October 2005

October 30, 2005

On Monday, the House rolls out its long-awaited version of health care reform. In brief, the Health Care Financing Committee and House Leadership have done a first-rate job drawing from all three major proposals (ACT Coalition/MassACT, Gov. Romney, Sen. Pres. Travaglini) and adding their own innovations. There are lots of ways we would do it differently -- yet the overall impression is one of a serious and thoughtful effort that demands respect. It also takes courage -- the employer responsibility issue is the third rail of health care politics. Speaker Sal DiMasi and Health Financing Chair Patricia Walrath have led an admirable effort and produced legislation that is nationally significant.

Just one example: progressives like employer responsibility and the conservatives like individual responsibility -- and neither likes the other. The result is stalemate as each side's second choice is status quo. By combining employer and individual responsibility, the House bill challenges both sides to put up or shut up. We'll see who's up to it...

We confess -- we're not wild about an individual mandate. After lots of discussion with many of our partners, we concluded not to reject an individual mandate out of hand IF: a. it were crafted so that noone gets caught if insurance purchase is not absolutely affordable; and b. if other key components are included such as -- employer responsibility, MassHealth expansion and restoration, fair financing, and support for moderate income families. Though we have not yet seen the legislative language, it's pretty clear that all our concerns are being addressed.

And yes, we absolutely agree with Len Stewart that more time for public consideration should be required. We're stuck with the legislative process we have, not the one we might desire.

Despite this, we're facing an historic opportunity this week to enact huge health reform that could result in coverage for 90%+ of Massachusetts' uninsured. Debate will start on Thursday at noon. Please stay in touch with the HCFA website for regular updates and summaries as well as this blog. If you have not contacted your state rep to indicate your support, p l e a s e do so before Thursday. And thanks!

October 30, 2005

The Health Care Financing Committee has released a 2-page summary of the highlights of the House health care reform bill, which will be approved by the Committee on Monday. You can read the summary by clicking here. The Globe has front-page coverage here.

Here's what we know about next week's schedule:

Monday 10:30 a.m. Health Care Financing will vote out a health reform proposal, State House room A-2

Monday 12:30 p.m. House Caucus to brief members on the proposal

Monday 2:00 p.m. Speaker DiMasi, Ways and Means Chair DeLeo, Health Care Financing Chair Walrath, and Financial Services Chair Mariano hold a press conference on the proposal, State House Members' Lounge

Monday after 2:00 p.m. House formal session – the House will vote on the debate rules for the health reform proposal’s amendments and scheduling

Tuesday noon - Business Leaders For Affordable Quality Health Care hold press conference to support employer assessments in House bill, outside House chamber.

Thursday noon - debate scheduled to begin in House on health reform bill. House members were warned that debate may go into the evening and possible will go into Friday.

October 28, 2005

Yesterday, the MassACT Coalition held a State House rally to celebrate the collection of more than 75,000 of the 100,000 signature drive to place real health reform before the Massachusetts electorate in November 2006. Here's the account from State House News:

"HEALTH CAMPAIGN ANNOUNCES SIGNATURE SUCCESS: As House leaders put finishing touches on their health care reform and insurance expansion proposal, proponents of a proposed ballot law overhauling the health care system announced today that they have collected 75,000 signatures and plan to reach 100,000 in the coming weeks. The grass roots organizers, under the oversight of the Greater Boston Interfaith Organization, say their army of 2,000 volunteers includes barbers and bishops, and construction workers and nurses. Signatures have been gathered in 336 of the state’s 351 cities and towns. Petition sponsors need to ultimately present 65,825 certified voter signatures. Campaigns often shoot to gather more signatures, since some are ruled ineligible. The measure, if adopted by voters, would expand Medicaid eligibility and benefits, repeal a $160 million uncompensated care surcharge paid by insurers and employers who offer health benefits, raise the per-pack cigarette tax by 60 cents, to $2.11, creates an assessment on employers to make sure all businesses are contributing to health care coverage costs, and adds smoking and tobacco cessation treatment and information to the MassHealth benefit package."

