May 2009

May 31, 2009

The Boston Sunday Globe's lead editorial affirms the conclusions of the Mass Taxpayer's Foundation that health reform has been affordable for Massachusetts. Excerpt:

FOR ALL THE fiscal problems the Commonwealth now faces, its three-year-old universal health insurance reform cannot be blamed for driving up state government costs uncontrollably. That is the conclusion of a study released last week by the Massachusetts Taxpayers Foundation, the watchdog group that is usually quick to expose state budget-busters. At a time when Congress is weighing its own health reform bill, the study debunks the notion that health reform is just a Big Dig in scrubs.

The study estimates that reform is costing the state an extra $350 million a year. The foundation finds that amount "relatively modest and well within early projections of how much the state would have to spend to implement reform." The recession has hurt the state's ability to sustain the gains of health reform, just as it has curbed funding for other state programs. But the foundation applauds the achievements of health reform "for so few new public dollars."

May 31, 2009

"Health reform has been a wise investment, one we must do our best to keep alive even in the face of this very difficult fiscal environment."
-House Speaker Robert DeLeo

Friday the Blue Cross Blue Shield Foundation of Massachusetts hosted their annual leadership summit, Care Beyond Coverage: The Next Generation of Health Reform at the John F. Kennedy library. The room was jam-packed with past, present and future leaders from the health care, business, labor and advocacy communities.

The audience heard special remarks from former Senate President Robert Travaglini and former Speaker of the House Sal DiMasi as well as comments from Senate President Therese Murray. The event marked the launch of the Foundation's new initiative, Care Beyond Coverage, which is focused on ensuring Massachusetts residents have access to the right care, at the right place and delivered at the right time. The summit focused on delivering findings from the first-year Care Beyond Coverage evaluation and featured three panel discussions on moving health reform forward.

Dr. Sharon Long, Principal Research Associate at the Urban Institute presented an update on the Urban Institute's report monitoring coverage and access in the first two years of health reform. Dr. Long provided data that demonstrates the successes and challenges of MA health reform. From 2006 to 2008 the number of adults with a usual source of care and access to preventive care visits, dental care visits and prescription drugs has continued to rise, with the low-income adults experiencing the greatest gains. However the report reveals the constraints in provider capacity; more adults had unmet health care needs because of difficulty getting to see a provider since the fall of 2006 especially low-income adults and those with public coverage.

A separate study on racial and geographic differences exposed geographical disparities as adults in the Southeast and Western regions of the state were shown to have more difficulty accessing and affording health care. She also found that Black and Hispanic adults in Massachusetts had less access to doctors, specialists and dental care and somewhat greater difficulty obtaining care than white residents in the Commonwealth.

Support for health reform continues to remain strong among working-age adults in Massachusetts.

Patricia Fairchild, Vice President of John Snow, Inc. provided valuable information on barriers to access with a focus on low and moderate-income residents and the newly insured. Her research included feedback from consumer focus groups and a pilot survey of HCFA Helpline callers, as well as the Mass. Medical Society's Physician Workforce Study and a survey by the Mass. League of Community Health. The research found:

  • 25% of newly insured adults experienced gaps in coverage during their first year of coverage.
  • Newly insured, residents with limited English/literacy skills, immigrants and residents with job or income changes faced particular challenges enrolling in plans and maintaining coverage.
  • High out of pocket costs especially for prescription drugs and the chronically ill, the affordability of premiums for people over 300% fpl, 55-65 years old and low-wage workers, and continuing medical debt pose significant cost barriers to MA residents.
  • Community health centers face issues with provider supply and capacity especially physician vacancies.
  • 71% of physicians reported difficulty making timely referrals and 11% of 30 day hospital re-admissions were potentially preventable.
  • Other barriers to coordination of care were challenges in referrals to specialty care, poor communication during patient transitions, insufficient care coordination, management infrastructure and consumer behavior and preferences not well understood.

The keynote address was delivered by House Speaker Robert A. DeLeo (text here, Word), giving his first address on health reform.

