February 2015

February 27, 2015

In the Globe's Capital section today, political reporter Joshua Miller provides a helpful lexicon of state budget terms, correctly titled, "Know the lingo and you can follow the budget process."

The term "MassHealth" is defined as: 

"If there is a tough beast to tame in the budget, it’s the cost of MassHealth, what the state calls its Medicaid program. Massachusetts spending on Medicaid, the state-federal health program for poor and disabled people, has grown at a much faster rate than tax money has in recent years. And it takes up a huge chunk of the budget, squeezing out other items. One-third of state spending in fiscal 2014 was on Medicaid, according to the Massachusetts Taxpayers Foundation. The state’s bungled rollout of its health insurance website added to the program’s fiscal troubles — though it’s not the state’s only health-spending challenge.

We know there's not a lot of space in the paper, but defining MassHealth simply as an expensive program, even in a budget glossary, misses a lot. We would add a bit to the definition.

First, from a purely fiscal point of view, MassHealth is both an expense to state taxpayers, and the state's largest federal revenue generator. For every dollar we spend, we get fifty cents or more back from the federal government. This is new money brought into the state that is spent in the local economy, generating economic value. The system is described well in a brief from last November from the Mass Budget and Policy Center and the Mass Medicaid Policy Institute (MMPI), appropriately titled, Understanding the Actual Cost of MassHealth to the State:

However, since MassHealth is jointly funded by the state and federal governments, much of this health care coverage is actually paid forby the federal government. Therefore, the “net” state cost of MassHealth (determined by subtracting the federal reimbursement and similar revenues from the budgeted total) gives a much clearer picture of the impact of MassHealth on the state budget than state budget totals alone.

Much of our MassHealth spending is matched dollar for dollar by the federal government. But in some case, like for many children, the feds pay 65% of the state's cost. And for the new people added to MassHealth due to the ACA, the reimbursement is 80%, or sometimes fully federally funded. And in addition to the federal revenues, there are rebates from drug manufacturers, and premiums paid by some members that go into the state's pot. Thus the actual true net cost of MassHealth turns out to be many millions less than it seems, around $6.1 billion, and not the $14.7 billion commonly cited in the budget.

Second, this budget focus misses the role MassHealth plays in keeping our state healthy and productive. MMPI created this infographic last December, highlighting MassHealth's broader role in both health care and the state generally. Here's the second page of the two-pager:

MassHealth Matters for Massachusetts

And finally, defining MassHealth just as a budget issue ignores the reason we have state government - to serve the people of Massachusetts. Any definition of MassHealth has to include the people in this video, also from MMPI:

      - Brian Rosman

February 26, 2015

Today the Massachusetts House of Representatives approved its committee chairs and members for the new legislative session. That big boom you just heard was the starting gun for the legislative process.

Among the new chairs is Boston Representative Jeffrey Sanchez, who will co-lead the Health Care Financing Committee. This committee considers all bills concerning MassHealth, the Health Connector, other program such as the Health Safety Net, and delivery system reforms. It also takes a second look at many health care-related bills first approved by other committees. It has been called the "super-committee" for health care. Rep. Sanchez will join his already announced Senate co-chair, Senator James Welch of Springfield.

Representative Sanchez has long been a good friend of HCFA and a strong advocate for strengthening access and affordability for Massachusetts health care consumers. We have worked with him on numerous issues, and he is sponsoring a bill we're supporting to reduce medical debt. He formerly was co-chair of the Public Health Committee, and has been a leader in many major health care issues over the past years. We're very pleased with his new role.

Representative Sanchez' move to Health Care Financing opens a House co-chair slot in the Public Health Committee. That position will be filled by Rep. Kate Hogan of Stow. She'll join Winchester Senator Jason Lewis as cochairs of that critical committee. Rep. Hogan is leading our efforts to protect confidentiality and medical privacy through a bill allowing patients to restrict access to Explanation of Benefit forms. Her co-chair Senator Lewis has a long history of leadership in public health, and Rep. Hogan will bring her strong background, and her long-standing interest in these issues to the work.

Another new House co-chair will be Rep. Aaron Michlewitz of Boston, who will co-lead the Financial Services Committee, which oversees private health insurance. His Senate counterpart is Acton Senator James Eldridge. Both will be strong watchdogs for consumer interests in private coverage.

