January 2010

January 27, 2010

Governor Patrick released his H. 2 budget proposal today, for fiscal year 2011, starting July 1. The budget continues the Governor’s strong commitment to health reform and the state’s vital health infrastructure. There are some cuts, including some painful cuts that we will do our best to overturn (there are also some important increases). But given the extraordinarily challenging economic situation, we profoundly appreciate the Governor making health a top priority for his administration. To the extent cuts are proposed, the Governor and EOHHS Secretary Bigby have made clear that these are temporary cuts that will be restored as revenues return.

As usual, the administration has provided a wealth of information online, making the Massachusetts budget proposal among the most transparent in the country. Key health-related resources include a detailed examination of the health issues in the budget, and a budget briefing on health reform.
As always, the
best instant analysis comes from the Mass Budget and Policy Center, including a concise summary of the health care proposals.

The budget includes several of we have long termed “win-win” policies. These are revenue proposals that both provide needed funds for health needs and improve the public health by discouraging consumption of unhealthy products. The public health impacts also reduce the cost of health care in the state, further benefiting the state budget. This strategy has been a successful tool, and we strongly applaud the Governor’s bold steps.

First, the Governor proposes to remove the sales tax exemption from candy and soda. This policy would put us in line with 40 other states, including Connecticut, Maine and Rhode Island, which do not exempt candy and soda from their sales tax, and it attacks obesity, a critical health crisis. Second, the budget closes a loophole that exempted cigars, smoking tobacco, and smokeless tobacco from the 2008 cigarette tax increase. By closing the loophole, the Governor’s budget discourages harmful tobacco use, particularly by teens. Revenue from both of these changes is earmarked for health care programs.

The budget also anticipates the extension of enhanced Medicaid funding, now scheduled to end on Dec. 31, 2010. Given the strong, bi-partisan support for extending the increase in state reimbursement rates (ours increased from 50% to 61%), this is an appropriate, prudent step that forestalls deep cuts that would have been damaging to the state’s economy.

With these revenue measures (along with others), the Governor is able to recommend a budget that continues our success in health reforms. Funds are provided to allow MassHealth enrollment to grow by 3%, including a substantial strengthening of children’s mental health services. The Commonwealth Care program is also slated to expand, by some 20,000 people. While there is much to cheer in the budget proposal, we highlight a few of the specific issues that jumped out on a first read:

MassHealth Adult Dental Care: The Governor proposes restructuring adult dental benefits for adults in MassHealth and Commonwealth Care, similar to the unadopted proposal from last fall. MassHealth would continue to cover preventive and emergency care, excluding restorative services. These would be available at Community Health Centers through the Health Safety Net, though the CHC dental system does not have the capacity to absorb all of the demand for services. This cut will have serious long-term impacts, including increased costly emergency room visits, job loss, and poor overall health for Massachusetts. We will work with the Administration to ensure all enrollees can access and afford the care they need.

Legal Immigrant Coverage: The Governor proposed a substantial increase in funding for the temporary “Bridge” program for special status legal immigrants. We commend the Governor for his ongoing efforts to provide benefits for this group, yet we also believe it is fundamentally wrong to separate a population based on immigration status. We strongly support full reinstatement of legal immigrants into Commonwealth Care, and we know the administration agrees with this goal. Until these funds are available, we will work with the legislature and the Administration to ensure that all immigrants have access to the temporary Bridge program, and that services are fully available to all enrollees.

Prescription Advantage, the state sponsored prescription assistance program for low-income elderly and some disabled individuals had yet another reduction in its budget. We were pleased that funding was allocated for outreach grants, thought a surplus in the Connector’s budget, and funding was increased for the DPH tobacco control program.

As the budget moves through the legislative process, we will keep our eyes on the big picture and small details that matter for vulnerable people dependent on our collective efforts through state government.

January 27, 2010

Today marks the two year anniversary of Yolanda Torres’ death. Yolanda was a remarkable young woman who shared her story of living with mental health needs in testimony before the Mental Health and Substance Abuse Committee in May 2007.

With the support of her family, Chapter 321 of the Act of 2008 (An Act Relative To Children’s Mental Health), has become known to many as Yolanda’s Law.

Lisa Lambert of the Parent/Professional Advocacy League has posted a remembrance of Yolanda and some thoughts on her legacy.

Matt Noyes

Policy Manager

January 27, 2010

The Members Lounge at the State House was a standing room only today when the Disparities Action Network (DAN) presented an event titled, Investing in Health Equity: Taking Action to Reduce Health Disparities in Massachusetts. Health Disparities Council Co-Chairs Representative Rushing and Senator Fargo welcomed the crowd, emphasizing the importance of addressing disparities to improve public health and reduce health care costs.

