April 2009

April 30, 2009

More than a hundred people gathered yesterday at Nurses Hall at the State House for the United We Stand For Public Health Coalition’s lobby day to protect funding for public health programs. Senator Richard Moore (D-Uxbridge), Chair of the Health Care Finance Committee, urged the crowd to speak to their representatives to help them understand the importance of public health and how they and those they care about are affected by the budget cuts to public health.

In addition to Senator Moore, Diana Mendez, a senior at Chelsea High School, Jacob Smith Yang, Executive Director of Mass. Asian and Pacific Islanders for Health, Mellisa Herren, Mother and Advocate in recovery, and Health Care For All’s Consumer Health Quality Council member, Lucilia Prates, spoke at the event.

Lucilia’s story was highlighted in one of the videos we released earlier this year. Please click here to view her clip. Lucilia’s father was a victim of medical errors and a hospital-acquired infection and passed away as a result. While Lucilia recognized that the system isn’t perfect, she highlighted the important work of the Department of Public Health (DPH):

Massachusetts and its DPH have been doing work to reduce infections and medical errors and improve the quality of health care in hospitals, nursing homes and other healthcare settings.

We need to continue to fund the DPH’s health care quality work and infection prevention work and the work of the Betsy Lehman Center for Patient Safety and Medical Error Reduction in order to ensure that others don’t suffer injury and death due to medical errors and infections the way my father had.

Representative Denise Provost (D-Somerville) filed two budget amendments to protect funding for the Division of Health Care Quality and the Betsy Lehman Center within the House budget. The amendments did not pass. Health Care For All and the Consumer Health Quality Council will continue advocating in support of funding when the Senate takes up the budget. For more information, contact Kuong Ly at kly@hcfama.org.
Kuong Ly

April 30, 2009

The release of the 2000 Surgeon General's report ignited our understanding of the connection between oral health and our overall health. This week, many advocates across the country are honoring Oral Cancer Awareness week by promoting awareness of the issue and educating the public on the importance of oral health.

The mouth is the gateway to the rest of the body. This means that when the mouth is not healthy, neither is the rest of the body. Dental decay is a bacterial infection of the mouth which has long term consequences on our health. Poor oral health among kids affects their ability to speak, eat and learn. In the longer term, dental disease has been associated with increased risk for heart disease, diabetes and even oral cancer. The connections between oral disease and oral cancer are well documented. When oral health is compromised, one’s overall health and well-being also suffers. Fortunately, dental disease is almost entirely preventable when public health measures are widely available.

To celebrate Oral Cancer Awareness Week, the Watch Your Mouth campaign has been working with coalition partners to educate their communities and the media about oral health. We congratulate Sharon Mastenbrook, Director of Public Health at Burlington, for speaking up on children’s oral health! Check out her op-ed published in the Woburn Daily Times Chronicle.
Christine Keeves

April 29, 2009

A coalition of more than 80 organizations, United We Stand for Public Health, has come together to protect public health funding in the Commonwealth.

The lobby day is 2:30 pm today at the State House Nurses Hall. The speakers include Representative Jeffrey Sanchez (Co-Chair of the Public Health Committee), Senator Richard Moore (Co-Chair of the Health Care Finance Committee), Barbara Ferrer, (Executive Director, Boston Public Health Commission) and Lucilia Prates (Health Care For All Consumer Health Quality Council).

Today's Boston Globe op-ed by MPHA executive director Valerie Bassett’s lays out in clear terms how we all rely on public health programs to keep our community productive and healthy. We are all rightfully concerned about a possible widespread flu outbreak. Public health is critical in preventing and responding to any emergency. But the day to day concerns are just as real:

Consider who is actually affected by the programs and services of public health - and what is at stake in cutting them almost 25 percent, as proposed by the House Ways and Means Committee.

The mother preparing breakfast for her children needs public health to ensure that the public water supply she relies on is clean -- so that her kids' oatmeal and hot chocolate are uncontaminated.

How about the businessperson hosting clients for lunch? Public-health funding ensures that the restaurant has been inspected and complies with health codes and anti-smoking laws - and that there is follow-up on reports of food-borne illness.

