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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

January 29, 2019

Prescription Drugs

  • Reduce Prescription Drug Costs (Representative Barber & Senator Lewis) – HD3442/SD1799
    • Prescription drug prices are the leading factor in driving up health care costs across the system, impacting the budgets of individuals, families, employers and the state. An Act to ensure prescription drug cost transparency and affordability will: provide transparency around the underlying costs to produce prescription drugs; restrain abuses of pharmacy benefit managers (PBMs); authorize the Health Policy Commission to set upper payment limits for unreasonably high-priced drugs; require pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using insurance; provide tools to strengthen MassHealth’s ability to negotiate lower drug prices; and support a permanent authorization and funding source for “academic detailing” to ensure doctors get accurate information to counter biased drug manufacturer marketing.
  • Limit the wining and dining of doctors by drug marketing sales personnel: (Senator Lewis) – SD791
    • Research has shown that the provision of meals is effective in influencing a doctor’s prescribing practices. In 2008, HCFA was instrumental in passing a Massachusetts law that limits these promotional efforts to “modest meals.” However, under strong pressure from drug companies and the restaurant industry, the state’s regulatory definitions have loose restrictions on meals and permit alcoholic drinks at these educational programs. An Act to define modest meals and refreshments in prescriber education settings will put reasonable limits on meals and ban all alcohol in these settings.

Children’s Health Access

  • Expand Health Coverage for Children (Representative D. Rogers & Senator DiDomenico) – HD2615/SD1167
    • Currently, low-income immigrant children who are not otherwise eligible for MassHealth can access only very limited health coverage, which leaves them without adequate access to many services, including prescription drugs, mental health services, durable medical equipment, dental services, and emergency care. An Act to ensure equitable health coverage for children would expand MassHealth coverage to low-income children whose only barrier to accessing comprehensive coverage is their immigration status. Other states, including California, Washington, Oregon, Illinois and New York have already enacted this policy.

Dental Care Access

  • Expand Access to Dental Care through Dental Therapists (Representatives Hogan & Senator Chandler) HD3436/ SD 1942
    • The most vulnerable populations in Massachusetts often forgo their oral health needs due to the lack of easy access to a dentist. An Act to improve oral health for all Massachusetts residents authorizes an additional dental professional, called the dental therapist (DT), to work with a dentist to provide oral health care to more people. DTs present a critical opportunity for Massachusetts to close gaps in dental access for seniors, low-income families, children, and people with special needs. 
  • Restore Full MassHealth Dental Benefits (Representative Honan & Senator Chandler) – HD2690/SD677
    • An Act relative to the restoration of MassHealth adult dental benefits will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. Important dental services that are vital for good oral health and saving teeth are not currently covered by MassHealth. Left untreated, dental disease can lead to systemic infection, hospitalization, and the worsening of other medical conditions. Oral health is an integral part of overall health and should be included in health coverage.

Private Health Insurance

  • Ensure Accuracy of Health Plan Provider Directories (Representative Barber & Senator Lewis) – HD2698 /SD744
    • Accurate provider directories are critical to ensuring that health coverage works for consumers.An Act to increase consumer transparency about insurance provider networks establishes a task force, chaired by the Division of Insurance, to make recommendations for regulations improving the accuracy of provider directories to ensure consistency across carriers. The bill also requires that provider directories be easily searchable, available to the public, and updated at least monthly.
  • Protect Consumers from Surprise Out of Network Bills (Representative Farley-Bouvier) – HD1762
    • Surprise billing occurs when patients receive out-of-network care that they did not or could not intentionally choose to receive, and then are faced with unexpected and unaffordable medical bills. An Act to protect consumers from surprise medical bills protects consumers by requiring health plans and providers to disclose comprehensive information to consumers about the network status of providers; requiring specific patient consent for out-of-network services; and prohibiting providers from billing consumers more than their in-network cost-sharing amount. Senator Welch filed legislation (SD1602, the PATIENT Act) that also includes provisions to protect consumers from surprise out-of-network billing.   