Here's my personal take: I've been involved in many coalitions over about 28 years in politics. I've never been involved in a coalition as real and dynamic as MassACT. It's broad and deep. It's so much more than smoke and mirrors, it's real. Congrats to David Jordan and Lisa Vinikoor who run MassACT, to Cheri Andes and those incredible clergy from GBIO, to Harris Gruman from Neighbor to Neighbor, to Dan Gilbarg from Coalition for Social Justice, to Celia Wcislo from SEIU Local 1199, to Joe Dart and Frank Callahan from Mass. Building Trades Council, to Phil Villers from Families USA, to Mark Govoni from United Food and Commercial Workers, and to Fawn Phelps, Brian Rosman and an amazing crew from Health Care For All and the entire 30 Winter Street gang.

Beginning on Monday when the Health Care Financing Committee releases its bill, there will no longer be three bills in play, just one. As my friend Judy Meredith would say, get ready for the fast lane.

October 27, 2005

It just doesn’t get better than this. An internal memo sent to Wal-Mart’s Board of Directors proposes how to minimize health care spending while limiting damage to the Company’s reputation. Click here to read the New York Times account which includes a link to the actual memo. So much here to digest, and so little space. Some tidbits… (“Associates” is Wal-Mart’s euphemism for “workers.”)

“Most troubling, the least healthy, least productive Associates are more satisfied with their benefits than other segments and are interested in longer careers with Wal-Mart.”

“Associates rank health insurance as the most important benefit Wal-Mart offers, but they also say it is the one with which they are least satisfied.”

“Healthcare is one of the most pressing reputation issues facing Wal-Mart. Survey work done last summer shows that people’s perception of our wages and benefits is a key driver of Wal-Mart’s overall reputation. … Moreover, federal and state governments are increasingly concerned about healthcare costs, and many view Wal-Mart as part of the problem.”

“Our healthcare offering is also vulnerable to attack. … our critics are correct in some of their observations. Specifically, our coverage is expensive for low-income families, and Wal-Mart has a significant percentage of Associates and their children on public assistance. … In 2004, 38 percent of enrolled Associates spend more than 16 percent of the average Wal-Mart income on healthcare. … In total, 46 percent of Associate’s children are either on Medicaid or are uninsured.”

“While critics have not yet harnessed all of these facts, they are successfully exploiting those they do have, suggesting that, when discovered, the others will also become effective ammunition.”

“Consumer-driven health plans are particularly attractive to the healthy, productive Associate segment … Moreover, a growing number of companies are implementing such plans, providing Wal-Mart with more political cover. … The primary reason for making this transition would be to reduce future benefits costs…Wal-Mart will also face reputation challenges in implementing this change given that progressives view such plans as the ‘Republican answer.’”

“We need to be more proactive in the public arena. Three efforts are needed here … Address the Medicaid issue head-on by reframing the debate (e.g., this is everyone’s problem, not just Wal-Mart’s) and by offering some type of counterproposal or compromise. This first effort is critical because Wal-Mart is under serious attack from state governments with regard to the number of Associates on publicly funded health insurance. These attacks show no signs of abating – in fact, they seem to be accelerating – and elected officials are proposing increasingly costly solutions. … Become more engaged in the national healthcare debate in general and on access (e.g., individual mandates) and affordability (e.g., bringing IT to healthcare) in particular. Establishing Wal-Mart as a leader on this critical issue will put us in the position to help shape the outcome of the public debate about the healthcare crisis in a way that is at least somewhat advantageous to our interests.”

Exhibit #5 is titled: “Significant Portion of Associates and Their Children Are Uninsured or on Government Insurance.” Among children of Wal-Mart Associates: 27% are on Medicaid/SCHIP and 19% are uninsured.

Rarely do we see such an unadulterated look at the real thinking of corporate America. Let’s hope this document gets around to policy makers.