People at risk for cancer, stroke and heart disease, diabetes, addiction, HIV, and Hepatitis C need information to prevent these diseases, to get screened, and to find out where to go for treatment. Community health workers, funded by public health, provide information to members of their communities and connect them to services.

Who needs public health? We all do. Every resident of the Commonwealth - whether aware of it or not - relies on a strong, functioning public health system - a system that is greatly endangered. Without public health, there is no way for the Commonwealth to succeed in education, economic growth, environmental innovation, or civic engagement.

See you at 2:30.
Mehreen Butt

April 28, 2009

We've long been puzzled by the opposition to the Massachusetts prescription regulations, since our state's leadership on this issue was just slightly ahead of the coming wave that will put everyone on record against marketing payments by drug companies to prescribers. We said back in January that the tipping point has been reached, and the tide was becoming a flood.

Now the flood is a deluge. Gardiner Harris reports in today’s New York Times that:

In a scolding report, the nation’s most influential medical advisory group said that doctors should stop taking much of the money, gifts and free drug samples that they routinely accept from drug and device companies.

The report by the Institute of Medicine, part of the National Academy of Sciences, is a stinging indictment of many of the most common means by which drug and device makers endear themselves to doctors, medical schools and hospitals.

“It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy,” the report concluded.

The institute’s report is even more damning than a similar one released last year by the Association of American Medical Colleges, which proposed tough new rules governing interactions between companies and medical schools.

In the wake of the association’s report, many schools and medical societies toughened their policies. The institute’s imprimatur is certain to accelerate this process.

“With the I.O.M.’s endorsement, issues that were once controversial now are indisputable,” said Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University. “Conflicts of interest in medicine are no longer acceptable.”

The Institute of Medicine is the latest in a string of entities and professional groups to recommend restricting gifts and increasing transparency in this arena. For those counting, here are the trend setters (in no particular order):

  • MedPAC
  • Senators Grassley and Kohl
  • Boston University School of Medicine
  • UMass Memorial Health Care and UMass Medical School
  • Partners Health Care
  • Stanford University
  • American Psychiatric Association
  • Johns Hopkins
  • North American Spine Society
  • University of Iowa
  • The Cleveland Clinic
  • Duke
  • University of Pennsylvania
  • The Association of American Medical Colleges
  • National Physician’s Alliance
  • The Editors of the New England Journal of Medicine

….and more to come

Georgia J. Maheras,

April 28, 2009

This morning the Division of Health Care Finance and Policy held a public hearing on proposed regulations which would increase reporting and disclosure requirements for student health insurance plans. The room was packed with students, advocates and other stakeholders who testified with concerns, questions and requests regarding the student health plans.

Theresa Koster from Gallagher Koster, a student health plan broker, spoke in opposition to the proposed regulations and her testimony contradicted some of what the students would later say about how the plans work. She stated that mandating schools to pro-rate premiums would add additional operational costs and intimated that this would lead to higher costs being passed on to the students. She also challenged the need for increased disclosure requirements, claiming plan information is already available to students, which was expressly contradicted in the students’ testimony. Koster explicitly asked what the purpose is in having all of this information reported since they adhere to quality standards and work very closely with their clients - the schools - to give the best benefit packages they can to the students.

The most compelling and truly sad testimony came from several students from the Student Health Organizing Coalition (SHOC). They represent a group of college students passionate about improving their health plans often because they had negative experiences with their student health plans. The students emphasized the inadequacy of the proposed regulations to address concerns with the structure of student health plans. The students shared horror stories of their struggles obtaining medical care and medications for diabetes, mental illness, tumors, endometriosis and other chronic conditions, forgoing necessary care and unknowingly racking up medical debt. The students called for increased accountability, higher standards, more transparency and a seat at the table during the insurance selection process. They emphasized that ‘affordability does not just mean lower premiums’ and that students should not have to choose between their education and maintaining health coverage.

Stephen Beckley, a student health insurance consultant, testified to express serious concerns with student health plans. Criticizing the plans as “horrifically inadequate,” he advocated for increased student education and more affordable, higher quality plans, which he says are possible. He asked that plans comply with the American College Health Association standards, which go a long way towards addressing the students’ concerns.