Health Care Affordability

December 19, 2018

Last Friday, a federal judge in Texas ruled in favor of a lawsuit arguing that the federal individual mandate, and the entire Affordable Care Act (ACA) along with it, is unconstitutional. We are greatly disappointed about this ruling. The decision is misguided and we are hopeful that it will be appealed by a higher court. We have seen firsthand the impact of this life-saving law; this decision is a dangerous step back in the progress we have made towards universal coverage in Massachusetts and across the country. We will join any effort to prevent the ACA from being decimated any further, whether by legislative, administrative, or judicial attacks at the legislative.

We do, however, want to make clear that there is no impact for now. The ACA is still the law of the land. The Texas ruling will likely go to the Supreme Court and the process will take time. We know that the combination of the elimination of the individual mandate at the federal level, the different deadlines for open enrollment periods in some states, and now this ruling have made the current open enrollment period confusing for consumers. Nonetheless, the law is still in the books. In Massachusetts, open enrollment through the Health Connector started on November 1, 2018 and runs through January 23, 2019. People who want coverage beginning January 1, 2019 must apply, select a plan and pay their premium (if there is one) before December 23, 2018. After that, people who seek coverage must apply, select a plan, and pay their premium no later than January 23, 2019 for coverage beginning February 1, 2019.

While the Texas decision does not have an immediate impact on coverage for millions of people across the county, we recognize that it is important to monitor the situation and think about the future potential impact on Massachusetts and beyond. Although Massachusetts was the model for the ACA and we have many protections in state law, the Commonwealth is not shielded from what happens at the federal level. Massachusetts relies on a partnership with the federal government to provide the robust coverage options available to our residents. Regardless of what happens, some state protections will remain law, like the prohibition on denying coverage to people with pre-existing conditions, but federal funding is necessary to keep the subsidized coverage options through MassHealth and the Health Connector intact. If the ACA were to ultimately be deemed unconstitutional, many protections and affordable health coverage options would be in jeopardy, and the Massachusetts uninsurance rate would shoot up, reversing over 12 years of progress.

We must not let the attempted sabotage of the ACA deter consumers. Open enrollment continues in Massachusetts until January 23, 2019. People receiving health insurance, including those who receive premium and cost-sharing subsidies through the Health Connector or coverage through MassHealth will have no interruption in their benefits. Don’t wait! Head to https://mahealthconnector.optum.com/individual/ to apply for health insurance, select a plan and pay your premium by January 23, 2019.

To learn more about the ruling and its potential effect on Massachusetts, see this story from the Boston Globe, which features our Associate Director of Policy and Government Relations, Suzanne Curry.

 

December 11, 2018

On Saturday, November 17th, HCFA hosted a successful health care enrollment and education session at the Waltham Public Library. This effort was part of the Health Connector's Stay Covered Campaign that aims at ensuring that Massachusetts residents utilize the Open Enrollment period to apply for health insurance or change plans.

In October, the HelpLine noticed an uptick in calls from the Waltham area particularly on the Spanish line. We found out that there were no longer any Certified Application Counselors at the Charles River Community Health Center. From the increased call volume, it was clear residents of Waltham would need additional support during Open Enrollment. Because we had not previously worked closely with community leaders in Waltham, we had to lay the groundwork to find a location and get the word out to the appropriate organizations.

Within a few weeks we found a location, met with community organizations, flyered businesses on main streets in Waltham, sent information through the school system, and outreached with Charles River. Due to the fear in immigrant communities about changes to public charge and what that means for health coverage, we wanted to have immigration counselors available at the event. We had immigration counselors from the Irish International Immigration Center and Catholic Charities along with a public benefits lawyer from Health Law Advocates. We had a Certified Application Counselor from Partners Newton-Wellesley Hospital as well as a Navigator from the Fishing Partnership assisting attendees alongside Health Care For All's Certified Application Counselors. A Community-Health Outreach worker from Charles River Community Health was on site for attendees that needed help finding a primary care physician.

