October 2011

October 30, 2011

Earlier this week, Health Care For All testified before the Joint Committee on Financial Services in opposition to a bill that would allow the pharmaceutical industry to market “coupons” for brand name drugs.  This bill is one among many before the Massachusetts legislature that would open up a whole new marketing ploy for the pharma and medical device industry.

As consumer advocates, we at HCFA see drug coupons as nothing more than a tactic to entice consumers into purchasing more expensive brand-name drugs, when cheaper and equally-effective generics are available.

Drug companies provide coupons in limited quantities and only for expensive name-brand drugs.  As soon as the coupons run out, consumers are forced to pay the high co-pay out of pocket for the duration of the prescription.  In some cases, they may need to take that drug for many years.  In the end, individuals are left with higher out-of-pocket costs, and the drug companies benefit by selling more of their most expensive drugs. If drug companies are serious about helping consumers afford drugs they need, they should simply reduce the drug price.

The health care system as a whole also incurs higher costs when drug coupons are utilized.  Because insurance companies pay the entire of cost of a prescription drug minus the co-payment, drug costs are significantly more when consumers choose to purchase a name-brand rather than a generic prescription drug solely because of a coupon.  In the long-run, this doesn’t benefit consumers but rather leads to increased insurance co-pays and premium costs for everyone.

For an account of how this plays out in the real world, listen to the story presented in this fabulous This American Life report of how a young man was lured by drug coupons into purchasing an acne drug that costs over $600 more than the generic version. NPR’s Planet Money reporter calls drug coupons part of an escalating arms race, as the drug industry tries every way possible to market its high-margin drugs directly to patients.

Coupons are already banned by Medicare and Medicaid, and the Commonwealth’s longstanding policy in this area should be maintained.  Legalizing drug coupons in Massachusetts would represent a significant step backwards in our efforts to control prescription drug costs.

Cost is the most significant health care issue facing the Legislature and the Commonwealth today. There's no question that allowing drug coupons would raise costs. Look at the experience of Union College, which experienced soaring drug costs when coupons expanded:

Beforehand, CDPHP [their health plan] spent roughly $500,000 each year for this class of antibiotic drugs. But by the first quarter in 2008, less than six months after the coupon was introduced, costs soared to $1.2 million, says Eileen Wood, vice president of pharmacy and quality programs at the plan.

CDPHP's cost for a one-month's supply of Solodyn, she says, was $500 with a $50 co-pay, compared to $40 a month with a $10 co-pay for the generic version -- which fewer people used because of the coupon.

"They're problematic because they do increase costs, which carries over, not only to the employer, but to the employee as well," [benefit director Eric Noll] adds. "Employees will end up paying a higher premium than they need to and the plan ends up paying a much higher cost. In the long run, everybody loses."

As we all wrestle with how to get escalating insurance premiums under control, it is important that we not lose sight of the progress we have made in addressing the ways in which pharmaceutical and medical device marketing can drive costs up health care costs.  Massachusetts should not take a step backwards in this fight.
-Alyssa Vangeli

October 30, 2011

Campaign for Better CareThe administration announced that Massachusetts will be receiving $3 million in federal Community Transformation Grants, to expand community-based programs aimed at improving wellness and reducing health care costs. The funds were authorized under the ACA. Another example of how the ACA is benefiting the Commonwealth (the state keeps a full list of all the grants we've received - around $77 million).

The funds will go to 43 cities and towns, and much of the money will support the Mass in Motion Municipal Wellness and Leadership Program, which works at the local level to support policy and environmental change to reduce obesity, improve nutrition, and promote active living. These programs have been demonstrated to improve health and reduce costs.

But dividing $3 million in one-time grants among 43 municipalities does not provide the sustained funding needed to make deep progress in controlling cost growth. Prevention is the key to stemming the growth of chronic disease, the most costly part of our health care system. With dedicated funding, applied throughout the state, we can make long-term improvements in health status, and save really big bucks.

That's why HCFA and the Campaign For Better Care is supporting the Mass Public Health Association's push to include the Prevention and Cost Control Trust proposal as part of payment reform. We know that sustained, dedicated, adequate funding for community-based prevention will pay off right away, and even more for the long run.
-Brian Rosman

October 27, 2011

Fact Check Web page on Romney The truth-telling FactCheck.org actually talked to Massachusetts health policy people, and comes up with the definitive last word on the charge that in signing chapter 58, Governor Romney initiated a program that provides "free health care to illegals." The verdict:

  • The Perry campaign was wrong to accuse Romney of signing into a law a new program to provide health care for the undocumented. The Health Safety Net program was a continuation of the Uncompensated Care Pool, with the same rules.
  • The Romney campaign was wrong to defend itself by claiming that HSN rules on benefits were instituted by the Patrick administration. The Romney administration administered the same rules when it supervised the Pool, and knew those rules would continue under HSN.

