October 2014

October 21, 2014

We've said it for years - the ACA will increase insurance coverage in Massachusetts.

And despite all of the failures with the Connector/MassHealth website and enrollment technology, new data from CHIA show a remarkable increase in insurance coverage in Massachusetts this year:

CHIA data show increase of 5.3% in Massachusetts insurance in 2014

The expansion in coverage comes from an increase in subsidized coverage through MassHealth, reflecting both increased eligibility due to the ACA, and the temporary transitional coverage that new applicants were placed into due to problems with the Connector web and eligibility system. The total increased enrollment in publicy-assisted coverage from Dec. 2013 through July 2014 was around 316,000 people.

Most notably, the big increase in publicly-assisted coverage was not matched by a substantial decrease in commercial, private coverage through employers. Commercial coverage from Dec. 2013 through July 2014 declined by just under 23,000 people, or 0.5%.

This has been a recurring theme in Massachusetts health reform, that bodes well for the ACA. The fears of "crowd-out" - that employers would drop their coverage en masse and push their workers onto public programs - has just not happened Employers for the most part have continued to offer coverage, and the expansion of assistance has picked up the formerly uninsured who could not afford or were not offered employer coverage.

This new Enrollment Trends report (released as a 1-page briefing, a 3-slide powerpoint, a spreadsheet, and technical notes) is based on an actual count of who is enrolled in each major insurer's plan. It's not exactly translatable into an uninsurance rate, which CHIA will be releasing early next year.

The bottom line of this study is very clear: Massachusetts continues to make exceptional progress in expanding health coverage to virtually every person in the state.

     - Brian Rosman

October 20, 2014

Lord and Taylor (Fun)draising

We are excited to announce that Health Care For All has joined forces with

Lord & Taylor for a major fundraising event -

providing you with some fashionably healthy savings


The Boston Lord & Taylor store on Boylston Street will be hosting its annual SHOP CHIC AND MAKE IT COUNT event on Thursday, November 6th from 9am to 11pm benefiting Health Care For All and other local charities.  

Tickets are only $5 each.

Here’s what each ticket offers you:

  • Coupon – Each ticket includes two 25% bonus coupons.*
  • Lord & Taylor cardholders will receive an additional 10% off all day long*
  • Opportunity to win great prizes
  • Savings Pass – 15% savings pass to be used all day long on regular and sale-priced merchandise storewide
  • Sign up for a new Lord & Taylor credit account and receive an additional 15% off all your day’s purchases, on top of the coupon or savings pass savings

*Some minor exclusions apply.

So you get fashionably healthy savings, and HCFA gets help for its work as the premier health care consumer advocacy and service organization in Massachusetts.

Contact Melissa Freitas at mfreitas@hcfama.org to order your tickets and learn more about this opportunity to help HCFA.

Connector and MassHealth Planning High-Intensity Outreach Campaign
October 15, 2014

(Note: we're a bit behind in our blogging, but as the Massachusetts health care blog of record, we want to catch up with a few items. Also see our previous item, Why the Mass Health Connector Website Will Work.)

Last Thursday, Oct. 9, the Health Connector Board met to discuss:

  • Small Business Service Bureau Contract Extension
  • Outreach and Communications Plans for Open Enrollment
  • HIX (Health Insurance Exchange) Project Update

Materials from the meeting are available at www.mahealthconnector.org (Go to Policy Center - Leadership - Board Meetings), with the main presentations available to downoad here on outreach and education activities and the HIX update. Keep on clicking on for our full report.

Why the Mass Health Connector website will work
October 9, 2014

Today's Boston Globe Podium section includes an update from Maydad Cohen, the Governor's health reform czar (horrible official title: "special assistant to the governor for project delivery." Please.). The bold forecast, "Why the Mass. Health Connector website will work" It's based on the report he provided to the Health Connector Board this morning.

The bottom line: "More people have health insurance in Massachusetts today than ever, and we will have a website that makes it easier for them to access coverage from day one of open enrollment."

We fully agree. We've seen live working demos of the site as well, and we're optimistic, too. The Connector, MassHealth and the administration are to be congratulated for fixing the problems. They saw the failures, and got to work to make it good. And it appears to be paying off. It should also be noted that the Connector Board meeting today also was told about extensive contingency plans in place if not all works at the start. This is praisewothy as well.

Connector HIX summary 10-9-14

(BTW, "website" is shorthand for much more than the actual web site - the guts is the eligibility and enrollment system that takes input from a user on the site, connects to various databases to confirm information, calculates eligibility for various programs using a very complex algorithm, informs the user of which program he or she is eligible for, and then process next steps, like choosing a health plan.)

Cohen writes that the turnaround came when a single point of authority was created, and the decision was made to adapt existing software used in other states, rather the create something from scratch. Here's where we are:

Though we have more to do, the hard work is paying off. CMS supported our August assessment that the new system will be ready for open enrollment, allowing Massachusetts to remain a state-based marketplace. Since then, we have finished IT system development and executed over 3,000 test cases. We’ve also developed comprehensive operations and contingency plans, including adding 430 staff to process applications. This planning shows we know that no matter how well built or tested, no IT system rollout is ever perfect. Regardless of any potential glitches, we will have ways to meet Massachusetts’ residents need for health insurance. That’s what Patrick means when he says health care is more than just a website. ...

