November 2013

November 26, 2013

Thanksgiving is about being grateful. Here at Health Care For All, we see every day the impact Massachusetts health reform has on people all around us. We know it can work, because we've seen it work. That's why we're grateful for the ACA and national health reform.

Please share this graphic far and wide:

(and see this more detailed ACA Thanksgiving discussion guide by the Washington Post's Sarah Kliff)

Thanksgiving Infographic final

November 22, 2013

Hope you got your acronym cheat sheet handy.

The Health Policy Commission (HPC) met for its tenth full commission meeting on Wednesday November 20th.  Several important issues were discussed at the meeting, including the patient center medical home (PCMH) certification, the Registered Provider Organization (RPO) program, the Office of Patient Protection (OPP) regulations, and several updates on cost trends and market performance including Cost and Market Impact Reviews (CMIRs). Follow along with the presentation deck for the meeting, and click on for our full report.

November 20, 2013

Today marks one year since the inaugural meeting of the Health Policy Commission (see our report, Commence Cost Control), and at Wednesday's meeting, board members will reflect on their first year, and look forward to the second year.

Dr. Paul Hattis was appointed to represent expertise in health care consumer advocacy on the HPC board. Dr. Hattis is a long-time friend of HCFA, through his leadership in GBIO, including co-chairing their health care team. We invited Paul to write his own reflections on the role of HPC in our efforts to control costs and reform our health care system, and his role as the consumer voice in its governance.

Paul HattisAs the Health Policy Commission (HPC) completes its first year of existence, HCFA has invited me to share some thoughts about this past year as well as preview what lies ahead. So here goes:

Writing to the Health Care For All community, I feel a good deal of responsibility holding the Consumer Advocate seat—a position given to me by Attorney General Coakley.  I generally see my role as worrying about the “whole” in the sense of the overall direction of access, cost and quality challenges that confront us in Massachusetts. We are also all incredibly fortunate to have Nancy TurnbulI, who serves as the Consumer representative to the Health Connector board, to be vigilantly working on relevant access, cost and quality issues that intersect with that Board’s work.

With just one year in, I would say that the 2012 health care cost law (Chapter 224) has covered some significant ground in a short period of time. That said, though, this law doesn’t rely on quick fixes. It’s designed to be for the long-term and, as such, health care reform is a work in progress with many moving parts to be developed in the coming months and years.  The same is true for the HPC.  Containing the growth in health care spending is no easy task; the attendant issues are often complex and the details matter.  Fortunately, we have a very dedicated group of Commissioners chaired by Stuart Altman from Brandeis; and an incredible HPC staff led by David Seltz.  Over its first year of work, the HPC has tackled a complex variety of issues within its charge and we continue to add staff to help us fulfill our statutory responsibilities.

It is hard to briefly summarize the broad charge given to the HPC under the 2012 law.  Suffice it to say, the Legislature created our Board and asked us to use a combination of some regulatory authority, moral suasion,  and good critical thinking to help move the health care system and its actors towards higher-value.  Specifically, the HPC from my vantage point has been asked to frame, name, tame, acclaim, shame and blame our way to a more affordable and higher quality health care system.  When I teach students at Tufts Medical School about Chapter 224, and talk about the HPC’s role, I tell them:

We are trying to navigate our way to reducing the growth in health care spending using “GPS:”

G—Global Payment:  Promoting and evaluating the evolution of the health care payment system away from fee-for-service toward value-based payment that incentivizes less wasteful care and improved quality.   Payment system reforms should also help to create a framework for improved care integration among providers with a special focus on improving behavioral health care from an access, cost and quality perspective.

P—Prices and Provider Transformation:   It is important to recognize that there are higher-priced and lower-priced providers in our state, with the challenge that some amount of this price variation is unwarranted.   This reality suggests that there are important societal gains from helping to promote a payment system that pays fairly to all for high value care, and encourages  all providers to become more efficient.  Promoting high value care also necessitates our making smart investments in challenged community hospitals to help them transform and thrive for the long-term.  The HPC is also charged with completing Cost and Market Impact Reviews of transactions which may have significant cost, quality, access or market implications.  Prices also relate to the consumer side, where, in the non-urgent care context, a goal is to make price and quality information more transparent and readily available to consumers so that they can “choose wisely.”

S—Spending Target:  The HPC is responsible for overseeing the efforts of all stakeholders  to reduce the overall growth in health care spending by creating a per-person “cost growth target”  which is tied to the overall growth rate of the economy.