Speaker DeLeo expressed his commitment to maintaining the gains of health reform despite the challenging economic climate:

Many of you know me as the former head of the Ways and Means Committee. You know that I take a rigorous approach to fiscal matters and examine the numbers carefully.

And, on that note, I would be remiss if I did not provide a word or two about the fiscal crisis we are currently facing. The climate is very, very grim – none of the economists or experts I spoke to last summer could have predicted these types of declines in revenue. What is worse is that these numbers continue to deteriorate.

That is the bad news. However, there is something else that is very much worth noting. Health reform has not caused this problem: In FY 2009, we allocated $869 million to pay for Commonwealth Care. Current projections show that we will actually spend less than that. For that reason, in our House budget, we left the Commonwealth Care program untouched, and we expect to see long term gains from this program and the expansion of coverage that it has provided.

The Speaker raised concerns with the growth of health care costs and said that he looks forward to recommendations from the Payment Reform Commission. Speaker DeLeo also addressed his concerns with the primary care provider shortage and the lack of coordination of care and highlighted the medical home demonstration model and health information technology.

May 31, 2009

Cindy Mann, a good friend of Health Care For All and Massachusetts health care advocacy, has just been named by the Obama Administration to lead the Center for Medicaid and State Operations (CMSO), which oversees Medicaid and CHIP at the federal level. Cindy will begin her new position on June 8th (HHS release here).

Cindy worked for many years in Massachusetts, for the legislature and Mass Law Reform Institute, and is on the board of Community Catalyst, our national partner.

Cindy is extraordinarily conversant with the details of the MassHealth waiver and chapter 58, and her appointment can only help Massachusetts as we begin to think about the next waiver renewal.

In her blog announcing the appointment, Cindy writes "Collectively, we have the chance of a lifetime to ensure that every person in America has access to affordable, quality coverage and to make Medicaid and CHIP the best programs they can be. How can we do anything less?"

Amen, and congratulations.
-Brian Rosman

May 29, 2009

Commissioner Jon Auerbach of the Massachusetts Department of Public Health (DPH) spoke Friday afternoon to a packed room as part of Health Law Advocates’ Brown Bag Luncheon Series. Commissioner Auerbach’s talk covered three hot-issue topics: the current H1N1 virus pandemic (more commonly known as Swine Flu), the effects of the current budget debates on DPH, and a new Public Health initiative to combat obesity, chronic disease, and promote wellness.

The Commissioner began his talk by addressing the government’s response to the H1N1 outbreak. Commissioner Auerbach stressed that while the spread of the disease was unfortunate, the occurrence has provided a great opportunity for the state to exercise its emergency response network. Moreover, he explained that the initial fear over the virus re-affirmed the need for the state to have a robust health system and method of accurate reporting in order to react to outbreaks of unexpected illnesses.

Commissioner Auerbach detailed many elements of the state’s response to Swine Flu. While early reports out of Mexico suggested that the virus was extremely deadly, Massachusetts did its due diligence in both monitoring and responding to the virus. The state has uncovered a wealth of information on H1N1 including the fact that the virus in general is not deadly (rather it is symptomatically consistent with the general flu) as well as some key differences between the general influenza virus and this strain. For example, while the general virus most severely affects the very young and the very old, the H1N1 virus is most prevalent in the 0-20 age group. While, DPH does expect the flu to become wide-spread, they plan to have a vaccine ready for dissemination by next flu season.

Moreover, the H1N1 outbreak has highlighted some considerable strength in Massachusetts’ health response system. Primary among these achievements was the state’s public communication and outreach. Within just 10 days after the first case in Massachusetts, educational materials were available in 14 languages, and state provider help-lines were able to provide medical information to over 4,000 callers, helping to stanch tides of concerned citizens looking to emergency rooms for care. As Commissioner Auerbach eloquently stated, “without a robust health system people will die, become more seriously ill or more injured than they otherwise would be.”

