June 2012

June 28, 2012

Moving Forward - Press event following Supreme Court Decision

(At a packed State House press event today, all of the key groups that came together to pass Massachusetts health reform celebrated the Supreme Court decision and affirmed our collective desire to move forward. The highlight was presentations by two consumers, each impacted by serious medical issues, and each able to get good care only because of health reform)

UPDATE: Thanks to our friends at the Mass Medical Society for this video:

BOSTON - Today policymakers, consumers and consumer advocates, religious leaders, providers, labor leaders, businesses, and insurers applauded the Supreme Court decision on upholding the individual mandate and other key provisions of the Federal Affordable Care Act. Under the slogan "Massachusetts Health Reform: Moving Forward", stakeholders that worked together to pass Chapter 58 (the 2006 Massachusetts health reform law) convened at the State House to celebrate this victory and to reaffirm their commitment to the Massachusetts law that increased health coverage to 98% of the Massachusetts

Today's decision in favor of the ACA not only means expanding access to care to millions of Americans but it will also have a direct impact for the residents of Massachusetts. Under the federal law, more middle income families in the Commonwealth will have access to coverage subsidies, young people will be able to stay on their parents' health insurance policies up to age 26, residents will enjoy a free annual primary care visit a year and senior citizens will experience a reduction in the cost of their prescription drugs.

The ruling was welcomed by policymakers, government officials, consumers' advocates, physicians, insurers and providers in Massachusetts who have seen the success of the state law that became the blueprint for the federal legislation signed by Obama in 2010.

"This is great news for Massachusetts and the country. We have already expanded access to health care for hundreds of thousands Massachusetts residents, and now we can do more", stated Amy Whitcomb Slemmer, Executive Director of Health Care For All. "The ACA will make a remarkable difference in the lives of millions of Americans, who will finally be able to get the health care they need."

"Today's ruling by the Supreme Court means that millions of uninsured Americas can see a path to getting affordable health insurance and obtaining the same benefits of improved health and security that people in Massachusetts have experienced under Governor Patrick's leadership," stated Secretary JudyAnn Bigby of the Executive Office of Health and Human services. "Massachusetts residents will benefit from the ongoing implementation of the ACA because more people will have access to affordable health insurance, seniors will continue to see their drug costs go down, and people with disabilities will benefit from a system of care that meets their unique needs. This is a great day for Massachusetts and for America."

"I welcome today's United States Supreme Court decision upholding the Patient Protection and Affordable Care Act. This historic opinion memorializes on a federal level what we are already doing here in Massachusetts - providing access to healthcare to all of our citizens. Accordingly, we will continue our work on health care reform, leading the nation as we collectively curb health care costs and deliver coverage to our residents. As all of the implications of today's ruling become clear, I am hopeful that the federal government will maintain its fiscal partnership with our efforts," stated House Speaker Robert A. DeLeo.

"We're elated that the nation will now be able to taste what we in MA give thanks for daily -- health care for our people", stated Reverend Burn Stanfield, President of GBIO. "Today's ruling ends the constitution debate around health reform, and it should end the rancorous political debate as well."

"Today's ruling is a validation of decades of work here in Massachusetts to expand health care coverage to all of our citizens," said Andrew Dreyfus, President and CEO of Blue Cross Blue Shield of Massachusetts. "All Americans will now have the same health care benefits and protections that Massachusetts residents have known for years."

"Today is an important day for millions of Americans who will now have access to health care coverage," said Gary Gottlieb M.D., President and CEO of Partners HealthCare. "Our state leaders can be proud of the example the Commonwealth has set in providing our citizens with primary and preventive care that will improve their health today and for the lives of generations to come."

June 28, 2012

On page 8 of Justice Ginsburg's concurring opinion (page 73 in this pdf), she cites the amicus brief submitted by Health Care For All along with our partners HLA, MHA, GBIO, Community Catalyst and the Mass League of Community Health Centers:

States that undertake health-care reforms on their own thus risk “placing themselves in a position of economic disadvantage as compared with neighbors or competitors.” Davis, 301 U. S., at 644. See also Brief for Health Care for All, Inc., et al. as Amici Curiae in No. 11–398, p. 4 (“[O]ut
of-state residents continue to seek and receive millions of dollars in uncompensated care in Massachusetts hospitals, limiting the State’s efforts to improve its health care system through the elimination of uncompensated care.”). Facing that risk, individual States are unlikely to take the initiative in addressing the problem of the uninsured, even though solving that problem is in all States’ best interests. Congress’ intervention was needed to overcome this collective
action impasse.