To date, we have placed more than 400,000 people into subsidized and unsubsidized coverage within budget because we always planned to provide more coverage to more people under the ACA. Despite technology challenges, we have not requested a supplemental appropriation to bring our program or administrative budgets into balance. Per member costs in legacy and temporary insurance programs have been cost-effective.

Why it’s worth it: Here in Massachusetts, we believe that health is a public good, and that everyone who needs insurance should be able to get it. Thanks to that fundamental belief, more than 97 percent of our residents have insurance. Massachusetts has increased the number of people insured since the ACA began here, and we are about to deliver better, faster access to health security.

I readily admit this hasn’t always been easy, and we made our fair share of mistakes. That sometimes happens when you take on a challenge this big. We have learned from our mistakes, enlisted outside expertise, and made significant improvements both to this project and the state’s IT management generally.

As we stand on the cusp of the next big milestone in Massachusetts health care reform, here’s what matters most: More people have health insurance in Massachusetts today than ever, and we will have a website that makes it easier for them to access coverage from day one of open enrollment.

Open enrollment starts on November 15, in 5 weeks. At HCFA, we're doing all we can to make sure it works, from serving as a sounding board and reviewing forms and materials for the Health Connector, to getting the word out to people who need to use the system, in every way we can. The ACA has already been good for Massachusetts, and we see it getting much better, soon.

  - Brian Rosman


October 6, 2014

Monday was Day One of the Health Policy Commission's 2-day Cost Trends Hearing, long dubbed "Health Wonk Boot Camp," by, well, us, back when it was 4 days long.

This year's festival is being held at a packed - standing room only, literally - Suffolk Law School. But for those who can't grab a seat, you can now watch online, through a live streaming feed. The live feed can be accessed Tuesday, starting at 9:00 am, on the HPC's home page, mass.gov/hpc.

We particularly encourage you to tune in or attend live on Tuesday morning, because at around 10:30, HCFA Executive Director Amy Whitcomb Slemmer will offer her remarks to the Commission.

Monday's sessions had a number of interesting presentations and a few sparks of real back-and-forth. Governor Patrick made news by announcing that the added cost to the state for the rebuild of the Connector web site and enrollment technology was $26 million. This is a tiny fraction of the claim of the cost made by the Pioneer Institute. Details are in the State House New Service story.

Martha Bebinger reported in on the hearings to WBUR's Radio Boston today, covering the Governor's announcement about the costs of the new Connector web site, progress on meeting the cost trends benchmark, Blue Cross' response to the Partner's acqusitions, and if prices will go down, or just grow slower. Listen below:

But the best coverage came through twitter, where the hashtag #CTH14 brought us snippets of reporting from the Commission and a number of observers. To get the flavor of the day, check out our curated stream-o'-tweets:


  - Brian Rosman

October 1, 2014

At The New Republic, Jonathan Cohn rounds up 7 charts showing the positive impact of the Affordable Care Act.  

This is a great summary of the latest findings in a number of areas. You know that coverage is increasing and uninsurance is down. But maybe you weren't aware that more people are paying less for their coverage this year compared to last year, or that employer premiums nationally went up just 3%. This piece is the perfect fact check rejoinder when someone incorrectly claims that Obamacare is increasing the deficit (it's lowering the deficit), or that insurers are abandoning the exchanges (15% more insurers participating next year). And there's lots of charts! Read it here.

To make his point that health coverage is improving overall health, Cohn uses an important study that looked at Massachusetts before and after our 2006 reform. Of course, we're always proud when the Massachusetts experience is used to inform the national debate. Here's the chart, which is somewhat difficult to interpret at first:

Chart:Massachusetts mortality declines after 2006 health reform coverage expansion (Annals of Internal Medicine)

The study is from last May, in the Annals of Internal Medicine. The lines in the chart are different measures of mortality, or death rates. The key lines to follow are the ones in the middle of the chart. This tracks premature death from causes that are “amenable to health care.” This means death rates from infections, cancers, cardiac problems, and other conditions that people should be more likely to survive with better medical care. The blue line is the death rate in Massachusetts. The black line compares us to 44 million people in 513 similar counties in other states adjusted to match Massachusetts in age, income, and other factors.

You can see how the blue line (our death rate) goes down a fair amount after health reform is implemented (the vertical blue box). That's health reform, saving hundreds of lives in Massachusetts.

The conclusion? Here's how the study authors put it: "Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care." They found that "reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates." One death was saved each year for every 830 people enrolled in coverage. The decline in mortality was nearly twice as large for minorities as it was for whites.

The researchers are confident that the study's findings are driven by the expansion in coverage due to health reform. For example, they did not find a decrease in death rate among people over age 65, who were covered by Medicare both before and after implementation of reform.

Cohn wrote a good summary of the study, here, and the NY Times covered it here.

  -Brian Rosman