The Commissioner detailed how the current economy will affect DPH, as public health needs have only become greater as the economy has dipped. HCFA has advocated for level funding for many crucial public health programs, including funding for its quality bureau, oral health programs and tobacco cessation programs. Many programs in DPH have been reduced by over 20% in the past year. The Senate did include a proposal that was supported by the Governor and the Department, the removal of the sales tax exemption on alcohol. This revenue stream would dedicate an addition $70Million to critical programs for the states’ most venerable populations.

Commissioner Auerbach concluded his talk on a positive note by discussing the state’s new public health campaign to combat obesity and prevent chronic disease, Mass in Motion. Obesity, with a very high rate in Massachusetts, is a primary cause of many chronic diseases including diabetes and heart failure. In Commissioner Auerbach’s words, the aim of the campaign has been to “change default behaviors” so that diets and exercise feel more like every day life rather than a chore. The campaign has three main legs: the first has been a statewide regulation for restaurants to post the calorie contents of their foods. As studies of a similar law in New York City have shown, when armed with information, people alter their behaviors. Not only have patrons in New York changed their ordering habits once given caloric information, but restaurants themselves have altered their menus to provide consumers with healthier alternatives.

All in all, Commissioner Auerbach demonstrated how crucial strong public health programs can be and how important it is for Massachusetts to have, and to continue to have, a robust public health department.

Brian Schon
HCFA Policy Intern

May 29, 2009

This morning, Jamie Katz, the Connector’s General Counsel and Melissa Boudreault, Director of Commonwealth Care, heard testimony on changes to the Commonwealth Care eligibility regulations (click here for regs). Some of the revisions, although deemed by the Connector as technical and stylistic, will make a real difference for folks who are enrolling in or trying to maintain CommCare coverage.

Jamie Katz and Melissa Boudreault heard testimony from two panels. Lindsey Tucker, Nancy Lorenz (GBLS) and Neil Cronin (MLRI) testified on behalf of the ACT!! Coalition.

The ACT!! panel urged the Connector to:

  • Keep eligibility requirements for CommCare as broad as possible, especially for those who are eligible for the new COBRA subsidy under ARRA, to minimize gaps in coverage;
  • Clarify and improve the payment plan and hardship waiver process;
  • Provide aid pending appeal of a denial or termination decision and allow for corrective action to rectify the situation;
  • Ensure that individuals who are auto-enrolled be assigned to the same health plan in which they were previously enrolled within a look-back period of no less than 90 days;
  • Strengthen consumer protections; and
  • Align coverage effective date with the date of enrollment.

In addition to the technical comments, Nancy shared a story about a client who had experienced gaps in coverage and difficulties with the payment plan and hardship waiver processes. Click here (pdf) to view ACT!!’s written comments, which were drafted by Mass Law Reform Institute.

Lorianne Sainsbury-Wong from Health Law Advocates introduced a panel including three past and present CommCare members affected by the eligibility regulations. Lorianne stated that many of her clients – included the individuals speaking on the panel – have difficulty paying their CommCare premiums. The common theme in each client’s story is that they had difficulty with the hardship waiver process, and they called for the need to broaden the criteria for being granted a hardship waiver. Melissa Boudreault and Jamie Katz were very receptive to each panelists’ comments. In fact, Melissa was very appreciative of the members’ testimony and said it was the most valuable to hear from real members.

The Connector Board is expected to vote on the final regulations at their June 11th meeting.
-Suzanne Curry

May 29, 2009

A recent Policy Brief on a Massachusetts Health Reform Survey funded by Blue Cross Blue Shield examined “Access to and Affordability of Care in Massachusetts as of Fall 2008: Geographic and Racial/Ethnic Differences”.

Oral health is an important part of overall health, and dental disease is associated with other chronic diseases such as heart disease, stroke, diabetes, and preterm birth. The survey looked closely at access to oral health services, and found large disparities in dental care visits by region as well as race/ethnicity.