Other House co-chairs with jurisdiction over health care issues continuing in their posts include Boston Rep. Elizabeth Malia, who continues as co-chair of the Mental Health and Substance Abuse Committee, and Newton Rep. Kay Khan, who will continue as co-chair of the Children and Families Committee.

HCFA has a broad legislative agenda for this session. Committee chairs - you will be hearing from us and lots of others looking to continue our state's leadership on health care.

  - Brian Rosman

Today the MA @HealthConnector & @MassHealth will hit HALF A MILLION eligible for coverage under #ACA. #WOOHOO!
February 19, 2015

Today the MA @HealthConnector & @MassHealth will hit HALF A MILLION eligible for coverage under #ACA. #WOOHOO!

UPDATE - here's the numbers as of the day before the scheduled end of open enrollment:

Connector enrollment Dashboard 2-23-15


Connector Dashboard 2-19-15 showing 497,251 found eligible for coverage


(Link to Connector enrollment dashboards)

February 17, 2015

HCFA activist Priscila Espinosa testifying at Senate forum 2-11-15

Over one-fourth of the Massachusetts state Senators gathered last week at UMass Medical School in Worcester to hear the concerns of their constituents. These forums, known as the Commonwealth Conversations Tour, are an initiative led by Senate President Stan Rosenberg aimed at giving people the opportunity to make their voices heard on important issues as this legislative session begins.

Priscila Espinosa of Clinton, MA, a HCFA Leadership Team member since spring 2014, spoke at the Worcester forum on behalf of health care reform legislation. As both a consumer with a chronic illness and an active advocate with Health Care For All, Priscila has worked hard to advance HCFA legislative priorities such as the Barrier Free Care bill.

The Barrier Free Care bill would eliminate out-of-pocket costs for certain high-value, cost-effective preventive care medications such as asthma inhalers, diabetic insulin, high-cholesterol medications, or hypertension drugs.

Each speaker had two minutes, and the following is Priscila’s testimony.

“Hi, good evening, my name is Priscila Espinosa from Clinton, Worcester County. Thank you Senators for hosting this forum and taking the time to listen to us. I am here on behalf of the Health Care For All Leadership Team to speak to you about garnering your support to pass the Barrier Free Care bill, which you may have noticed has been introduced, and tossed back and forth the past couple of years. Unfortunately this bill has not passed and we need your support to do so. The Barrier Free Care bill prevents people with a chronic illness, such as heart disease, mental/physical disabilities, cholesterol, hypertension, and diabetes, just to name a few, from foregoing their medical treatment (plan) due to high out of pocket expenses such copays for visits, medications, high deductibles for treatment or medical durable equipment. As a consumer and as someone who has loved ones with a chronic illness I urge you to pass this bill. I am sure we all know someone or have a loved one with a chronic illness. 

I also urge you to consider restoring full dental benefits [for adults on MassHealth], which were cut 5 years ago. In the past years you have done a great job restoring some benefits, but it is not yet fully restored. Please fully restore them!

Lastly, to wrap-up I would like to close with our heart disease model, which you may have noticed that a few days ago it was Wear Red for Women, to raise awareness about heart disease. With the Barrier Free Care, insurers will save $5,000 per/person, the patient will save $500+ per year, and medical adherence goes up 4.4-6.2%. This bill will not cost the state any additional spending; in fact it will save you money due to its prevention efforts. You may or may not know this, but heart disease is the #1 death toll, not just women, but for the US. Thank you for your time.”

When asked about the experience of testifying, Priscila described it as “Nerve-wrecking, but empowering! It felt wonderful to speak on behalf of such an awesome organization and Leadership Team.”

Over 40 people spoke at Wednesday’s forum moderated by Senator Chandler, with each speaker getting just two minutes to talk. Total attendance was over 100 people, and the senators stayed until the end to listen to everyone who signed up to speak.

The forums continue on the North Shore on Feb. 23. You can click here for more information. If you are interested in getting involved in our advocacy efforts and attending future forums, contact Francisco Ramos at 617-275-2937 or at framos@hcfama.org.

The forum was also covered in the Worcester Telegram, including a great picture of Priscila testifying.