She also cites the brief from the Commonwealth, filed by Attorney General Coakley.

Congrats to everyone that worked on the briefs, and to the Honorable Court!

June 28, 2012

Under the slogan "Massachusetts Health Reform: Moving Forward", stakeholders that worked together to pass Chapter 58 (the 2006 Massachusetts health reform law) will react to today's Supreme Court decision affirming the constitutionality of the federal Affordable Care Act and will reaffirm their commitment to the Massachusetts law that increased health coverage to 98% of the Massachusetts population.

Must Click: Our Ari Fertig presents this for your viewing pleasure:


June 27, 2012

AARP Blog asks members to fight for prescription gift ban
AARP is the largest membership organization in the Commonwealth, with over 800,000 members in Massachusetts. With state budget conferees about to make the final decision on the prescription drug marketing gift ban, they have revved up their engines for a huge lobbying push. Their activities include thousands of calls and emails to their members, asking them to contact legislative leaders. They've also started drive-time radio ads on WBZ. Listen:

[audio http://www.hcfama.org/_data/n_0001/resources/live/AARP%2030%20REVISED%20...

(click here if player doesn't work in your browser)

Also joining AARP in opposing repeal of the gift ban is a group of student members of the American Medical Student Association. They've created wonderful graphics and tools for advocacy, here: tinyurl.com/giftban. Here's an example:

You can take action too! The final budget is expected later this week, so call your legislator today.

June 25, 2012

The fiscal year ends on June 30th – there are just five days left to help Health Care For All this year!

Health Care For All (HCFA) needs your support to fully fund our HelpLine. Will you make a donation today? HCFA’s fiscal year ends June 30, 2012 and we need your help to continue to reach and assist residents of Massachusetts.

Here’s how your gift helps:

$50 Helps a consumer better understand their health insurance options.

$150 Screens a caller for eligibility for lower-cost and free health insurance programs, fills out an application for benefits, assists him/her in enrolling into a health plan, and schedules their important first doctor’s appointment.

$250 Helps to provide health care access to non-English speaking individuals across the state by providing culturally competent and linguistically appropriate outreach materials.

$500 Connects a family with the care they need during a serious health crisis, such as a child’s mental health diagnosis.

$1,000 Organizes a community meeting to bring residents together to talk about the problems they are facing and act to improve health outcomes in their community.

HCFA’s HelpLine is an underfunded and vital direct service program that assists Massachusetts health care consumers navigate the health care system and enrolls residents directly into coverage.

Thank you for considering a donation today to Health Care For All!

To make a tax deductible donation, click here , call 617-275-2926 to make a pledge over the phone, or mail a donation to: Health Care For All, 30 Winter Street, 10th Floor, Boston, MA 02108

Thank you for your support!

The Staff and Board of HCFA

June 23, 2012

Last week, WBZ-TV reporter Jon Keller turned his investigative eye to the pharmaceutical marketing gift ban.

Who is suffering because Massachusetts law prohibits drug companies from showering doctors with fancy gifts and trinkets, as part of their marketing efforts to push high-cost, brand-name drugs?

Keller found the victim: the candy man. Yes, we're talking chocolate wing-tip shoes, so your pharma drug rep can "get a foot in the door." Retail price: $48.98. Really.

According to Keller's report, a local candy maker isn’t selling as many chocolate shoes since the ban took effect.

We are not making this up. The shoes really were promoted to drug salespeople as a way to quote, get a foot in the door, unquote.

Why are we worrying about the candy makers? Maybe because the old arguments don't hold up anymore. The restaurant industry is doing fine (2012 is their biggest year on record), and the drug industry conferences are roaring into Boston (BIO just had their biggest conference ever here this week). So it's Willy Wonka who is suffering.

But here's the thing. You and I pay for these shoes. We pay for it in higher drug prices, as much of the millions spent on marketing gets added to the cost of drugs. We also pay for it in higher taxes, as drug manufacturers get to deduct the cost of their marketing promotions from their taxable income, thus reducing the taxes they pay (and increasing ours).

What Keller's report did not include is the myriad of independent studies (many of them collected here) that demonstrates that gifts to doctors, perhaps even candy shoes, influences their prescribing. Obviously, the drug industry wouldn't be buying the shoes if they didn't work.

