January 2014

January 30, 2014

Normally, the retirement of a member of Congress representing a district nearly 2,000 miles from Massachusetts would not be mentioned on this blog.  But Congressman Henry Waxman’s announcement today that he will be leaving public life at the end of this year is a notable exception.

During his 40 (yes, 40!) years in the House of Representatives, there was scarcely any piece of health care legislation that did not have his fingerprints on it.  As Chairman of the Health and the Environment Subcommittee, Waxman held the first hearings into the emerging HIV/AIDS crisis, exposed deceitful practices by the tobacco industry, and authored legislation that created the generic drug industry.

Expanding health coverage was a passion.  He is responsible for expanding Medicaid coverage to millions of low income children, pregnant women, and seniors, and along with our own Senator Ted Kennedy, he worked to ensure that children of working families had health coverage through the Children’s Health Insurance Program (CHIP).

In 2009, Congressman Waxman became chairman of the Energy and Commerce Committee, giving him a pivotal role in an effort to achieve one of his lifelong goals: guaranteeing that all Americans would have access to health insurance through the Affordable Care Act.

One would be hard pressed to find a more effective or dedicated policy maker to the principle that the health care system must work for consumers.  In countless ways, Massachusetts residents have benefited from the work of a congressman from California.  Our country is a better place for his efforts and Congress will have very large shoes to fill when he leaves.

(Full disclosure: I had the incredible honor and privilege to work for Congressman Waxman from 1999-2002 as a junior aide in his Washington office.)

-Matt Noyes

January 30, 2014

Huge news.

Today the Department of Public Health announced the first grant awards to nine recipientsfrom the $60 million Massachusetts Prevention and Wellness Trust Fund. This marks a historic milestone in Massachusetts health reform, as we expand our focus on preventing disease and keeping people healthy.

The awards will focus on combating tobacco use, pediatric asthma, hypertension, and falls among older adults. According to DPH, the nine partnerships will serve a total of 978,000 people, with a focus on reducing health disparities based on race, ethnicity, income, and other factors.

Health Care For All was part of a broad coalition of health, civic, business, and labor leaders – led by the Mass Public Health Association – that pushed for the Trust as part of the 2012 cost containment legislation.

Massachusetts is the first state in the nation to pioneer this investment in community-focused prevention.

The lead grantees (each of which are partnering with numerous other groups) announced today are:

Barnstable County Department of Human Services
Berkshire Medical Center
Boston Public Health Commission
Holyoke Health Center
City of Lynn
City of New Bedford Health Department
City of Worcester
Manet Community Health Center
Town of Hudson

Each grantee will receive up to $250,000 for a planning grant, and, may receive $900,000 to $1.5 million annually over the next three years to implement their plan.

The MPHA release and Patrick administration announcement, with lots of details, are below:

January 24, 2014

HPC slide showing major components of cost trends report

The Health Policy Commission (HPC) met Wednesday, January 8, for its first meeting of 2014.  Following suit from the last full meeting, the 2013 Cost Trends Report was a main topic of discussion. Also on deck was a presentation about the award recipients for the Community Hospital Acceleration, Revitalization, and Transformation (CHART) program and an update on the registration of provider organizations.

Materials from the meeting are here, and our full report is on the back side.

January 16, 2014
DPH Chart
Source: Mass Budget and Policy Center

Details here.

These are the weeks that the final decisions on the governor’s budget proposal for next year are being made by the administration.

We have a number of budget requests for health care, starting with full restoration of dental benefits for all adults on MassHealth.

But we also want to highlight the ongoing, cost-foolish, crisis of inadequate funding for the Department of Public Health (DPH).

DPH has been asked to do more and more with less and less funding in recent years. Last year spending was up a bit from the year before, but public health is still way behind. According to the Massbudget Budget Browser, adjusted for inflation, overall public health spending in FY 2014 is down $77 million, around 12%, from where it was in 2008.