Five HPC subcommittees have been delegated an array of tasks for taking the first cut at these issues and others that fall under our broad charge.  After subcommittee processing and discussion, the full HPC Board is then referred relevant matters for its review, and as appropriate, can take official action on matters before it. (BTW:  For those interested, the subcommittees are often a great place to hear more detailed discussion about issues, and also afford opportunities for public comment; all of our meeting logistics are available at www.mass.gov/hpc or on Twitter via @Mass_HPC.)

November 19, 2013

Connector enrollment 11-12-13

The Health Connector Board met this past Wednesday (Nov. 14) to discuss open enrollment, broker commissions, and progress in getting ready for the ACA.  Materials from the meeting are here, and click on for our full update.

November 17, 2013

The Obama administration's decision to permit insurers to continue to offer plans they otherwise would have cancelled (here's some good place-it-in-context background from The New Republic's Jon Cohn) is still subject to state insurance market rules.

Already a number of states, including Washington, Arkansas, Vermont and Rhode Island, have ruled that they will continue to insist that all new plans offered in the state comply with the consumer protections in the ACA. Note that "grandfathered" plans, in existence before the ACA was signed in 2010, were always still allowed to be offered to people who wished to renew those plans.

Massachusetts has not yet announced its decision (see the Monday morning UPDATE below), although we understand the Division of Insurance is looking closely at the issue. On Friday, HCFA sent a letter to DOI urging them to reject this option. Here's our letter:

November 15, 2013

Joseph G. Murphy, Commissioner
Kevin P. Beagan, Deputy Commissioner, Health Care Access Bureau
Massachusetts Division of Insurance

Re: Transitional Policy for Carrier Compliance with Federal Market Reforms

Dear Commissioner Murphy and Deputy Commissioner Beagan:

We are writing regarding yesterday’s letter from Gary Cohen, Director of the Center for Consumer Information and Insurance Oversight (CCIIO), to state Insurance Commissioners, which provides information on the “transitional policy” allowing health insurance issuers to choose to continue coverage that would otherwise be terminated or cancelled due to requirements under the ACA market reforms, and allowing affected individuals and small businesses to choose to re-enroll in such coverage.

We urge you to formally reject allowing carriers in Massachusetts to continue coverage under this transitional policy.

Health Care For All has received no calls from consumers complaining about losing coverage due to the ACA. As you know, we’ve long had virtually all of the protections that the ACA extends nationally. All insurance in Massachusetts has met the 2014 federal requirements around covering pre-existing conditions and not discriminating based on health status or gender since the 1990s. People in Massachusetts are subject to minimum benefit requirements that are very similar to those in the upcoming federal law. For example, under minimum creditable coverage standards, Massachusetts residents have had prescription drug coverage since 2009. Similarly, we have had state mental health insurance mandates for years.

We are concerned that the transitional policy would unnecessarily disrupt the existing ACA transitions in Massachusetts, create consumer confusion, and unsettle premium rates, which have been finalized for plans starting on January 1, 2014.

While the majority of Massachusetts plans were already in compliance with the federal market reforms, there are some benefit improvements under the ACA that will improve coverage for families. The President’s decision may make sense in a national context; however, for Massachusetts there is no need to turn the clock back.

A number of other states have already determined that this transitional policy would not be in the public interest, including Arkansas, Washington and Vermont. We urge Massachusetts to join these states in protecting consumers and the insurance market.

Sincerely,

Amy Whitcomb Slemmer, Esq.
Executive Director
Health Care For All

We'll update this post when there's a decision from DOI.

UPDATE:

Were very pleased that on Monday morning, Division of Insurance Commissioner Joseph Murphy sent this letter to federal officials, rejecting the option:

Mass letter to CCIIO 11-18-13

November 7, 2013

Last week, on a day full of victories, the President of the United States visited Boston to defend the Affordable Care Act. He began his historic appearance at Faneuil Hall with the self-deprecating and not altogether untrue observation that his visit was not the biggest event of the day, given the Red Sox World Series game that night.

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The President’s appearance was capped off with a wonderful introduction by Governor Patrick, who, with the President waiting in the wings, suggested that he would take the opportunity to introduce all of us to the President (watch the video above to see both the Governor’s and the President’s speech).

We thank Governor Patrick for detailing some of the remarkable consumer stories represented in the audience, mentioning the hard working and often unsung advocates who worked tirelessly for reform’s success, and telling the unvarnished truth of some of the challenges of implementing reform. Governor Patrick discussed the challenges of bringing various stakeholders to the health care reform table to hammer out a shared vision and set of goals founded on the rock solid certainty that health care is a human right and a public good.