Glad that's over. -Brian Rosman

October 25, 2011

While the Obamacare/Romneycare circus continues to spin out of control, how about a reasoned, knowledgeable discussion of the contrasts and similarities by two people who know what they are talking about?

The video above comes from MassINC and their CommonWealth Magazine. They produce a series of informative "Face-to-Face" video conversations on trending topics.

This installment looks at the relationship between Obamacare and chapter 58, the 2006 Massachusetts health reform law. Tim Murphy, the Romney administration's secretary of Health and Human Services and point person for the reform policy development, and John McDonough, then HCFA Executive Director and later the health policy advisor to Senator Kennedy, calmly agree for the most part. It's illuminating, though there's not much red meat.

When you're done watching, and you need a thumping soundtrack for your health policy videos, you can go back to stuff like this:

-Brian Rosman

October 24, 2011

LA Times HealdineWith former Massachusetts Governor Mitt Romney seeking the Republican Presidential nomination, his record is under the microscope by his opponents and the press. Unfortunately, most of the muck being heaped on our universal health care law is misguided or incomplete, including a story in today’s L.A. Times which focused on Massachusetts’ Health Safety Net program. While the story's angle is that Romney implemented a program which provides low-income, illegal immigrants with access to free health care services, it did not explore several other key elements of the Health Safety Net – for example:

1. The Health Safety Net program authorized in Chapter 58, the health reform bill that Governor Romney signed, was not a new program. It was just a new name for a program previously called the "Uncompensated Care Pool." The HSN program, like the Uncompensated Care Pool, was funded by an assessment on hospitals and insurers. The money went out to reimburse hospitals and health centers for the costs they incurred from providing health care to low-income uninsured patients, regardless of immigration status. The Uncompensated Care Pool goes back to the 1980s. The HSN is the same thing, with a new name. Prior to the passage of chapter 58, the Romney administration administered the Uncompensated Care Pool, which also covered undocumented residents.

2. The HSN program is not an insurance program. No one gets an insurance card, no one gets any guaranteed benefits, no one gets any right to care. It's a health provider reimbursement program. Under federal law (passed in the Reagan era), all hospitals are required to provide emergency care to anyone, without asking about immigration status. Community health centers have similar obligations. So the HSN program is how Massachusetts deals with the cost of providing those services. While undocumented people are able to get health care because the program, the program exists to benefit hospitals and health centers, not the individuals.

3. Every state has its own method of financing care for the undocumented. In Massachusetts, it's the HSN program. In Texas, to pick a random example, it's the county hospital system. Look at this report in the Houston Chronicle, for example: Texas hospital districts spent $677 million in public funds in 2008 to provide care to undocumented immigrants. So the fact that under Governor Romney's watch the state reimbursed hospitals for care provided to low-income uninsured, some of whom may have been undocumented, is not that surprising. Probably every state does it, one way or another.

From our point of view, all people, regardless of status, are entitled to adequate health care. Even if you reject this value, the economic and community health benefits to legal residents justifies providing access to care to everyone.

Meanwhile, this story is sure to be picked up and exaggerated and turned into attacks and discussed in political terms. We'll keep working to promote good policy, and set the record straight.
-Victoria Bonney Goodwin

UPDATE
As predicted, things are getting more and more anti-factual. Romney advisor Eric Fehrnstrom was on MSNBC today, claiming that HSN coverage for undocumented immigrants was started only under Deval Patrick's administration. That's just not true, as the rules on citizenship and eligibility didn't change between the old Uncompensated Care Pool under Romney, and the HSN under Governor Patick (the name change officially took effect on 10/1/07). The RIck Perry campaign is pushing against Fehrnstrom's explanation this with screenshots from a web page from our friends at massresources.org, taken from 2006. Watch this video, posted by "perrytruthteam:"

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October 21, 2011

Today The Blue Cross Foundation hosted a breakfast where the results of a poll entitled “Public Perceptions of Health Care Costs in Massachusetts” were presented to a packed room of interested health policy people by Robert Blendon of the Harvard School of Public Health. After the presentation Nancy Turnbull moderated a lively panel Martha Bebinger of WBUR, Susan Connolly from Mercer, John Marttila of Marttila Strategies, and our own Amy Whitcomb Slemmer.

Not shockingly one of the most agreed upon poll questions was, “How important is it for the state government of Massachusetts to take some major action to address rising health care costs in the state?” 74 percent of respondants answered “very important.”

We at Health Care for All and in our Campaign for Better Care couldn’t agree more.