DPH does not have adequate staffing and resources to fulfill all of its duties in a timely manner. For example, the Quality Division of DPH has been working hard on a new responsibility – implementation of the medical marijuana law. In the meantime, they are continuing their work on hearing complaints about care in nursing homes, hospitals, and clinics, and investigating those they deem most pressing. No doubt they could investigate more of the complaints if they had the funding to fully staff that team. They have been asked to start work on educating the public about end-of-life care and palliative care. The quality division also collects, analyzes and reports on Serious Reportable Events and healthcare-associated infections in hospitals. While these reports are supposed to be issued annually, providing relatively up-to-date information for both consumers and providers, they have fallen behind because of the need to keep up with the more immediate demands on their time. New reports on both SREs and infections may be coming out in the late winter/early spring, much later than had been anticipated.

Another example: the ambitious provision in chapter 224 for a comprehensive health planning effort has been dramatically scaled back. Instead of looking at a wide range of health services, to figure where there is either an oversupply or undersupply, the project is limited to looking only at one service, mental health.

Certainly every legislator and state budget official knows that public health is a core funtion of state government, and that investments in public health pay back profusely in lower medical costs for everyone, including the state.

As we move into the budget season, we strongly encourage the Governor and the legislature to ensure that DPH has enough funding to fulfill its mandates and serve the public by improving care for all residents of the Commonwealth.

-Deb Wachenheim

January 13, 2014

HPC slide showing major components of cost trends report

The Health Policy Commission (HPC) met Wednesday, January 8, for its first meeting of 2014.  Following suit from the last full meeting, the 2013 Cost Trends Report was a main topic of discussion. Also on deck was a presentation about the award recipients for the Community Hospital Acceleration, Revitalization, and Transformation (CHART) program and an update on the registration of provider organizations.

Materials from the meeting are here, and our full report is on the back side.

January 10, 2014

Today’s Connector Board meeting focused on open enrollment progress, IT issues and coverage workarounds. The Connector leadership expressed a strong commitment to extending coverage to everyone eligible, without gaps and delays. At the same time, they acknowledged continuing problems with the IT, both the website and the eligibility processing systems. They are determined to find solutions and seek accountability for the deficiencies.

The meeting attracted more press than the Connector has seen in a long while, with a lengthy media scrum after the meeting. Coverage included the Springfield Republican, andSpringfield’s channel 22, and the Boston Globe and Herald. Materials from the meeting are posted here. Our full report is coming right up:

January 10, 2014

For years advocates have worked to share a message that Massachusetts knows well: Oral health is critical to overall health, and dental insurance is health insurance. The messaging looked like it would pay off when dental coverage for children was mandated by the ACA as one of 10 Essential Health Benefits that must be offered by compliant insurance plans. However, as illustrated by this NPR story, the route to expanded access to quality, affordable children’s dental coverage is not as foolproof as one would hope.

NPR’s Julie Rovner reports the gaping loophole present in the new law. Families aren’t required to buy dental coverage for their children when shopping through states’ health care marketplace exchanges. Though the coverage is technically mandated, there are no penalties for families who do not purchase it.

Further, the process by which families obtain pediatric dental coverage presents obstacles in and of itself that could impede families’ access to coverage. These obstacles are twofold: structural confusion and cost.

Both exist in Massachusetts, despite our Connector’s strong support for dental plans.

Because some plans in the marketplace include embedded pediatric dental coverage, while other plans require that coverage be purchased separately, there exists an underlying confusion and inconsistency. Secondly, because these stand-alone dental plans are not eligible for federally-sponsored subsidies, families face an economic disincentive to buy such plans—and the most vulnerable families (namely those with particularly tight budgets) may not be able to afford them at all.

With 1 in 10 children from low-income families suffering from untreated dental problems, the issue of access to dental care is both immediate and widespread. Though the ACA has laid a strong foundation by declaring children’s dental coverage one of its 10 essential benefits, there remains much to be done to ensure that the oral health needs of children across the state are equitably met.