Andrew Cohen, from our ACT!! partner organization The Access Project, expressed appreciation for the reporting and disclosure requirements and raised several concerns about the structure and governance of student plans. He echoed the concerns raised by the students in their testimony and offered some solutions to the problems they raised. Cohen asked that students be provided with standardized, clear information about their coverage and the process for filing grievances. He requested that each campus designate a staff member to handle concerns that students will have with their coverage. Andrew also asked for information about the number of students who exceed per service and benefit caps, the number of students using Health Safety Net as wrap coverage and the costs, and details about brokers that contract with schools.

The ACT!! Coalition weighed in to express our support for the proposed regulations and briefly discussed our concerns with the inadequate coverage and unaffordable cost-sharing in many student plans. For more details check out our post on WBUR’s Commonhealth blog.

If you would like to learn more or get involved in student health plan issues please contact Catherine Hammons at chammons@hcfama.org.
Catherine Hammons

April 28, 2009

Today at noon, Health Care For All supported the Stop the Cuts coalition in a State House rally.

Members of the coalition – including SEIU, Neighbor to Neighbor, NASW, Coalition for Social Justice – packed the hearing room to hear from speakers about the importance of raising revenues to protect services. From the coalition’s media advisory: “As the House begins the tough debate on their FY10 budget…a broad coalition of advocates for schools, working families, and our communities will simultaneously be holding an event and lobby day to show lawmakers the detrimental effects over $1 billion in cuts will do to Massachusetts’ communities and families. Lay-offs to our teachers and police officers are resulting in overcrowded classrooms and unsafe streets. Instead of cutting the budget more, we must be raising new revenue to invest in education, infrastructure, and social programs. Finding new revenue streams is the only way to help save our state in this economic crisis.”

Click here (pdf) to learn more about specific cuts. After hearing from a few speakers, including Mayor Curtatone of Somerville, attendees lobbied their representatives.
Lindsey Tucker

April 27, 2009

Yesterday the Globe reported on the impact of age-based pricing for health insurance. Older people can be charged twice as much for the same coverage, which can force older consumers to purchase less comprehensive policies. The Globe article showed the plight of Sue Rummel, a 62-year old self-employed Danvers seamstress struggling with $2,400 in medical debt from a less expensive, skinnier plan with high out-of-pocket costs. The ACT!! Coalition empathizes with older residents faced with unaffordable coverage, and we have significant concerns with age-based pricing (see our blog and the interesting comment back-and forth from March).

ACT!! echoes our coalition member AARP, quoted in the article: we believe that consumers should be protected from spending more than 10% of their income on health care. We have worked for the past few years with the Connector and their regulations on the Affordability Schedule to limit the share of their earnings consumers must spend on health insurance.

ACT!! also supports considering all out-of-pocket expenses, such as co-pays, deductibles and co-insurance, when determining affordability for the purposes of the individual mandate. Since as a state, we are requiring that all residents obtain health coverage, we need to ensure that this coverage is truly affordable. An Act Relative to Health Care Affordability (S. 549/H. 1102) , championed by Senator Mark Montigny and Representative John Scibak, improves the state’s Affordability Schedule for the individual mandate by expanding the definition of affordability to accurately reflect all health care costs consumers face.
Catherine Hammons

April 27, 2009
One Massachusetts image of ecology of state structures we rely on

One Massachusetts image illustrating ecology of state structures we rely on

Three State House events will allow us to let our Representatives know that the public supports increased revenue to maintain our system of public structures that keep our communities safe and healthy, educate our children, and draw businesses to our state.

1. As the House considers revenue proposals today, the broad Stop The Cuts Coalition will gather today (Monday 4/27) at noon in State House room B-1. The message is we need to raise new revenue to invest in our future and reduce these cuts so we can invest in our schools, infrastructure and social programs to rebuild our economy.

2. A coalition of more than 80 organizations, United We Stand for Public Health, has come together to protect public health funding in the Commonwealth. The Lobby Day is Wednesday, the 29th, 2:30 pm at the State House Nurses Hall.