The briefing featured a segment of the award winning documentary Unnatural Causes, which highlighted the social and geographic issues that impact health outcomes. Public health experts in the film described the link between areas with high rates of diabetes, hypertension, and asthma complications and the composition of those neighborhoods in terms of food access, green space, public safety, and other socioeconomic conditions. The film emphasized the importance of social and economic policies that address health disparities by attacking their root causes.

State experts addressed questions about health and place with the energetic crowd. Mr. Elmer Freeman (CCHERS), Professor Renee Landers (Suffolk University Law School) and Dr. Nancy Norman (Boston Public Health Commission) all discussed the need for a coordinated state strategy to improve health disparities in Massachusetts. The state’s Executive Office of Health Equity was highlighted as an important leader to coordinate strategies and develop solutions that involve all of the relevant agencies in state government, such as education, housing, transportation. Legislation to codify the Office in statute is currently before the Health Care Financing Committee (S.810).

The Disparities Action Network thanks Representative Rushing and Senator Fargo for their support of this event, and leadership in the legislature on health disparities. The coalition also recognizes the continued commitment of Secretary Bigby and the Executive Office of Health and Human Services in working towards health equity in Massachusetts.
-Brittany McDaniel

January 26, 2010

House Bill 3897: An Act Relative to Postpartum Depression will have a hearing on Wednesday before the Joint Committee on Financial Services.

The bill ensures that pregnant women will be able to receive universal screening and referral to treatment for depression during the perinatal period. Approximately 15% of new mothers in Massachusetts suffer from postpartum depression. Lead sponsor, Representative Ellen Story (D-Amherst) will be holding a press event prior to the hearing at 9:30am at the Grand Staircase in the State House. Following the press event, the hearing will begin at 11am in Gardner Auditorium.

We encourage everyone to attend this event and contact your legislator about providing postpartum depression screenings for Massachusetts women. You can also download a fact sheet on the bill.
-Brittany McDaniel

January 25, 2010

All the hand-wringing about the "meaning" of the Scott Brown victory for health reform seems misplaced.

First, polling of Massachusetts voters taken right after the election shows a very confused message. This blog post by Maggie Mahar is long, but is the best summary of the polling data. Bottom line: "the Massachusetts special election does not serve as a referendum on health care legislation. The voters who chose Brown chose him for myriad reasons. They say that they knew he opposed the legislation; about half of his voters counted this in his favor, while half counted it against him. Go figure."

Part of the confusion stems from public knowledge gaps. National polls show support for the policy elements of reform is much higher than support for "the health reform bill." Nate Silver of the 538 blog has great analysis and charts here.

More important is this: the impact of the election depends on what we do now. It's what's next that counts, not what happened. It's up to us.

If we take our collective energy for health reform, and continue to let our representatives know that this matters for us, than we can make it happen. Families USA President Ron Pollack said it well, in an open letter to Congress you can sign:

Health reform has never been easy. That lesson has come up throughout this year’s legislative process – as if decades of failed reforms had not yet made that clear.

Health reform, however, is an imperative for our nation’s families. Without reform, health costs will continue to grow much faster than wages. Without reform, many millions of hard-working people and their children will join the ranks of the uninsured and underinsured.

And without reform, businesses, staggered by increasing employee health costs, will either drop coverage or will be unable to make needed investments. As a result, our nation’s economy – and the ability to create good jobs – will suffer.

We must not let that happen.

Some members of Congress have said that we should abandon health reform for a later time. But make no mistake, if we abandon reform now – after moving further than ever before towards meaningful reform – we will not get back to this crucial agenda for a long, long time.

Some other members have suggested that we play "small ball": adopt only the most popular measures, such as prohibiting exclusions of coverage for people with pre-existing conditions, and drop the more systemic reforms.

Unfortunately, that will not work.

As a number of states have learned, insurance market reforms – as important as they are – cannot work without expanded health coverage. Insurance market reforms implemented alone will lead to skyrocketing premiums as sicker, older people secure coverage and younger, healthier people don’t. This incremental approach is a recipe for disaster – both substantively and politically.
One last point: The policy slurs and defamations by health reform opponents, which will undoubtedly continue, cannot be effectively answered unless and until reform is enacted into law. It is only then that Americans around the country will see its benefits.

This is your moment for political courage, vision, and leadership. We urge you to move meaningful health reform forward to its needed enactment.

What can we do?

We urge you to take two critical steps.