Highlights of the report include:

  • Adults in the Western region were less likely to have had and dental care visits than adults in the MetroWest region, while those in the Southeast region were less likely to have a usual source of dental care visits.
  • Adults in the Western and Southeast regions were more likely to report unmet need for dental care than were adults in the MetroWest region.
  • Hispanic adults were significantly less likely to have had a dental care visit (69.8% versus 76.3%) than white adults.
  • Black adults were also significantly less likely than white adults to have had a dental care visit in the last 12 months (66.0% versus 76.3%).

A large part of these disparities stem from a lack of enough dentists to go around. Nearly 25 percent of communities in the Commonwealth do not have a practicing dentist. This uneven distribution of oral health care means that many families, particularly those in Western Massachusetts, must travel long distances to get the care they need. This burden of travel often translates into an inability to access care.

We can do better than this. The state’s current system of oral health care is an uneven patchwork of services, so we need to be creative when developing ways to deliver oral health care to all communities. For more information about how to close the gaps in the oral health care system, please contact Christine Keeves, Oral Health Communications Coordinator at 617-275-2919 or ckeeves@hcfama.org, or visit our website.

-Christine Keeves

May 29, 2009

On Tuesday June 9, 2009 at 10:00 am, the Joint Committee on Public Health Hearing will consider health disparities bills including the Disparities Action Network's two legislative priorities, SB. 810 and SB. 811. Please join us and advocate for health equity at this important public hearing.

Click here to view the Committee Invitation (.pdf) from Senate Chair Susan Fargo and House Chair Representative Sanchez.

Click here to learn more about the Disparities Action Network.

May 29, 2009

The Joint Committee on Health Care Financing held a public hearing on Wednesday May 27th. Several bills were heard relating to insurance, the Insurance Partnership program, medical malpractice and the health care workforce.

Georgia Maheras testified on behalf of the Affordable Care Today (ACT!!) Coalition in strong support of Senator Montigny’s bill, An Act relative to coverage for chronic illness (S. 551). This bill would eliminate co-payments for all prescriptions and devices used for the treatment of chronic illness, a bold step forward in Massachusetts’s attempt to make quality health care affordable for everyone. Research has shown that increased cost sharing, especially in the course of treatment of chronic illness, serves as a barrier to patients who are seeking care. Even relatively small co-payments have been associated with lower rates of seeking preventive services and co-payments for treatment of chronic illness would only hinder the treatment’s rate of success. It makes economic and medical sense to eliminate chronic illness cost-sharing. Prevention will increase and costs will decrease. Estimates have shown savings of nearly $2,000 per patient annually, along with a decrease in mortality rates. Twelve states across the country have already eliminated it from their Medicaid programs, with successful results.

Mary Lou Buyse from the Mass. Association of Health Plans spoke in opposition to S. 551. Buyse argued that eliminating copays for chronic care would violate health reform’s mantra of shared responsibility and lead to increased costs and utilization. Buyse fervently stated that health care should not be free.

Representatives from the small business, artist and insurance communities testified on the Insurance Partnership bills: S. 530/H.1083 An Act Improving the Insurance Partnership Program, H. 1071 An Act Relative to the Insurance Partnership and H. 1078 An Act Relative to Massachusetts Artists. Health Care For All is supportive of S.530/H. 1083, which would increase eligibility for the IP to 400% fpl from the current 300% fpl level. These bills also increase by 50% the payment to employers who participate in the plan by providing coverage to eligible employees. H. 1078 goes further than S.530/H. 1083 and raises the eligibility level to 400% fpl. It also makes more extensive changes to the program, including eliminating the 6-month look-back. This bill also would allow self-employed people to receive Commonwealth Care, expand the Section 125 requirement to firms with 5 or more employees, and direct the Department of Revenue to review how Adjusted Gross Income (AGI) is calculated for individuals with a combination of self-employment and wage income. HCFA opposes H. 1071, which appears to cut back on eligibility for the IP in 2009. We support an in-depth appraisal of the strengths and weaknesses of the IP and the other health assistance programs. A comprehensive, rational framework should be devised that equitably provides help to everyone who qualifies for assistance. To read our full testimony click here (.pdf). Kathy Bitetti, Executive Director of our ACT!! Coalition partner The Artists Foundation, also spoke in support of H. 1078 and H. 1083 and urged the Committee to not let self-employed people and people with combination incomes fall through the cracks.