October 26, 2005

Please consider yourself invited to attend a State House rally for Real Health Reform on Thursday at noon at the Grand Staircase (second floor). At the rally, supporters of the MassACT ballot initiative will announce that we have collected more than 65,000 signatures on our way to 100,000. (65,825 needed to qualify).

This rally happens as the House gets ready to debate their own health reform plan. On Thursday, they will approve a debate-rule which will set limits on the ability of members to offer amendments. On Monday the 31st, it's expected the Committee on Health Care Financing will release its legislative proposal. Wednesday, Thursday, Friday -- these are the days for floor debate.

Individual mandate ... employer assessment ... Medicaid expansion ... provider rate hikes ... insurance market reforms ... new taxes ... cost containment ... what's in and what's not? They're not saying. What to do? Stay close to this space.

October 25, 2005

HCFA has been working with other consumer groups including Mass. Senior Action, AARP, MassPIRG and others to protect MA senior citizens when the new Medicare Prescription Drug Law (aka: Part D) starts in January. Here's an account from State House News:

"In a letter released today, 36 of 40 state senators called on the Senate president and budget chief to include language in an upcoming budget bill that will ensure that Medicaid and Prescription Advantage program enrollees receive the same level of prescription drug benefits as the state makes the transition to the new federal drug benefit under Medicare. The language recommended by the senators would require pharmacies to dispense a one-time 30-day supply of medications to a beneficiary who arrives at a pharmacy and learns that their medications are not covered under the new federal program.

"The one-time supply, senators say, will give beneficiaries time to contact their physicians and seek out a substitute drug or file for an exception. The proposal also calls for a “wrap-around benefit” to pay higher Medicare drug plan co-payments. And pharmacists would be required under the language to disseminate information sheets about the new Medicare drug benefit and who to contact for assistance. Supporters of the bill say its cost is difficult to estimate because it’s not clear how many present beneficiaries would take advantage of the bill’s provisions, if adopted and signed into law. The letter, distributed by Sen. Mark Montigny (D-New Bedford) was addressed to Senate President Robert Travaglini (D-East Boston) and Senate Ways and Means Committee Chairwoman Therese Murray (D-Plymouth)."

Special thanks for Mark Montigny for taking the lead on this. Mark has been the leading champion for senior drug needs since 1996, and we appreciate his continuing advocacy.

October 24, 2005

A new study by the Economic Policy Institute, using US Census data, shows an alarming drop over the past five years in the proportion of workers able to obtain health insurance on the job. Here’s the surprise:

“Among the working population, the average loss in employer-provided coverage was 2.7 percentage points between the 1999-2000 and 2003-04 periods. As shown in Table 7, some states fared better than others. Workers in nine states experienced significant declines in coverage during this period. The sharpest rate decline was in Virginia, with a 6.7 percentage-point decline in coverage. The next largest declines were in Indiana, Massachusetts, and New Jersey, all with 5.6 percentage-point declines.”

There has been an assertion in the MA health reform debate that Bay State employers are hanging in there and not dropping worker health insurance coverage. Ain’t necessarily so…

October 22, 2005

It is now clear that the leadership of the MA House of Reps is seriously considering a mandate on individuals to purchase health insurance as part of its health reform package due out October 31st. Plans are for the House to rush consideration of their plan that same week, leaving little time for review and discussion. After they spent six months developing their plan, we urge them to provide the public at least six days to understand, analyze and consider their proposal.

Click here to see today’s front page Boston Globe article on the proposal. The disclosure was made by Speaker DiMasi himself. The information is sketchy. How would it be structured or enforced? It appears the House will establish income based thresholds (ie: 2% of income for folks between 100-200 percent of the federal poverty line [eg: 200% FPL for a family of four is $38,000]; 3% between 200-300% FPL, etc.) – if an insurance plan meeting certain standards costs less than the target income threshold, individuals and families who do not purchase coverage would be subject to financial penalties. What would the penalties be? What would the standard product entail? What about deductibles and co-payments? What about the cost of living in different parts of the state? On and on … lots more is not known than known about their thinking…

Beyond the details … Is a mandate for individuals to purchase insurance something to be considered or rejected out of hand? If an individual makes no claim on public resources – is it right to use the coercive power of the state to require them to purchase a private commercial insurance policy? What about employers? If we mandate individuals to buy, should we not also mandate employers to provide? And what if they don’t? Will this provide yet another excuse for employers to stop offering coverage? And will the State then assume any responsibility for families who are paying well beyond their means to buy health insurance coverage now?