-Jene Bass and Courtney Chelo

January 8, 2014

Two Upcoming Events of Interest:

The MA Department of Public Health has been holding a series of Community Health Dialogues around the state to talk about the work and priorities of the Department and hear from community members about their work and their concerns/suggestions for DPH. The final dialogue is taking place this Friday, January 10, 9:30-11:00am, at the Carter Auditorium in Boston. Learn more here.

Also, the Schwartz Center for Compassionate Healthcare is holding a free webinar as part of its Compassion in Action webinar series on Tuesday, January 14, 4:30-5:30, titled “Yes, Empathy Can be Taught!” Learn more and register here.

  – Deb Wachenheim

As part of the ACA in 2014 Medicaid Will Expand Eligibility to Include More Low-Income Adults - adds parents and Adults
January 1, 2014

Raise a glass and sing Auld Lang Syne to remember two historic MassHealth programs that are ending today.

New Years Day 2014 brings profound changes to MassHealth, our Medicaid and CHIP program. These changes will transform the program as much as the changes that accompanied the creation of MassHealth, in 1996.

The national transformation will be even more dramatic, as starting on 1/1/14, the ACA allows all states to set Medicaid eligibility based solely on income. And, as usual, it all starts with Massachusetts.

MassHealth is built on a federal waiver originally granted to the Commonwealth in 1996. It allowed the state to begin to break out Medicaid from its traditional role as the health program that goes along with welfare. Cash welfare benefits generally go to 4 groups, and these were the ones eligible for Medicaid before 1996: the elderly, children, parents, and those with disabilities. The 1996 MassHealth reform allowed more parents and children to become eligible. Even more revolutionary was eligibility for adults who were not parents, under a new program called MassHealth Basic.

MassHealth Basic was originally set up to cover what Judy Meredith affectionately called “bums in the street,” adults with below-poverty incomes who had been out of work for the past year. Because the program was a federal experiment, the state was given the ability to reduce benefits, cap enrollment, and even eliminate the program to control expenses.

So in April, 2003, eligibility for the program was reduced as then House Speaker Tom Finneran demanded deep budget cuts in health care programs. Over 36,000 people lost coverage. HCFA launched a furious campaign to restore the program, and in October, 2003, the program was brought back to life. The replacement coverage program (with further reduced benefits) was called MassHealth Essential, as lawmakers tried to come up with an even stingier adjective than “basic.”

But budget concerns again led to the Romney administration to cap enrollment in 2005. Eventually 12,000 people languished on the waiting list, eligible for coverage, but with no slots to allow them to enroll. We insisted that the broad health reforms then being negotiated include ending the waiting lists for MassHealth Essential. The final version of Chapter 58 (“RomneyCare”) included the provision ending the enrollment cap (section 107).

Source: excerpt of Kaiser Family Foundation chart

Source: excerpt of Kaiser Family Foundation chart

Starting today, the ACA lets all states choose to offer Medicaid  based solely on income. That provision builds on a model pioneered in Massachusetts.

Here, MassHealth Basic and MassHealth Essential are ending today, to be replaced by a new program, called MassHealth CarePlus. Many people formerly in Commonwealth Care will also get their coverage through CarePlus. Here’s a MassHealth guide to CarePlus, and a general FAQ on changes to the MassHealth program for 2014 under health reform.

(Also ending today is the Medical Security Program, which dates back to the 1988 Dukakis universal coverage law and provides coverage to people receiving unemployment insurance, and the insurance partnership program, a Weld administration-era program for workers in small companies that never took off the way Charlie Baker envisioned.)

We’re pleased that CarePlus will simplify and unify various flavors of MassHealth into a more rational program design, so we’re not sad to see Basic and Essential go away. Their tortured history represents the long struggle for expanding health care to those with no other source of coverage.

As one of the models for the ACA’s Medicaid expansion, MassHealth Basic will lead to coverage for as many as 10 million people nationally in the states that choosing the expansion. Another 3.6 million eligibles live in states that are not expanding coverage now.