The House Ways and Means budget represents an additional cut to Public Health on top of FY 2009 9C cuts made by Governor Patrick in October 2008, forcing DPH to again take the lion’s share of cuts within the Executive Office of Health and Human Services.

Our public health system is a great success, protecting the most basic necessities we all rely on: water, air and food, as well as identifying and stopping the spread of communicable diseases and infections. Public health programs prevent violence, teen pregnancy, obesity and diseases through education and regulations and provides a critical safety net to people in need of direct services such as nutrition support, Early Intervention for developmentally delayed children, family planning, and addiction treatment.

Reductions in funding for Public Health undermine the success of Health Reform because public health programs save money: for every dollar spent on public health services, the Commonwealth will save at least $4 in future costs. If enacted, the budget cuts would severely disable Massachusetts’ once-thriving public health system, undermine the very structure that supports a healthy Massachusetts, widen the racial and ethnic disparities gap, increase the cost of health reform, and put every resident of the Commonwealth at risk. These severe cuts to public health reinforce the urgent need for the legislature to pass new revenues, especially revenues dedicated to public health.

There is a critical role for public health in the debate over cost containment and achieving health equity in the Commonwealth. Health care reform has been an indisputable success in terms of expanding health coverage for Massachusetts residents. Public Health is a central component in moving forward to make health reform success sustainable.

3. One Massachusetts (responsible for the sublime graphic at the top of this post) is sponsoring a virtual rally, encouraging everyone to contact their legislators to support an adequate, balanced tax package that both addresses our structural deficit and stabilizes the public programs that we depend on.

April 26, 2009

Two recent developments give me strong confidence that national health reform will happen this year.

First is the decision by Congressional leaders -- under strong pressure from President Obama -- to set a deadline (October 15) after which the Senate can pass health reform by a simple majority, without a filibuster. This is the budget reconciliation process, which allows for limited debate and a majority vote. All the details are in this and this post by Jonathan Cohen ("reconciliation is a game-changer") and this one by Ezra Klein ("It's hard to overstate the importance of this decision. This could be the day that health care reform went from being unlikely to inevitable."). There's also some good background analysis in the Times, too.

Second is this video, which, if it achieves viral status, will clinch the deal:

Brian Rosman

April 24, 2009

Every week we highlight the voices of real people that contact our HelpLine every day. Once a week you will be introduced to a family whose life has changed for the better due to health reform. If you or anyone you know needs assistance applying for free or low-cost health care coverage, please contact our HelpLine online, or call 1-800-272-4232. Here’s this week’s entry:

Carlos has always been a very healthy young man. He has always loved sports, and football has been his passion in life. What he never realized was that someday he might really need health care. About six months ago when playing football he severely hurt his knee. That’s when Carlos realized the importance of having access to quality and affordable health insurance.

While looking for emergency care, Carlos learned from a close friend about all the advocacy work Health Care For All does in Massachusetts and the health insurance options offered by the state. After a few weeks of applying for the MassHealth and Commonwealth Care programs with help from the Helpline counselors, he was notified about his eligibility.

Soon after, Carlos had all the best care necessary to fix his knee. He had a surgery performed and two weeks later he was under the care of a rehabilitation specialist with regular physical therapy twice a week. He says that this whole process happened incredibly smoothly, and today he already feels confident enough to walk and play again.

This is what he had to say:

“Life brings us unexpected surprises and I just feel lucky to happen to be in the right state to be able to find solutions for all my needs. Health reform happened just about the right time for me, and I can’t thank enough Health Care For All, and the helpline counselors for all the kindness and help given to me on this important moment of my life.”

Monika Lira Malhoit

April 24, 2009

Thanks to Massachusetts health reform, a remarkable 432,000 people now have health insurance. Many of those newly insured are now seeing doctors for the first time in years. However, as health care advocates, we understand that access to insurance is the first step. We know there are still many challenges to work through, particularly facilitating an enormous shift in thinking and behavior, resulting in cost savings and better health outcomes. To make a cultural and behavioral shift takes strong will, education, and time.