Now, we never knew these shoes existed, and actually, they are pretty cool. We like candy shops to have lots and lots of business. But any day now the House-Senate budget conference committee will be deciding whether or not Massachusetts law will continue to restrict marketing practices that distort objective prescribing and inflate the cost of health care for all us. We hope they will decide to focus our medical spending on disease stoppers, rather than everlasting gobstoppers.
-Brian Rosman

June 20, 2012

Individual mandate data released by the Health Connector and Department of Revenue from the 2010 tax year indicate that Massachusetts’ individual mandate is working.  The report shows that 99% of tax filers required to report health insurance status complied, and 92% reported being insured with Minimum Creditable Coverage (MCC)-compliant coverage for all of 2010.  Relatively fewer filers – 44,000 or 1% of filers – were assessed a penalty in 2010, as compared to 2009.

As we have seen over the past six years, shared responsibility is indeed the cornerstone of Massachusetts health reform.  Individuals, government, and business all contribute to make health reform work.  Yesterday on the Washington Post Wonkblog, Sarah Kliff looks at how this principle works from a national lens:

Over the course of five years, insurance coverage in the state has increased, premiums have decreased and virtually everyone has abided by the new requirement. While public opinion is favorable - two-thirds of Massachusetts residents support the law - the state does face challenges ensuring that the law is affordable.

“What we’ve seen in Massachusetts, and what the modeling has supported, is that we wouldn’t really be where we are today without an insurance mandate,” said Sarah Iselin, president of the Blue Cross Blue Shield Foundation of Massachusetts. “You can get closer to where we are, but you wouldn’t be all the way there.”

There is no doubt that health reform has been successful in increasing access to health coverage for over 430,000 Massachusetts residents.  But, as Nancy Turnbull asked when the last individual mandate data were released, why are so many of the remaining uninsured low-income?

As with previous years, nearly two-thirds of the full-year uninsured in 2010, or 110,000 people, had incomes below 150% fpl (about $16,000/year for an individual and about $33,000 for a family of four by 2010 standards), many of whom are potentially eligible for MassHealth or Commonwealth Care.   With implementation of the Affordable Care Act, we have an opportunity to re-engage the health care community to find and enroll people into the subsidized health insurance coverage they are eligible for.
-Suzanne Curry

June 19, 2012

HCFA and its Campaign for Better Care have been working with the Mass. Public Health Association to advocate for the creation of a Prevention and Wellness Trust Fund. This trust would offer funding for evidence based community programs that focus on prevention and wellness. We believe this is an investment that will increase overall health in the Commonwealth but additionally if invested fully will be an actual cost saver to the overall health system.

 Both the Senate and House have passed legislation that would make Massachusetts the first state in the nation with a Prevention and Wellness Trust Fund dedicated to community-based public health programs.  But real success hinges on funding.

Both branches have already passed legislation to create the Trust and dedicate significant funding to it.  But the funding levels vary widely: $20 million in the House bill and $100 million in the Senate bill.  The difference in funding - $80 million - is now at stake as a six-member Conference Committee hammers out a final bill.

Take Action Today: Please call your state Representative and Senator and ask them to sign onto a letter by Representative Jason Lewis and Senator Harriette Chandler that urges the Conference Committee to dedicate a minimum of $100 million over 5 years to the Prevention and Wellness Trust.

• Read the sign on letter here and tips for calling your elected officials here.

• Find your Representative and Senator here.

• Learn more about the Prevention and Wellness Trust here.

To learn more, visit www.MPHAweb.org or contact Maddie Ribble at mribble@mphaweb.org.

June 18, 2012

As the House and Senate budgets head into conference committee negotiations, a new study reaffirms what we already know: prescription drug marketing coupons are a bad deal for health care consumers.

The study, The Cost of Drug Coupons, published in the Journal of the American Medical Association (JAMA), found that drug coupons can significantly increase both out-of-pocket costs and health care premiums for consumers. The study compared monthly and annual costs for three similar statin drugs: two brand-names which have co-pay coupons available and one generic. The brand-name version cost insurers five times as much as the generic, which in turn leads to higher health care premiums for everyone in the insurance pool.  Even with the coupon discount, the co-pay for one brand-name drug was still more expensive than the co-pay for the generic, resulting in higher out-of-pocket spending by the consumer.

Drug coupon programs can also have detrimental effects on patient health and intrude into patient privacy. When a coupon program ends, patients unprepared for sharp increases in their prescription copayments may stop taking the medication and experience nonadherence-related side effects. Some drug coupon programs also require patients to give out their personal and medical information on websites, allowing pharmaceutical companies to target those patients in the future.

Urging physicians to avoid giving out drug coupons or encouraging drug coupon use unless the patient has demonstrated financial hardship and a clear clinical indication for that particular drug, the author warns – if pharmaceutical companies have the goal of reducing cost-related nonadherence, they should find a better way to reduce drugs costs for patients experiencing financial hardship.