As our team of volunteers arrived to set up, a line of folks already awaiting enrollment and immigration services at the Waltham Public Library greeted us. While our counselors put together the final touches in their respective work spaces, we began to welcome the Waltham community. Family by family we listened to needs and proceeded accordingly. The services sought after varied from first time medical insurance coverage, to renewals, and immigration consultations. The room was filled with parents with newborns, children at play, grandparents waiting patiently, and adults chatting with friends who came to the event together seeking to have their questions answered. Over the span of five hours, we saw people come and go, hopeful to be assisted with health care and immigration support.  

We ended up serving 82 households with help getting health coverage. 70% spoke Spanish, 14% spoke Portuguese, 13% primarily spoke English and 3% spoke Haitian Creole.  Of the 82 attendees, 14 households opted to speak with one of the immigration lawyers. 60% were referred by Charles River, 29% heard about the event from a friend or relative, 6% heard from school, 4% heard about the event from the library, and 1% specifically mentioned seeing a flyer.

Many thanks to the Health Connector for their tremendous support and their efforts to get people covered this Open Enrollment season through their #StayCovered Campaign. Thank you to all volunteers and Health Law Advocates, Catholic Charities of Boston, and Irish International Immigrant Center for partnering with HCFA to address questions regarding the impact of the use of benefits for immigrants. Thank you also to The Fishing Partnership Support Services and Partners Health Care for your continuous support and for offering to assist HCFA's HelpLine in enrolling individuals into health insurance at the event.

 

December 5, 2018

In 2016, the rate of uninsured children in the United States hit an historic low of 4.7 percent. In a report released last week, the Georgetown University Health Policy Institute’s Center for Children and Families finds that number increased to 5 percent in 2017, marking the first rise in the number of uninsured children nationally since comparable data was first collected nearly a decade ago. 

Here in Massachusetts, we boast an uninsured rate significantly lower than the national numbers. Nevertheless, this report gives us pause because it shows that the Commonwealth joined eight other states in experiencing a statistically significant increase in its rate of uninsured children, with the numbers increasing by 0.5% from 15,000 children in 2016 to 22,000 children in 2017. The reasons for this are not clear, but the findings should be a wake-up call to all of us.

Nationally, the report attributes these shifts in large part to “strong national currents” that include the ultimately unsuccessful effort to repeal the Affordable Care Act (ACA) and cap federal Medicaid funding, a Congressional delay that caused a temporary lapse in funding for the Children’s Health Insurance Program (CHIP), and efforts to undermine ACA Marketplaces which includes reducing outreach and enrollment grants as well as shortening the enrollment period. The authors caution that “…there is every reason to believe the decline in coverage is likely to continue and may get worse in 2018.” At the heart of this warning is worry about the recently proposed changes to the federal “public charge” rule which creates new tests on income and use of public benefits for lawfully present immigrants seeking to adjust their immigration status. The report cites a recent study that found that “implementation of the proposed rule could lead to a reduction in Medicaid enrollment of between 2.1 million to 4.9 people and posits the likelihood that children would “make up the majority who are disenrolled.”

At Health Care For All, we know that health insurance coverage is at the foundation of ensuring that children can access the health care services they need to grow, learn and thrive. Massachusetts is doing well, but we must remain vigilant in our efforts to enroll children and families in high-quality, affordable coverage and to protect, improve and expand the coverage that is available.
 
Our efforts must include active and vocal opposition to the proposed changes to the public charge rule during the public comment period. Join us now by learning more about the proposed changes and submitting your own comment of opposition before December 10th.

-Natalie Litton

November 5, 2018

The Department of Homeland Security (DHS) officially posted the "public charge" regulatory proposal that would significantly expand the list of public benefits that will pose barriers to immigrants' ability to obtain permanent residence via family or employment channels and prevent many from switching between non-immigrant statuses.
 