First, call your member of Congress today. Urge him or her to push forward with health reform - right away. We have heard that the Massachusetts delegation is not getting many calls. We need to change that. If you don't know who your Representative is, you can look it up at WhereDoIVoteMA.com. Here are the numbers:

  • Michael Capuano, 8th: (202) 225-5111
  • William Delahunt, 10th: (202) 225-5601
  • Barney Frank, 4th: (202) 225-5931
  • Stephen Lynch, 9th: 202-225-8273
  • James McGovern, 3rd: (202) 225-6101
  • Edward Markey, 7th: (202) 225-2836
  • Richard Neal, 2nd: (202) 225-5601
  • John Olver, 1st: (202) 225-5335
  • John Tierney, 6th: (202) 225-8020
  • Niki Tsongas, 5th: (202) 225-3411

Second, attend a rally Tuesday. HCFA is joining with moveon.org, HCAN and many other groups to rally for health reform. We will gather at 1 Bowdoin Square, Boston (map) at 6:00 pm on Tuesday, January 26th. Click here for more information and to sign up.

Remember, it's not over until we say it's over.
-Brian Rosman

January 25, 2010

Two conservative research institutions recently looked at Massachusetts health reform. One concluded that, while not all the evidence is in, the plan has achieved success in reducing the number of uninsured in Massachusetts.

The other study looked at the census data that shows a steep decline in the number of uninsured, and decided that people must be lying on the survey. As a result, they say the gains in coverage must be cut by almost half. Also, people getting insurance through their employer or on their own should be counted as a "cost" of health reform, self-reported health hasn't improved, and oh, young people aren't moving here because of health reform. Guess which study made it to the Wall Street Journal?

The fair and balanced report came from the Pioneer Institute. The report (by Amy Lischko and Anand Gopalsami) is the first in a series of report cards on MA health reform. This installment looked at 4 metrics concerning access - (1) coverage growth; (2) Commonwealth Care and crowd-out; (3) employer coverage; and (4) use of preventive care. They gave a grade of "A" on the first criterion, a B on the second and third, and an incomplete on the fourth. The report is worth reading, and contains solid analysis from a conservative point of view.

The hit job comes from the Cato Institute, a libertarian-oriented Washington think tank that opposed Massachusetts health reform from the beginning. The authors (Aaron Yelowitz and Michael Cannon) ignore relevant evidence, make egregious errors and unwarranted assumptions, and reach a pre-ordained conclusion.

The paper's errors were so severe that the Division of Health Care Finance and Policy sent the authors a corrections letter, calling the report "misleading and unfounded," and requesting that the letter be posted on the Cato website.

The centerpiece of the Cato study is an assertion that the CPS (Census Current Population Survey) data showing a decline in the number of uninsured Bay Staters can't be trusted. Since the individual mandate requires people to be covered, they reason, people must be lying to the survey takers. They liken the question asked by survey researchers, "Did you have health insurance last year?" as the functional equivalent of, "Are you breaking the law?"

Of course, there's no evidence that anyone is lying on the survey. The DHCFP rebuttal letter goes into details about their flawed analysis. In any case, the survey data is backed up by the state's data collected from insurers, which shows a net gain in coverage of 408,000 people from June 2006 to June 2009. This point is ignored by the Cato crew.

The Cato report goes on to look at crowd-out, focusing on a drop in private coverage among kids and adults below 150% of the poverty line. However, since all of these children, and most of these adults, were eligible for state-subsidized benefits long before Chapter 58, attributing this change to health reform is clearly erroneous. Similarly, the report maintains that a drop in in-migration to Massachusetts by young adults must be due to health reform. Yet health reform dramatically lowered the cost of individual coverage, and authorized a new low-cost plan for young adults. None of this figures in the Cato analysis.

The most telling point is the report's insistence that the "cost" of health reform should include all health insurance spending by anyone in Massachusetts affected by the law. By redefining the concept of the cost of government program to meet their libertarian mindset, the authors move into tendentious territory far removed from regular discourse.

For sure, this report is not aimed at Massachusetts, but at the ongoing national debate. In addition to the Wall Street Journal editorial, the Washington Times ran an op-ed by the authors. Next time, we hope they look at the Pioneer Institute for some guidance on how a right-wing critique can be formed.
-Brian Rosman

January 24, 2010

The Health Care Quality and Cost Council (QCC) met this week, focusing on a quality initiative aimed at improving care transitions in the Massachusetts health care system. The initiative, entitled “Reduce Readmissions and Improve Care Transitions,” is part of the State Quality Improvement Initiative (SQII). SQII was launched nationally in 2008 by The Commonwealth Fund and AcademyHealth in order to assist states’ efforts to address quality deficiencies and engage in state-level planning.

