth and again puts Massachusetts on the map as a leader in access to health coverage.

December 2, 2019

Massachusetts is known for its dedication to expanding access to health care, especially for the most vulnerable populations, including children. As a state, Massachusetts has led the cause by developing health coverage systems which were used as models for the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA). The Georgetown University Health Policy Institute Center for Children and Families (Georgetown CCF) recently released their annual report about the child uninsurance rate. This year’s report, The Number of Uninsured Children is On the Rise, compares health insurance data from the US Census Bureau’s American Community Survey from 2016 through 2018.

While children’s health coverage rates had been improving for many years prior to 2014, due in large part to the creation of programs like CHIP, the ACA further decreased the rates and number of children without insurance to their lowest levels in 2016. These programs allowed for an increase in coverage eligibility and simplification in the enrollment process. However, since 2016, children’s participation rates in Medicaid and CHIP have decreased for the first time since 2008, when participation began to be measured.

Although the state continues to lead with the lowest uninsured rate for children in the US, the uninsurance rate for the Commonwealth’s children increased by 0.2%, comparing 2016 and 2018. Our blog post on last year’s Georgetown CCF report on uninsured children highlights an increase in the child uninsurance rate even in Massachusetts – from 1% to 1.5% from 2016 to 2017. Looking at this year’s report, it appears the uninsurance rate for children in the state has actually decreased from 1.5% to 1.2% between 2017 to 2018. However, compared to 2016, the actual number of uninsured children continues to be slightly higher.

To put this in context, Massachusetts continues to lead the nation in health coverage for children. The Georgetown CCF report highlights other states where state and federal policy decisions have led to an increase in uninsured children, with no progress in moving the needle in this respect. Almost half (49.6%) of uninsured children in the US reside in just six states – Texas, Florida, California, Georgia, Arizona, and Ohio. Of these states, Texas, Florida, and Georgia have not expanded Medicaid for parents or childless adults, and there are still several other states that are “holdouts” in this regard – which can impact health coverage for children as well. The report shows one state – North Dakota – has made some progress in decreasing the child uninsurance rate.

Many factors can lead to the continued downward trend of health coverage for children during the past couple of years. The report cites the decrease in public health coverage as a major factor in the increase in uninsured children. Current federal policymakers have had a different approach when it comes to access to care. Attempts from Congress to repeal the ACA and the administration in chipping away at certain ACA protections, the repeal of the individual mandate penalty in 2017 and funding cuts for ACA outreach and enrollment have all brought a reduction in infrastructure and focus on ensuring enrollment in health coverage. Even the delayed budget extension for CHIP led to confusion among families who rely on the program about whether the benefits would continue. Researchers at Georgetown CCF believe that the increase in negative immigration rhetoric and policies on the federal level have also deterred families from enrolling their children in public benefits, including health insurance, such as parents disenrolling their eligible children despite their legal immigration status.

In Massachusetts, Health Care For All and stakeholders in the health care community are dedicated to protecting and improving access to health coverage. We also know that having health insurance does not necessarily translate into having access to care. Some health insurance comes with high costs and some safety-net programs, even for children, have caps on services and leave gaps in coverage of necessary care. That is why HCFA and the Children’s Health Access Coalition is advocating for a bill which would ensure that low-income immigrant children in our state have equitable access to coverage. An act to ensure equitable health coverage for children (H. 162/ S. 677) better known as Cover All Kids, seeks to expand comprehensive MassHealth coverage to low-income children who would otherwise be eligible except for their immigration status. This bill would help more than 30,000 children and young people in our state obtain the coverage they need, to live, learn, and thrive. If your child or the children you serve are facing barriers to accessing because they depend on the Children’s Medical Security Plan (CMSP), MassHealth Limited, or the Health Safety Net (HSN), share your story today and together we can a difference! Now is the time for Massachusetts to Cover All Kids.

August 22, 2019

The Blue Cross Blue Shield of Massachusetts Foundation has released a new report on uninsurance rates across the state, The Geography of Uninsurance in Massachusetts: An Update For 2013-2017. The report is based on the five years of data from the census’ American Community Survey (ACS), which surveys 2 million households annually to identify uninsured residents. Here is a basic rundown of the findings of their research and what you need to know! If you’re interested, you can find the full report here.

The uninsurance rate across the state varies drastically but there are some clear trends. Communities in more urban areas, like the Boston region, have the highest uninsurance rates. However, in wealthier and more suburban communities, like those in the MetroWest Region, the uninsurance rate is the lowest in the state. Below, you can see the top 10 communities in both uninsurance rate and number of uninsured.

Health Care For All’s HelpLine provides multilingual and culturally competent direct services to improve access to health insurance and care for underserved communities such as the ones listed in the table.

The residents in these communities are generally from similar demographics. A little bit less than half of these residents are noncitizens and about one-quarter of the families have incomes below the federal poverty line. Residents from the most uninsured communities face barriers to receiving consistent coverage because of these disadvantages. In the map below, the red shows communities with the most uninsured residents and the beige show communities with the fewest. The biggest concentration of uninsured residents comes in and around the Boston area.

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