Two sets of bills generated much discussion: childhood vaccines and medical malpractice reform. DPH Commissioner John Auerbach and several other experts from the fields of pediatrics and public health spoke in strong support of Rep. Wolf’s bill, H.3453 An Act establishing the Massachusetts childhood vaccine program and the Massachusetts immunization registry. The experts emphasized the need to ensure that all kids receive necessary and cost-effective vaccinations. Senator O’Leary as well as Mass. Medical Society President Mario E. Motta spoke in support of his medical malpractice reform bills – S. 573 An Act providing for a fair judgment interest rate for medical malpractice actions and S. 574 An Act relative to malpractice reform; representatives from the Mass. Academy of Trial Lawyers argued in opposition to these bills.

Catherine Hammons
Health Reform Associate

May 28, 2009

Early last week, the Commonwealth’s Health Disparities Council held its monthly meeting to continue their work on creating policies to reduce health disparities among Massachusetts residents.

Since the Senate was in the midst of addressing their version of the FY10 budget, the meeting was chaired by Rep. Rushing and Sec. Bigby in the absence of Senator Fargo. The Report Card Group provided an update to the Council on its work thus far and presented a timeline for moving forward. The indicators they presented that are schedule to be included in the first draft of the report card are based on a model from the National Women’s Law Center. A number of Council members raised concerns about the indicators chosen and offered several suggestions for additional indicators focused on the social determinants of health.

Judy Parlato, Clinical Advisor from the Division of Health Care Finance and Policy presented updated information on Hospital Race and Ethnicity Data Collection, a commission recommendation. She outlined use of the data, shared information on race and ethnicity standards as well as the process for developing the Division’s new race and ethnicity requirements, and presented details of the Division’s implementation process. Parlato reported one great improvement: no missing data from participating hospitals found data collection easier to accomplish once they better understood how it would be used. Georgia Simpson May, Director of the Department of Public Health’s Office of Health Equity also provided the Council with an update of her office’s work on Interpreter Services.

The Council recently launched their new website (mass.gov/hdc) and encourages the public to visit it for the latest information and meeting materials. Any questions should be emailed to HDC@state.ma.us. Materials from this meeting will also be posted on our website as soon as we have them.
- Jessica Hamilton

May 28, 2009

When the omnibus Act Relative To Children’s Mental Health (Chapter 321 of the Acts of 2008) was signed into law last year, there was one provision that was not included: reimbursement for collateral contacts by commercial insurance.

Collateral contacts can be more accurately referred to as coordination of care. When an adult is working with a mental health professional, the adult can typically express what is going on in his or her life directly to the clinician in such a way as to make treatment effective. When it is a seven year old, it’s not so simple.

Children are not little adults. To have treatment of mental health needs be effective, it is vital that the treating clinician speak to other people in the child’s life – parents, teachers, pediatrician, etc. Only through this coordination will the child have the best chance to have his or her mental health needs addressed properly.

Of course, to protect the privacy of the young people involved, this type of coordination would only be done with parental consent.

In Massachusetts, the state already reimburses mental health clinicians for collateral contacts when children are covered under MassHealth. Commercial insurance, on the other hand, does not provide this benefit. Mandating reimbursement for collateral contacts will ensure that care coordination is the standard practice rather than an exception to the rule.

The collateral contacts piece of Chapter 321 was not included in the final version of the law because a cost analysis had not been completed by the Division of Health Care Financing and Policy. The cost review was completed late last year and it found that collateral contacts are extremely inexpensive – 5.5 cents per member per month or 0.01% of total premium costs.