The Campaign for Better Care believes that Massachusetts can improve the health and economic security of all residents by reforming the health care system to provide care that is affordable, cost-effective, coordinated, equitable and high-quality.

A critical tool for improving care is payment reform. Re-orienting the way doctors, hospitals, and other providers are paid can align incentives to promote patient-centered care that focuses on health and disease prevention, lowering health care costs.

We urge a comprehensive approach to improving our health care quality and controlling costs. Since the most robust and reliable factor in cost containment is having healthy residents, payment reforms should be coordinated with broad steps to promote prevention and wellness, especially for the most medically and socially vulnerable residents.

Think health care costs are too high? Get involved with our consumer driven Campaign for Better Care by contacting Paul Williams at pwilliams@hcfama.org.

October 20, 2011

Ya know when you’re doing the Hokey Pokey and ya get to the end when you put your whole body in? You don’t just leave your lips, teeth, tongue and gums outside the Hokey Pokey circle, do you? No. Because they’re as much a part of your whole body as your right elbow, foot or hand. (And, frankly, just as fun to shake all about).

If you’ve followed HCFA for a while now, you know that we don’t mess with oral health disparities (though we’re not above comparing them to catchy children’s songs) and that we strongly believe that oral health is overall health.

Oral health disparities are one of the biggest cost drivers in the American health care system. Our current health care system treats the mouth as separate from the rest of the body but, in fact, oral health is linked to all sorts of costly whole body health issues. If more were done to treat illness when it starts in the mouth and provide quality dental care to people before more costly care is needed, our state and national health care systems would see serious savings.

This week, our work to address oral health disparities in Massachusetts was recognized by the DentaQuest Foundation as part of their “20 States for Oral Health 2014 Initiative.” Calling them a “silent epidemic” across our state and nation, DentaQuest has made meaningful investments in order to address oral health disparities across the country. According to a recent report from the Institute of Medicine, nearly 5 million children went without regular dental checkups in 2008 because of financial limitations, and 33.3 million Americans live in an area with a shortage of dental professionals. The multi-year Oral Health 2014 Initiative aims to eliminate such disparities by supporting organizations who are building community partnerships. HCFA was granted $100,000 by The Foundation to continue our current advocacy work aimed at bolstering essential dental benefits for the most vulnerable residents of our state and strengthening the overall dental delivery system in MA.

We are grateful for this honor and to partner with an organization that will support us as we push for legislation that will better integrate our health care system so that oral health is viewed as part of overall health.

And that’s what it’s all about!

October 20, 2011

The highest court in Massachusetts – the Supreme Judicial Court – heard oral arguments two weeks ago for Health Law Advocates’ class action lawsuit, Finch et al v. Connector Authority, on behalf of more than 40,000 legal immigrants barred from joining the Commonwealth Care program. If you missed the Oct. 6 oral arguments, you can now watch them online here.

You can also read the briefs of both sides on the SJC site. In addition to the main brief filed by HLA, friend of the court amicus briefs were submitted in support of the right of legal immigrants by the Mass Law Reform Institute (joined in by Health Care For All, the Irish International Immigrant Center and MIRA, the Massachusetts Immigrant and Refugee Advocacy Coalition), the Asian Pacific American Legal Center, the Chinese Progressive Association, and the ACLU of Massachusetts (all pdfs).
-Alyssa Vangeli

October 20, 2011

In a recent blog post we suggested that the Federal Pre-Existing Condition Insurance Plan (PCIP) was a health insurance option for Mass. residents currently locked out of the private health insurance market. We have received additional information from our partners at CMS that we’d like to share with our readers. Please forward this information far and wide and contact our HelpLine, 1-800-272-4232, with questions or concerns.

Clarification has been given to us as to how a Mass. resident goes about applying for and enrolling in a PCIP plan. Persons that have been uninsured for six months or more and cannot get health insurance through our private health insurance market due to it being closed for enrollment may be eligible for a plan through the PCIP. The applicant must provide obtaining a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that the individual has or had a medical condition, disability, or illness. The letter must also include the applicant’s name and medical condition, disability, or illness and the name, license number, state of licensure, and signature of the doctor, physician assistant, or nurse practitioner. People can apply for a PCIP plan at www.pcip.gov or by calling 866-717-5826.

Also, CMS has issued this consumer alert regarding an unauthorized website:

The Centers for Medicare and Medicaid Services: Consumer Alert - October 9, 2011

Website Warned on Suggesting Linkage to Government Agency – Could Mislead Consumers

The Centers for Medicare and Medicaid Services (CMS) has recently become aware of a website that has the appearance of being an official government website for the Pre-Existing Condition Insurance Plan.