In today’s Boston Globe article, “ER visits, costs in Mass. Climb,” Liz Kowalczyk reported about the increase in ER visits between 2005- 2007 and wrote, “The large portion of visits in which the patient didn't require immediate treatment, or could have been treated in a doctors' office, remained essentially unchanged over those years at 47 percent.” As health reform implementation was in its infancy in 2007 we agree with Kate Nordahl, assistant commissioner for policy and research at the state Division of Health Care Finance and Policy that we need 2008 data before reaching any conclusions.

Many people used the emergency room as their primary care before health reform was passed because they had no other options. We, along with many other advocates, providers, and insurers are working to educate all consumers that ER visits are not the substitute for seeing a primary care doctor. People have questions about how to navigate our complex health care system. Skilled outreach workers at community health centers have answers and can best connect residents in their communities to the most appropriate care. To fulfill the promise of health reform we must ensure that community health workers and public health programs are adequately funded.

See this fact sheet on the pending House budget amendment sponsored by Representative O'Day to assure funding for community outreach and enrollment assistance.

Primary care providers and patients must be supported appropriately so that the best care can be delivered in the best setting for the best price. There are precedent setting reform efforts happening right now in Massachusetts aimed at rethinking the way patients receive care and how their doctors are paid. These efforts strive to make primary care the focus and would cut ER visits. In addition to behavioral change we need reform of our health care payment system to reward providers for keeping patients healthy and to improve the way we reimburse preventive care. As we reach closer to our goal of keeping all Massachusetts residents as healthy as possible we must think strategically about how to use our resources to manage and prevent disease in the most cost-effective way.
Catherine Hammons

April 24, 2009

The federal court (<a href="http://www.prescriptionproject.org/tools/solutions_resources/files/0040.pdf) upheld Vermont’s Pharmaceutical Data Mining Law as constitutional. According to the Vermont Attorney General:

The court found that the Vermont law reasonably regulates the information that data mining companies obtain from individual Vermonters' prescription information. This data is then compiled and sold to pharmaceutical companies so that their salespeople can target individual physicians for the marketing and sale of new prescription drugs. The new law would allow physicians to protect the disclosure of this information for marketing purposes.

The Legislature's goal in enacting the data mining law was to contain health costs by ensuring that physicians focused on generic alternatives where appropriate. The Court found that even a one percent change in prescribing practices could result in a two million dollar cost savings for Vermonters. The lawsuit alleged that the law violated the data mining companies and pharmaceutical companies right of free speech. The District Court soundly rejected that contention, finding instead that the law reasonably regulated commercial speech. Attorney General William H. Sorrell embraced the decision as a vindication of the Legislature's courageous efforts to curb the mounting costs of health care in this state. "It is a testament to our Legislature and to the courage of this small state that we continue to lead the way on important public health issues."

As we reported here, the Joint Committee on Health Care Financing held a hearing on March 26th that would ban pharmaceutical data mining on March 26th. The state has some important interests in banning this practice:

1. Protecting the privacy of patients and providers; and

2. Saving money

As the US District Court says in today’s decision: “Coincident with the phenomenon of ‘data mining,’ pharmaceutical industry spending on direct marketing has increased exponentially.” The pharmaceutical industry spends approximately $30 billion (that’s more than the state’s annual budget) a year to promote its drugs. It spends about half of that developing new drugs and treatments. Why does it spend this kind of money? Because it works. Data mining can boost overall drug profits 3 percentage points and sales of new-to-market drugs by 30%.

Pharmaceutical marketing works, in large part, because the detailers walk into doctors’ offices with the doctor’s profiles in hand to fine tune their message. Detailers rely on this information and find it critical to ‘making the sale’. The companies spend money now on marketing because it works and they get a good return on their investment. The ban on data mining will change that.

By banning data mining, we remove the ability of industry detailers to be so specific in their message. The sales detailers will be forced to be more generic and objective in the information they present to prescribers because they will no longer have access to data mined information. The result is that there will be less prescribing of new, costly drugs.

Vermont predicted at least a 1% savings as a result of this ban-- huge money in a tight state budget year. How much do you think Massachusetts could save?
Georgia J. Maheras