This piece of the original omnibus bill was refiled for the current legislative session as H. 3586 / S. 757, An Act Relative To Coordination of Children’s Mental Health Care, and was heard yesterday by the Joint Committee on Mental Health and Substance Abuse.

Testimony was given in support of the legislation by two panels.

On the first panel, Dr. David DeMaso, Psychiatrist in Chief at Children’s Hospital Boston and Professor of Psychiatry and Pediatrics at Harvard Medical School, illustrated the importance of coordination of care by asking Senate Chair Jen Flanagan to imagine herself as a third grade teacher with a student displaying mood swings and classroom outbursts. In an effort to more effectively attend to the behaviors while also teaching the other students, isn’t it a good idea to talk with the child’s psychiatrist, Dr. DeMaso asked.

Similarly, Dr. DeMaso asked House Chair Liz Malia to put herself in the shoes of a pediatrician treating a young woman with severe asthma. Before changing her patient’s medication to address her asthma, wouldn’t it be responsible for her to speak to her patient’s mental health clinician to avoid a potentially dangerous interaction with her antidepressant medication?

The second panel featured testimony from Central Massachusetts: Cathy Apostolaris from the Winchendon Project, Tony Poti from the Choices Program, and Dr. David Keller, a pediatrician from Webster. For all three of these individuals, care coordination has been vital to the success of their work.

Passage and enactment of An Act Relative To Coordination of Children’s Mental Health Care is the top legislative priority of the Children’s Mental Health Care. More effective coordination of care is an important step in addressing the mental health needs of Massachusetts’ children.

Matt Noyes
Children's Health Coordinator

May 26, 2009

Commonwealth Care open enrollment has begun! (press release here)

CommCare members who would like to change their health plans may do so from now until June 25th. According to CommCare Director Melissa Boudreault, “If you are happy with your current health plan, members don’t have to do anything, members should read the information packets being sent to them and see if their premiums are going up or down, and whether other plans they are considering have network relationships with the physicians, hospitals and community health centers they are likely to use.”

The Connector has sent customized open enrollment materials to all 174,000 current CommCare members that list the carriers available to each person. The list of carriers, their monthly premiums and where they are available are posted on the Health Connector’s website at www.MAhealthconnector.org. For a current provider directory, members can also go to the Health Connector website or contact the health plan directly.

CommCare members who want to change plans can do so on the Connector’s website or by calling the Connector’s toll-free customer service line, 1-877-MA-ENROLL (1-877-623-6765) Monday through Friday from 8 a.m. to 5 p.m. Members with total or partial hearing loss should call 1-877-623-7773 during those same hours.

Anyone with questions or concerns about the CommCare open enrollment process or their health insurance options may also contact the Health Care For All Helpline at 1-800-272-4232.

May 26, 2009

These blog posts are so easy. All it takes is a little time to pass.

Excerpt from full page pharma industry Globe ad, August 2008:

"On the Governor's desk sits legislation that could well determine the future of the life sciences industry in Massachusetts. ...

"The chilling effect that this will have on the life sciences industry in Massachusetts could not be more obvious. The impact on thousands of Massachusetts patients desperate for medical hope will be profound. Clinical trials being done today in Massachusetts will most certainly only be available elsewhere tomorrow. The hope for so many patients, suffering so much, will be diminished."

Boston Business Journal, front-page story, May 22, 2009:

Headline: "Big drug companies hiring steadily
Industry bucking job-cutting trend

"Massachusetts' strength as a research and biotech capital is spurring several large pharmaceutical companies to expand here even as they shrink elsewhere.
...
"Merck, for instance, plans to double its Massachusetts-based workforce. ... AstaZeneca is completing a $100 million expansion of its research facility in Waltham. ... Novartis, which already employs 1,500 in Cambridge, is another company adding a division to its Bay State portfolio. ... Sanofi-Aventis...has recently been on an acquisition spree and is busily raising its profile in Massachusetts.

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