Pharmacies have also begun to aggressively push back on drug coupon programs due to cost concerns, according to recent article in the Wall Street Journal. Drug coupons undermine the benefit designs meant to promote the use of lowest-cost clinically appropriate products, according to CVS Caremark, which has the second-largest pharmacy-benefit business.  In an effort to counter the unnecessary use of expensive brand-name drugs promoted by coupons, CVS recently began blocking coverage entirely for 34 treatments – half of which were supported by co-pay coupons.

Repealing the drug coupon ban would raise out-of-pocket costs and insurance premiums for Massachusetts consumers and potentially cause pharmacy businesses to block coverage for certain medications at the expense of patient needs.  At a time where our state is on the cusp of payment reform to contain health care costs, weakening our current drug coupon ban would be taking a step backward, rather than forward, in creating a more affordable health care system.
-Helen Yan


June 15, 2012

Subsidized coverage plans will include BHP for people above the Medicaid income limit

Yesterday the House and Senate passed a supplemental budget bill (pdf) that includes many provisions needed to move forward with implementation of the Affordable Care Act in Massachusetts. Governor Patrick is expected to sign the bill quickly.

The bill includes important provisions to authorize a Basic Health Plan and state help to maintain existing subsidy levels for residents between 200-300% of the federal poverty level. These provisions will strengthen ACA implementation in Massachusetts.

Other sections authorize various state agencies to implement reinsurance, risk adjustment, non-payment for provider preventable conditions, and establishment of child-only, catastrophic and stand alone dental and vision plans, as required by the ACA.

The bill also contains provisions implementing the Delivery System Transformation Initiative, the component of the new Medicaid Waiver that provides federal funds for seven safety net hospitals.

HCFA strongly supported these provisions, and is pleased Massachusetts is moving forward with ACA implementation.
-Helen Yan

June 13, 2012

The Senate passed a budget amendment filed by Senator Chandler that would provide $7.2 million in additional funding to restore coverage for composite (tooth colored) fillings for front teeth for both MassHealth and Commonwealth Care Plan Type 1 recipients. In addition, Amendment #605 would require the Division of Health Care Finance and Policy (DHCFP) to study the increased cost of emergency room treatment for dental problems, that occurs when people have no other source of care, and to develop a specific code to track ER visits for dental conditions.

This is a first step toward incremental restoration of MassHealth adult dental benefits, but it needs to make it through the conference committee to be enacted! Representative Scibak and Senator Chandler are circulating a sign-on letter asking the conference committee to accept Amendment #605 as adopted by the Senate. So far, 36 Representatives and Senators have joined them. Please call your legislators today and urge them to sign on.

Here are a few talking points to get you started:

  • Let them know that Representative Scibak/Senator Chandler is circulating a sign on letter, urging the conference committee to support MassHealth adult dental benefits.
  • Cuts to the MassHealth dental program severely restrict residents' access to essential oral health care services, causing needless pain, suffering, and illness.
  • Lack of comprehensive and consistent oral health care also prohibits many adults from entering or remaining in the state's service-based workforce because they have missing teeth.
  • Senate Amendment #605 will begin to address employability issues and put Massachusetts on a path toward full restoration of comprehensive dental services.
  • Let them know that the deadline is Friday and ask if they will support oral health by contacting Representative Scibak/Senator Chandler to sign on to the letter.

If you have any questions, please contact Courtney Chelo, OHAT Coordinator, at 617-275-2935 or cchelo@hcfama.org.

June 8, 2012

Today federal HHS released a report detailing the successes of Consumer Assistance Programs, including Health Care For All’s HelpLine. In 2010, as a result of the Affordable Care Act, 35 states were awarded grants to provide consumers with assistance navigating their health care coverage. The Massachusetts Executive Office of Health and Human Services was a grant awardee and subcontracted with Health Care For All and Health Law Advocates to launch the Mass. Consumer Assistance Program.

As described in the report, CAPs achieved impressive success including:

  • Provided individual assistance to 207,460 consumers;
  • Assisted 22,814 consumers (76 percent of all closed cases) in successfully challenging their issuer’s decisions, finding coverage, and resolving their private health insurance problems;
  • Obtained more than $18 million in savings on behalf of consumers in addition to the unquantifiable benefits from finding more affordable health care and getting the benefits that consumers need; and
  • Reached hundreds of thousands of consumers through outreach and education efforts.

Hundreds of thousands of people throughout the country would be without needed health insurance assistance was it not for the work of the CAPs. The critical work of these programs will be essential for successful Affordable Care Act implementation. Check out this video for more about the Mass. Consumer Assistance Program:

-Kate Bicego