This new website - preexistingconditioninsuranceplan.com - is not maintained by any government programs and consumers are strongly urged not to submit any personal information requested by this website under the assumption that it is a government website.

CMS is taking the appropriate steps to protect consumers from being misled.

The Pre-Existing Condition Insurance Plan made available through the Affordable Care Act makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition.

The Pre-Existing Condition Insurance Plan:

  • Covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.
  • Does not charge you a higher premium just because of your medical condition.
  • Does not base eligibility on income.

Individuals interested in this new federally backed program should visit: www.pcip.gov or call 866-717-5826.

-Kate Bicego

October 20, 2011

It's amusing to read a Herald columnist fulminate about a state agency showing flexibility and respectfully treating people as individuals.

It's even more amusing to recall the Herald's editorial position on the individual mandate. Before the mandate became part of "ObamaCare," the Herald understood how requiring individuals to take responsibility where appropriate - enforced through the tax system - was good policy:

“The governor's proposal to make coverage mandatory for individuals - while helping them piece it all together - should be part of the solution. ... An individual mandate that carries tax penalties for failure to obtain insurance will help meet the coverage goals. (Boston Herald editorial, 2/6/2006)

When the individual mandate penalties were instituted, Governor Patrick urged the Connector to be compassionate and generous in providing mandate waivers to people who can't afford to buy coverage. The Connector is implementing this policy. The Destito's are being given an opportunity to let an independent evaluator hear their side.

Our state's 98+% coverage rate demonstrates the success of our coverage policy. The next challenge is to reduce the cost of care, by re-orienting our health care delivery system to focus on prevention, wellness and overall health.

-Brian Rosman

October 17, 2011

Quality and Cost Council Meeting Wednesday
The Health Care Quality and Cost Council is holding its monthly meeting this Wednesday, October 19, 1:00-3:00pm. Note the change from the usual location-the meeting is at the Division of Health Care Finance and Policy, 2 Boylston Street, 5th floor, Daley Conference Room. The agenda (pdf) includes updates from the Expert Panel on Performance Measurements, the Quality and Safety Committee, and the Advisory Committee. There will also be updates on progress on some elements of the Roadmap to Cost Containment: comparative effectiveness and health information technology. Meetings are open to the public.

MITSS Forum and Annual Dinner
Medically Induced Trauma Support Services (MITSS) is holding its annual fundraiser/dinner on Thursday, November 1, starting at 5:45pm at the Westin Copley Place in Boston. This year MITSS is also hosting a forum before the dinner, which is free but requires registration. The forum, “Implementation of Clinician Support Programs Following Adverse Events,” is jointly sponsored with the MA Medical Society and also takes place at the Westin Copley Place, 1:00-4:00pm. Learn more about the dinner and the forum on the MITSS website.
-Deb Wachenheim

October 17, 2011

Boston Mayor Tom Menino jumped into the payment reform this week, devoting his weekly column to the topic.

The Mayor echos many of the policy concerns raised by the Campaign For Better Care, GBIO and HCFA, hitting 3 critical points:

  • Access to high quality, culturally competent primary care is at the heart of any successful payment reform regime. Because of this, changes to our health care payment system must also address the primary care gap.
  • Nearly 75 cents of each health care dollar each year is spent on treating chronic diseases, such as diabetes, cancer and high blood pressure, while only 5 cents or less of every dollar goes to preventing these diseases. Research demonstrates that community-based prevention efforts – such as creating more equitable access to healthy foods, preventing asthma hospitalizations among high-risk children and preventing tobacco use among youth – has a big impact on reducing high health care costs, by keeping people healthy before they ever need treatment.... Legislators should incorporate the concept of a prevention trust fund into the final payment reform legislation to ensure an ongoing investment in prevention and public health.
  • We must protect our most vulnerable residents by maintaining the health safety net and emphasizing strong consumer protections in the healthcare marketplace. In this new system that rewards providers for keeping patients healthy, we must be sure not to create incentives for providers to discriminate against patients who are sicker or who need more care than others. Safety net institutions, because they care for patients who are disproportionately burdened by social and economic inequities as well as chronic disease, should receive reimbursements that recognize these additional costs.

We applaud the Mayor and welcome his efforts to assure a strong payment reform bill. In his column, the Mayor recognizes that risks and rewards: "Payment reform legislation, which will restructure the way healthcare providers are paid for their services, has the potential to reduce waste, save healthcare costs and boost quality of care all at once. But while there is great promise in this new cost-saving strategy, it is not without risks."

We urge the legislature, which is now drafting payment reform legislation, to closely follow the Boston Mayor's lead.
-Brian Rosman

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