As part of the national Protecting Immigrant Families (PIF) campaign, the Massachusetts Law Reform Institute, Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), Health Care For All and Health Law Advocates are working together to make sure that we in the Commonwealth of Massachusetts respond to these administrative actions effectively and strategically.

Since its publication in the Federal Register on October 10, 2018, a 60 day comment period has opened for the public to oppose the rule. The public comment period is open until December 10, 2018. We've launched a public comment drive, with a goal of 3,000 comments from Massachusetts. No special expertise is needed: Whether you're an immigrant yourself, a community advocate, a service provider, a business owner, an elected official or just a concerned citizen, you can help us ensure that the government is overwhelmed with opposition to the "public charge" proposal.

MIRA has put together guidance and helpful resources on their website; and they also have an easy-to-use comment submission form with questions to guide you.

For more information, please view this public charge statement on behalf of Massachusetts Protecting Immigrant Families Campaign (PIF-MA: MIRA, HCFA, HLA, MLRI).

Please also see these resources for advocates available in English, Spanish, and Portuguese.

October 24, 2018

Health Care For All and Health Law Advocates represent the needs of consumers in the health care system. As organizations focused on coverage, access, and affordability, we are concerned that Ballot Question 1 could have unintended consequences. Our goal is to ensure that consumers can make an informed decision about this question.

Meeting the proposed nurse staffing ratios could be particularly challenging for community-based hospitals, community health centers, and safety-net hospitals that disproportionately serve people of color, immigrants, and low-income families. It could put pressure on our behavioral health system, which is already experiencing significant staffing shortages, and could further reduce access to care. In addition, the Massachusetts Health Policy Commission projects an additional $676 million to $949 million annual cost to the health care system if the initiative passes. These costs may ultimately be passed on to consumers in the form of higher premiums and out-of-pocket expenses.

Health Care For All will continue to advocate for health justice in Massachusetts by promoting health equity and ensuring coverage and access for all. Health Law Advocates will continue to provide pro bono legal representation to low-income residents experiencing difficulty accessing or paying for needed medical services.

October 18, 2018

The Department of Homeland Security released the public charge rule for public comment. It was published in the Federal Register on Wednesday, October 10, 2018, marking the beginning of the 60-day comment period. At least 22 Senators have already opposed the rule in a letter to DHS, asking for it to be withdrawn altogether. After DHS considers public comments received on the proposed rule, DHS plans to issue a final public charge rule that will include an effective date at least 60 days after the date the final rule is published. In the meantime, and until a final rule is in effect, federal immigration officials will continue to apply the current public charge policy.

As part of the national Protecting Immigrant Families (PIF) campaign, the Massachusetts Law Reform Institute, Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), Health Care For All and Health Law Advocates are working together to make sure that we in the Commonwealth of Massachusetts respond to these administrative actions effectively and strategically.

The public comment period is open until December 10, 2018. We've launched a public comment drive, with a goal of 2,000 comments from Massachusetts. No special expertise is needed: Whether you're an immigrant yourself, a community advocate, a service provider, a business owner, an elected official or just a concerned citizen, you can help us ensure that the government is overwhelmed with opposition to the "public charge" proposal.

MIRA has put together guidance and helpful resources on their website; and they also have an easy-to-use comment submission form with questions to guide you.

For more information, please view this public charge statement on behalf of Massachusetts Protecting Immigrant Families Campaign (PIF-MA: MIRA, HCFA, HLA, MLRI).

September 24, 2018
You may have heard about proposed policy changes that could affect immigrants’ use of public benefits (government programs that may help you pay for food, housing, health care such as MassHealth and other living expenses). New federal regulations are proposing to change the definition of who is a “Public Charge,” a person who is likely to become dependent on the government for financial and material support. This change could affect the ability to adjust status or petition for a family member. 