Meeting materials are here, and our full, detailed report is below the fold.

January 22, 2010

At last week’s Public Health Council meeting, Commissioner John Auerbach presented the 2009 Betsy Lehman Center Patient Safety Recognition Awards. This annual award was established in 2005 to recognize leadership and innovation in patient safety, including public awareness, education and promotion of systems-based solutions through the implementation of best practices. Eligible applicants and nominees include health care facilities, organizations and individuals. The award was presented to both Marlborough Hospital, and the UMass Medical Division of Cardiac Surgery. Commissioner Auberbach commented that 2009 “was a unique year, in that there were two applicants who were wholly worthy of the award.”

Following the presentation of awards, a panel addressed oral health in the Commonwealth. Dr. Jewell Mullen, Director of DPH’s Bureau of Community Health Access and Promotion, spoke to the importance of oral health as a part of overall health, and stressed that access to medical care is a right, and not a privilege, and that we have to treat dental care as a part of that. Ralph Fuccillo, President of the DentaQuest Foundation, presented on the comprehensive plan being developed by a large and diverse group of stakeholders that have convened as the Better Oral Health for Massachusetts Coalition. Lynn Bethel, Director of DPH’s Office of Oral Health, presented the Office’s burden document, “The Status of Oral Disease in Massachusetts,” released in November 2009. The report includes some important statistics:

  • 57% of women did not have their teeth cleaned during their pregnancy
  • 17% of the state’s 3rd graders had untreated decay
  • 71% of non-Hispanic Black 3rd graders did not have dental sealants
  • 90% of residents between ages 25 and 44 living in dental health professional shortage areas have lost at least one tooth
  • 59% of nursing home residents have untreated decay
  • 93% of public schools did not have a school-based oral health prevention (dental sealant) program
  • Massachusetts ranks 36th in the nation for water fluoridation status
  • 66% of licensed dentists with a Massachusetts address are not MassHealth (Medicaid) providers

Commissioner Auerbach closed the q&a with the panel stating that we have come a long way, and calling the room to action to keep working to improve oral health and overall health for all Massachusetts residents.
-Courtney Chelo

January 22, 2010

Yesterday, about 75 people from across the state met to discuss a new plan for improving the oral health of the Commonwealth. This movement, lead by the Better Oral Health for Massachusetts Coalition (BOHMA), is a broad-based statewide collaborative of programs, providers (dentists, dental hygienists, physicians and other health providers), lawmakers, state oral health officials, insurers, health advocates, policy leaders and consumers in communities from Cape Cod to the Berkshires.

With a focus on improving access to care for all, reducing disparities and promoting equity in Massachusetts’ oral health, BOHMA will work to:

  • Increase access to oral health services and prevention.
  • Promote positive policy, advocacy and public awareness concerning oral health.
  • Strengthen, diversify and expand Massachusetts’ oral health workforce.
  • Promote and support ongoing statewide assessment and surveillance systems.
  • Form a clear oral health action plan that incorporates at least all of these elements.

BOHMA coalition members, including many members of HCFA’s Oral Health Advocacy Taskforce, have been hard at work for the past year putting together an inclusive plan. Yesterday, after a greeting from Senator Harriette Chandler, stakeholders reviewed the plan one more time. The final plan is slated to be released in March (click here for the plan draft (pdf)).

To learn more about current oral health advocacy work, please visit www.hcfama.org/oralhealth.
-Christine Keeves

January 21, 2010

I've been waiting for months for the right time to post this video. Waiting until the absolute moment of greatest need. Today, our favorite blogger, Washington Post's Ezra Klein, broke it out and forced our hand, probably not even knowing its significance. So here it goes.

(He did add the important fact that John "Bluto" Blutarsky was later elected to the United States Senate.)

With the election of Scott Brown, the immediate reaction was to proclaim the end of health reform. But those of us who have gone through this before know it's not over. Even tonight, Barney Frank took back his rash initial statement that all was lost (see this, too).

Senator-elect Brown has voted in favor of health reform, and comes from the state whose system is the foundation for much of the substance of the national bills. He knows and has seen first hand what a difference it makes when people have access to life-saving health care services.