A little history. The Blue Cross Access Foundation started this ball rolling by proposing an individual mandate as one of three reform options – though tied to about $900 million in new government spending to support affordability – an amount considered politically infeasible. Gov. Romney proposed an individual mandate as part of his legislative proposal filed in July. We and other dismissed his scheme because it was tied to mythical $200 policies no insurer has yet to outline (see companion Globe story today for more on that), and because his plan included inadequate financing to support individuals with limited incomes. The emerging DiMasi mandate is tied to no such scheme – no low cost plan or subsidies, just a straight mandate. And it could emerge into public view for the first time on October 31st and be whisked through the House by the end of that week.

We need to prepare now … can you help us out? Reply to this blog below or email me at: mcdonough@hcfama.org

October 21, 2005

Good piece in yesterday's Washington Post on the pitfalls of high deductible, so-called "consumer driven" or "consumer directed" health plans. Here's the money quote:

"Elizabeth Fowler can be called an educated health care consumer: An expert on health care policy, she used to be the chief health and entitlements counsel for the Senate Finance Committee. But she was pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan -- a type of insurance designed to protect consumers from catastrophic medical costs while prompting them to shop wisely for routine care.

"The policy Fowler bought from Definity Health through the Federal Employees Health Benefits Program in 2003 featured a low premium (her share was $1,000 a year) and a relatively high annual deductible of $600. Fowler had no major problems that year, but she had few health care needs outside of some dental work.Last year, however, her out-of-pocket expenses doubled. Along with her premium, she paid nearly $1,500 for allergy shots and physical therapy for a bum knee. Fowler had been aware that she might pay more under a high-deductible policy if her health or luck turned bad, but she never realized just how much. "You need to read the fine print," she says.

"'I appreciate the concept of making consumers more aware about health care costs,' says Fowler, a District resident who now works in the private sector. But 'I didn't understand the full consequences' of choosing a high-deductible policy. Fowler's health plan left her confused and with a pile of paperwork -- including late-payment notices from doctors -- and big costs, some of which she considered improper. She says her experience was 'awful,' adding, 'I don't consider it consumer-directed and it's certainly not consumer-friendly.'"

Fowler's $600 deductible was actually a bargain. Average deductibles in Health Savings Accounts plans, according to Health Affairs, about $2000 for an individual and $4000 for a family. This so-called solution is only the source of a whole new source of problems for consumers.

October 20, 2005

Check out the first fusillade against the MassACT ballot initiative in today’s Boston Herald business section – click here. The piece was written by the Herald’s retail reporter Donna Goodison who was led to the story by the Retailers Association’s Jon Hurst. In this, we can see the initial outlines of the emerging public conversation over the initiative from the opposition side.

First is the argument over language. The Attorney General’s official summary refers to the money to be paid by employers who don’t provide health insurance to their workers as an “assessment” while the Retailers call it a “tax.” Where have I heard this tune before? Then there’s the Hurst quote: “This type of mandated employer payroll tax doesn’t exist anywhere except for Hawaii.” Well, Hawaii actually has a law which requires employers to provide health insurance to their workers – no payroll tax or assessment at all. The MassACT initiative requires employers who don’t cover their workers to pay an assessment of 5 or 7% – far less than the cost of providing insurance – to assist the state in helping uninsured workers get coverage.

One factual error in the article – Mass. AFL-CIO is not part of the MassACT coalition, though it does include Service Employees International Union, United Food and Commercial Workers, Mass. Building Trades Council, and more unions likely to join soon.