There was poetry in the choice of Faneuil Hall for the President’s speech, as many in attendance were also present in April 2006 for the Chapter 58 signing ceremony. I hope that the President enjoyed being surrounded by people who are living with and grateful for the benefits of the Affordable Care Act. I am also hopeful that this event will be part of what turns the tide in favor of the ACA. Plenty of comments can be made about the national website snafu. We know that health care reform is more than a website. The truth is that there is power in gathering people who have had their lives improved by this law, and there is no better balm to quell the fears of patients and health care consumers than hearing directly from people just like them. People who have navigated the system, have been living with health reform for more than 7 years, and can sleep better at night knowing that they will not have to choose between bankruptcy and a needed operation, or between paying rent and taking their child to a check-up.

President Obama speaks

Our system and the Affordable Care Act are not perfect, but they are a huge improvement over the status quo in most states. Change is tough but the President and the insured people of Massachusetts invite our friends in other states to try it, and like it. Sign up for health insurance. Find a doctor or health care provider with whom you feel comfortable and then take your insurance for a spin, either for an annual preventive check-up, or to address a problem or concern.

Health Care For All can boast credit for delivering more than 20 consumers to the White House staff members who were responsible for organizing the event. Most of the people we suggested were incorporated either on the stage or in the audience. Of the people on stage, 17 were HCFA staff, partners, or consumers. Even a week later, we are still walking a bit above the ground after the President’s historic appearance, and we hope that he will return again when he needs to be reminded face to face of what the successful implementation of Obamacare looks like. Thank you Mr. President.

-Amy Whitcomb Slemmer

November 7, 2013

Jon Stewart talks about who is telling the truth about the ACA

Last night Jon Stewart, of course, put the latest newsblork in the proper context. Go watch it.

One more thing that should be mentioned in this whole "if you like your plan, you can keep it" thing is the disruption that chapter 58 caused to private health coverage in Massachusetts. Lots of people with substandard plans (remember MEGA Life? We still do) had to change their coverage in 2007 as part of the introduction of minimum creditable coverage (MCC) - specifying minimum benefit levels to meet the individual mandate. A lot more people's coverage was disrupted in 2009, with the additional requirement that prescription drugs had to be included as part of MCC.

Yet Massachusetts seemed to take it all in stride, even though there was (and still is) serious opposition to the prescription drug requirement. Nobody was accused of any bad faith. There were no accusatory hearings or posturing, just some bills filed that die in committee every year.

Like I said, go watch this.
-Brian Rosman

November 5, 2013

http://www.youtube.com/watch?v=656bbzXAZsk

At today's Obamacare hearing before the Senate Health, Education, Labor & Pensions Committee, Senator Elizabeth Warren brought in the voice of experience - the Massachusetts health reform experience.

In her question to federal CMS adminstrator Marylyn Tavenner, Senator Warren repeated a line from last week's Faneuil Hall event with President Obama and Governor Patrick: "Health reform in Massachusetts, like the Affordable Care Act, is not a website, it’s a values statement."

She pointed out that enrollment in Massachusetts started slow and closed fast, with very few enrollments in the early months, and a surge in late 2007, right before the individual mandate took effect.

What I can tell you all from the experience is that getting everyone into a new health care system wasn’t easy and it wasn’t quick....

But because we were committed to making the law work, and making sure people had affordable health care, we kept working on it. We fixed the problems, we hit the pavement , we did whatever it took to get people signed up.

What we learned in Massachusetts is that when it comes to enrolling in health care, many of us wait until the end to get it done.

She also reminded Washington about our initial website glitches and other enrollment snafus. But that did not result in delaying or closing down the program. "We kept working on it because we stayed focused on what mattered – our conviction that no one deserved to be bankrupted or shut out of the health care system when they got sick."

Senator Warren got it right. In fact, over the past 7 years, under both the Romney and Patrick administrations, and several Health Connector leaders, state officials worked closely with advocates and stakeholders on a number of enrollment issues that arose. Poorly-worded questions on enrollment forms were fixed, or eliminated, and over time enrollment issues got better and easier. With the implementation of the ACA in Massachusetts, new challenges have arisen, and state and Health Connector staff are working extraordinarily hard to meet these challenges.

We commend and thank Senator Warren for her history lesson today.
-Brian Rosman