House and Senate leaders, along with the White House, today began discussing how to get something done in the new environment. The video above can do the trick. How do we know? Because it happened before. Massachusetts health reform passed the House and Senate in November, 2005. An impasse between the House and Senate over the employer assessment stalemated the branches for months on end. Until:

Businessman Jack Connors Jr., co-founder of the advertising giant Hill Holliday, Connors, Cosmopulos, Inc., and a broker of early discussions between key interest groups recalls heading off for a golfing weekend in Florida in February 2006 confident of the reform bill’s passage only to return to a Boston Sunday Globe headline: “Hopes Fade on Reforms in Healthcare.”
Connors immediately grasped the depth of the business coalition’s tactical blunder, and hoped humor would defuse the Speaker’s ire. He called [Speaker] DiMasi’s office to ask for 15 minutes, and before heading over to the State House, ordered up a film clip from the Hill Holliday archives. It was the scene from the classic 1978 comedy about campus fraternity life, “Animal House,” in which Bluto Blutarsky exhorts his dejected Delta House frat brothers to rally in defiance of the menacing Dean Wormer. Arriving at DiMasi’s office, Connors popped the videotape into the Speaker’s VCR player, stopping it at Bluto’s famous declaration: “What, over? You say over? Nothing is over till we decide it is over!”

And then Connors gave his version: “With all due respect Mr. Speaker, it’s not over till I say it’s over.” DiMasi and Connors shared a laugh, and by the end of the meeting they’d agreed to work together towards a per-worker assessment of $300. Connors kept his part of the bargain, meeting over the next few weeks with business leaders, insurers, health industry executives and Senate Pres. Travaglini to sell the compromise. The deal was cemented at a Sunday night meeting with business leaders in DiMasi’s office and, a month later, the reform bill became law....

(excerpted from Forging Consensus: The Path to Health Reform in Massachusetts, from the MA BCBS Foundation; see also this March 2006 Globe column.

Every day, we see the impact the Massachusetts reforms have had on the health and security of formerly uninsured residents (see examples here). The moral imperative to extend good, affordable health coverage to all Americans wasn't going to be met in a single bill, at a single time. We know that strong majorities in the House, Senate and the public support expanding coverage, reducing costs and improving quality of care.

We fully agree with the statement of our partners at Community Catalyst: ""Now is the time for Americans across the country to keep telling our Members of Congress that we need quality, affordable health care." As Bluto and the Delta Tau Chi brothers cry out at the end of the scene, let's do it.
-Brian Rosman

January 21, 2010

Yesterday, EOHHS Secretary Bigby announced that Terry Dougherty will permanently take the post of Medicaid Director. Terry served as interim director since September, and will continue to serve as Assistant Secretary. Terry's work is cut out for him. Beyond the immediate budget issues, it's time for the state to begin thinking about the next iteration of the MassHealth waiver, the agreement with the federal government that structures and funds most of our state health programs. The current waiver expires at the end of June, 2011.

We look forward to working with Terry to ensure that the 1.2 million MassHealth members continue to get quality care.

Here's the announcement from Secretary Bigby:

I am pleased to announce that Assistant Secretary Terry Dougherty will assume permanent leadership of the Office of Medicaid, while continuing to serve as Assistant Secretary. As you know, Terry has served as Interim Medicaid Director since September and has led the agency in a challenging fiscal environment. Throughout, he has shown a commitment to improving and streamlining services for the more than 1.2 million MassHealth members. It’s clear that he will continue to lead MassHealth thoughtfully and strategically. I am delighted that Terry will assume additional this responsibility over the long-term and look forward to our continued work together on behalf of the people we serve.

-Suzanne Curry

January 21, 2010

On January 1, the Medical Security Program (MSP) enacted a number of regulatory and programmatic changes (details). MSP provides health coverage, either through COBRA subsidies or a Blue Cross plan, to low-income workers on unemployment assistance.

On our HelpLine, we’ve heard from many MSP enrollees who can not afford needed care due to the changes. Today, Division of Unemployment Assistance (DUA) Assistant Chief Counsel Ed Santella presided over a hearing on the emergency revised MSP regulations which would:

  1. Reduce presumptive hardship for enrollment in the direct coverage program from 200% fpl to 150% fpl; and
  2. Deny MSP benefits to an individual eligible for but not enrolled in a spouse’s employer sponsored insurance.

Neil Cronin from the Mass Law Reform Institute and Kate Bicego from Health Care For All testified on behalf of the ACT!! Coalition, raising concerns that the regulatory changes would restrict MSP eligibility. Beyond the regulatory changes, Kate talked about HelpLine callers who are facing difficulties accessing care due to increased cost-sharing. Click on the links below to see testimony submitted by ACT!! and partner groups:

The DUA website has more information on the programmatic changes and on information sessions DUA is hosting regarding the changes.

We urge DUA to take the experiences of MSP members into consideration as they finalize the regulations.
-Suzanne Curry