One important part of the Initiative left out of the story – the MassACT initiative will lower the cost of health insurance for every employer who provides health insurance to their workers, by eliminating a $160 million current surcharge on health insurance used to fund the state’s Uncompensated Care Pool. We think that puts the quote – “It’s expensive to create jobs in Massachusetts today, and I don’t think we should make it more expensive” – from the Greater Boston Chamber of Commerce’s Jim Klocke in a different light. We agree – let’s make is less expensive for employers to provide health insurance to their workers. And let’s stop requiring employers who cover their workers from subsidizing care for workers in firms that don’t offer coverage. That’s exactly what the MassACT initiative does.

October 18, 2005

oday, the Romney Administration, with little fanfare, unveiled a health care cost and quality website – click here. The site allows you to compare hospital performance on cost and quality data on nine medical conditions: heart attack, coronary artery bypass graft, congestive heart failure, gastrointestinal hemorrhage, hip fracture, hip replacement, maternity, pneumonia, and stroke. So, for example, you can learn which hospitals have above average, average, and below average quality and costs on hip replacements. If you would like to read the Gov’s press release on the new site, click here.

Gov. Romney has been bragging since last February about plans to launch this site. His press release includes congratulatory quotes from business and insurance leaders talking about how great the site is for consumers. Prior to launch, the Governor’s people met with business reps, health plans, and provider groups to solicit their input. Also prior to launch, HCFA and other consumer organizations such as MassPIRG and AARP sent a letter to Gov. Romney asking if we too could preview the site and offer advice on how to make it more consumer friendly. We were called by the Administration and told a meeting would be scheduled. We called three times to set up the meeting and never heard back.

The site’s not bad – for consumers with post-graduate degrees. If the Administration had any desire to put together a site that would be user friendly for regular consumers, they missed the mark by a country mile. There are great experts in Massachusetts with know-how to make sites consumer friendly. No evidence the Administration called any of them. This site will not be used by many consumers – though that doesn’t seem to be the point. Gov. Romney wants to run around the country bragging about how he “fixed” health care in Massachusetts, and this is one more bragging point only loosely connected to reality.

October 17, 2005

How to pay for health care reform to help the uninsured? House leaders leaked to the Globe over the weekend that they were considering cigarette and/or alcohol taxes. In today’s State House News Service, Sen. Pres. Travaglini votes for slot machines at race tracks. Read more ... and tell us what you think...

“New government revenues generated by adding slot machines at four state racetracks represent a "more appropriate and defendable" way to expand health insurance coverage than raising taxes, Senate President Robert Travaglini said Monday. Speaking to reporters in a State House hallway, Travaglini said the new revenue that could be achieved through slot machines, estimated at $350 million per year, would significantly help state policy makers to expand access to affordable health insurance for the more than 500,000 residents without it.

"’That's why the Senate voted the way they did for the slots,’ he said. ‘An expansion of gaming seemed to be a more appropriate and defendable vote than a tax vote. We didn't dedicate any revenues, but clearly when you have health care reform coming, you have higher education needs that are significant, all these things that are pending. That's going to be a new source of revenue that seems to be a little more defendable than voting for a tax.’

“Travaglini did not rule out raising the alcohol or cigarette tax as a new revenue source, but repeatedly emphasized that such a proposal is not included in the plan he filed this spring to reduce the number of residents without insurance by half. Legislation from the Health Care Financing Committee is expected to surface for consideration by the Legislature by month's end. A tax increase remains under consideration.

“Gov. Mitt Romney has said he would not support new taxes to pay for expanding access to health care, and has also come out recently against slot machines or other expanded gaming tactics. During his first year in office Romney expressed interest in new gaming revenues to help the state with its budget crunch.The Senate supported slot machines at racetracks on a 26-9 roll call vote. The House in recent years has voted against similar proposals, but gaming expansion supporters believe they may have new life now that gaming expansion opponent Thomas Finneran is no longer the Speaker of the House.”