HCFA wants to make sure that you have the most accurate information about these changes, so that you can make the best decision for you and your family. 

  • There has been no change to the “public charge” rules at this point if you are in the US and contemplating adjusting your immigration status or sponsoring someone who is already here. These are proposed regulations that still need to go through a formal federal review process before changes are made.
  • Currently, the only benefits considered under “public charge” are cash benefits (Supplemental Security Income or Transitional Assistance for Needy Families (TANF) or payment for long-term care institutionalization).
  • Over the next several months, the proposed rule could potentially impact other benefits, including: MassHealth (except MassHealth Limited); Supplemental Nutrition Assistance Program (SNAP/food stamps); Medicare Part D Prescription Drug Subsidy; Section 8 Housing Choice Voucher Program; Section 8 Project-Based Rental Assistance; and Public Housing. There is no need to disenroll from these programs at this time. If the regulations are approved, individuals will have 60 days to withdraw from them before they impact people. After that time, the use of these benefits is dependent on other factors that should be discussed with an immigration counselor or attorney.
  • If you are sponsoring a family member who is currently living outside the country, you should check with an immigration counselor or attorney about whether receiving public benefits could affect your pending petition.
 
Health Care For All (HCFA), the Massachusetts Immigrant Refugee Advocacy Coalition (MIRA), Health Law Advocates (HLA) and many other organizations work to protect Massachusetts immigrants and ensure they have the right to access public benefits, including health care.

To learn more about changes regarding the “Public Charge” determination and how to be part of the campaign to oppose these changes, you can send an email to organizing@hcfama.org.

Attached here is a list of organizations that are trusted in the community and provide free immigration services. Some of these organizations may have limited capacity and may not accept new cases, please call first to ensure that they can help you. 

September 21, 2018

CHIA Report cover

Last week’s release of the Annual Report on the Performance of the Massachusetts Health Care System by the Center for Health Information and Analysis (CHIA) tells us that while total health care expenditures grew much more slowly, patient spending increased significantly in 2017.

In what was heralded as good news, the growth rate of Total Health Care Expenditures (THCE) in 2017 fell below the 3.6% benchmark set by the Health Policy Commission (HPC). Nevertheless, THCE did grow by 1.6% to $8,907 per resident.

While that’s unequivocally good news, not all is well. What does the report show for consumers across the Commonwealth as they try to access the care they need to live healthy lives? Digging in, the report includes the following findings:

  • Pharmacy and hospital outpatient spending remained the largest drivers of THCE growth. Prescription drugs are still skyrocketing in price, compared to other health spending. Drug costs went up 5%.
  • Annual growth in fully-insured premiums accelerated – from 2.0% in 2016 to 4.9% in 2017.
  • Between 2016 and 2017, member cost-sharing continued to grow at a faster rate (5.7%) than inflation, average wages, and premiums.
  • By 2017, 28.2% of members with private commercial insurance were enrolled in high deductible health plans.

In short, while total expenditure growth is down, patients are spending more – to pay for prescription drugs at the pharmacy, to pay their monthly premiums, and to cover co-pays for care before they meet their deductibles.

Health Care For All (HCFA) is deeply concerned about the implications this increased spending has on the ability of individuals and families to access the comprehensive, high-quality care they need when they need it. HCFA’s Director of Policy and Government Relations Brian Rosman told the Boston Globe, "We know that people with high cost sharing, high co-pays, high deductibles end up delaying care that they need and that leads to worsening of their conditions and higher costs later on.”

We need to take more aggressive action to control the growth of drug prices and to contain out-of-pocket costs so that access to equitable, affordable, and comprehensive health care is a reality for ALL Massachusetts residents. Stay tuned to learn more about HCFA’s priorities for the upcoming legislative session and how you can get involved.

                                                                                                                                                                                          -Natalie Litton

September 6, 2018

Massachusetts Health Connector

It’s hard to believe, but true. Massachusetts has among the highest costs for medical care in the country. Yet, paradoxically, for people who obtain their insurance through the Health Connector, we have the lowest average premium costs in the country. Our “benchmark plan” (explained below) is the second lowest nationally. And these findings apply to the unsubsidized cost of the plans, before the federal tax credits and state ConnectorCare subsidies.  As one expert analyst put it, “Which state has the least-expensive ACA policies? Take a guess. No, guess again.” (link)

A number of senior Connector staff members explore this in a blog post in Health Affairs. They point out that what makes this even more remarkable is that Massachusetts requires insurers to cover more benefits than national standards due to our extensive state benefit mandates. In addition, plans here must limit out-of-pocket costs as part of state health reform’s “minimum creditable coverage” requirements. Yet, our premiums are still the lowest. Robust consumer protections need not come at the expense of affordability.

Average state exchange premium levels are calculated based on premiums paid by all individuals purchasing coverage, at every metallic tier and for every carrier. For 2018, the Massachusetts average monthly premium was $385, compared to a national average of $600 a month, making us the lowest in the country. We were the lowest in 2017 as well.    

The benchmark premium is the premium for the second-lowest cost silver plan offered in a state’s exchange. The federal government uses that amount as the basis for setting federal tax credits offered to people eligible for subsidized coverage under the ACA. For this measure, we are the second lowest, at $316 per month for 2018. Rhode Island is a smidge less, with a $311 monthly premium (see this chart). Offering a low benchmark plan saves federal taxpayers money because it leads to lower tax credits APTC subsidies. Unsubsidized shoppers also save money, because they can choose from low-cost silver plans.

The blog authors emphasize that Massachusetts’ success in keeping premiums more affordable can provides lessons to other states. A number of factors contribute to our broad enrollment, which keeps premiums low. One of the Health Connector’s most unique features is the ConnectorCare program for individuals earning up to three times the poverty level. The program provides additional state subsidies to lower-cost silver tier plans by providing both premium and cost-sharing subsidies “on top” of Affordable Care Act subsidies. Enrollees have access to zero or low-dollar premium plans, zero or low-dollar co-pays, with no deductibles or co-insurance. Massachusetts’ extensive network of enrollment assisters reach out and help people enroll in coverage. ConnectorCare covers approximately 190,000 individuals, constituting about three-quarters of total individual enrollment in the Health Connector. This extensive membership rewards ConnectorCare plans that offer low premiums, encouraging them to keep administrative costs low and take advantage of their MassHealth managed care plan networks.

Massachusetts’ lower premiums are also a function of the competition in our marketplace, with multiple carriers offering plans and a structure that encourages comparison shopping. The Health Connector’s standardized plan requirement lets consumers make apples-to-apples comparisons among plans, rather than face a jumble of different deductibles, copays and benefit levels.  Affordability of health coverage is also helped by the large risk pool that includes plans offered by small employers as well as individual coverage. In addition, because Massachusetts has retained its state-level individual mandate, fewer healthy individuals are tempted to go without coverage.

The Massachusetts health care policy community should be proud of our collective work together, reflected in the success that the Health Connector has achieved in controlling premium growth over the past few years. Yet challenges will persist. In 2019, the continued withholding by the Trump administration of federal Cost Sharing Reduction payments to insurers will again force carriers to increase premiums, raising costs for unsubsidized individuals.

More broadly, there’s still much to do to make health care affordable for everyone in the state. Many people struggle with high deductibles and copays. Drug costs in particular continue to go up unabated and the state needs to take aggressive steps to rein in pharmacy costs. Lots of good ideas are being tossed around for states to consider.

States should look to Massachusetts as a laboratory for good policy ideas. Already, New Jersey, Vermont and DC have followed our lead and passed their own individual mandates. Other states are looking at this option as well. Ultimately, it will take a federal government supportive of increased insurance coverage and affordability to continue the progressive path interrupted by the 2016 election.

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