      -Priscila Espinosa and Megan Crow


February 13, 2015

Open enrollment was scheduled to end on Sunday, Feb. 15. But see this, just in from the Health Connector:



BOSTON – February 13, 2015 – The Massachusetts Health Connector and MassHealth announced today they are extending the deadline to complete an application and pick a plan to Feb. 23, acknowledging the toll a series of snowstorms in Massachusetts – including another one forecast for this weekend – has taken on operations and the ability for people to sign up for insurance.

The deadline was Feb. 15, but the extreme weather has led to a number of days this month with the call center short-staffed, leading to long wait times for consumers looking for assistance. The extension gives applicants an additional week to complete an application, find out if they qualify for MassHealth or Health Connector coverage, select a plan and make a payment as necessary. The Feb. 23 deadline for making a payment stays in place.

“We here in Massachusetts have experienced an extraordinary month of weather that has not only limited our operations, but also taken over the day-to-day lives of residents as they shovel out and try to deal with the snow,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We worked closely with the Baker-Polito Administration to create this extension, which gives people a little more time to finish up what they need to do to get health insurance through the Commonwealth.”

Through Feb. 11, more than 464,000 people had completed an application and been determined qualified for MassHealth or a Health Connector Qualified Health Plan. About 343,000 have enrolled in coverage, including 240,000 being automatically enrolled in MassHealth, and an additional 102,000 enrolling in a subsidized or unsubsidized Qualified Health Plan through the Health Connector.

The series of snowstorms in recent weeks led to the closure of the Commonwealth’s offices on four occasions, which led to limited staffing of the Health Connector’s and MassHealth’s call centers and long wait times for applicants seeking assistance. To account for this, the Health Connector has created an additional one-week period after Feb. 15, during which Massachusetts residents can continue to enroll.  This additional period, along with already-established expanded call center times, gives applicants more time and access to assistance.

With another significant storm forecast for this weekend, the Health Connector’s call center will not be taking inbound calls on Sunday, Feb. 15, but will make return calls to consumers who have requested calls. For those who want to check on a payment made in recent days, members are reminded that it can take a few days for a payment to be processed with the member’s bank, and they are encouraged to contact the Health Connector when it resumes full staffing on Tuesday, Feb. 17.

The Health Connector has already expanded its call center hours through Feb. 23, including weekend hours next Saturday and Sunday, Feb. 21 and 22, from 9 a.m. to 3 p.m., and on Monday, Feb. 23, from 7 a.m. to 9 p.m.

The Health Connector’s walk-in center expanded staffing at the 133 Portland St., Boston, office is in place today. Weekend plans will be made based on the forecast and public transportation availability. Visit MAhealthconnector.org for updates. Additional walk-in center opportunities may be available as the Health Connector works with its partners to define staffing and infrastructure capabilities.

February 12, 2015

Connector summary slide 2-12-15

The Health Connector Board met today.  With open enrollment for Connector plans (but not MassHealth) ending in on Sunday, there was lots of talk about accomplishments and challenges.  An affordability schedule (that also sets parameters for subsidized premiums) was preliminarily approved, continuing our long-standing approach to what is considered affordable. It was the first Connector board meeting for their new Executive Director, and, oh, and there's a new Chair of the Connector Board, as the Baker administration creatively used some flexibility in the statute to reshuffle the leadership and membership of the Board a bit.

Under the law establishing the Connector, the Board Chair is the the Secretary for Administration and Finance (ANF), or his or her designee. Also on the board are the Director of Medicaid and the Commisioner of Insurance, or their designees. Today,  ANF Secretary Kristen Lepore designated Executive Office of Health and Human Services (EOHHS) Secretary Marylou Sudders to serve in her place, and thus be the board chair. Then in turn,  the new Assistant Secretary for MassHealth, Daniel Tsai, designated ANF Secretary Kristen Lepore to represent MassHealth on the Board. So in sum, MassHealth is out, EOHHS is in, and is the new chair. Secretary Sudders noted that part of the thinking behind the change is that “it is the Governor’s expectation that health care and finance be equally considered.” (Although, for today's meeting, Secretary Lepore was represented by her Director of Health Care Policy, Lauren Peters, as a designee's designee.)

Secretary Sudders welcomed Louis Gutierrez to his first Board meeting as the Executive Director of the Health Connector. Gutierrez noted the accomplishments so far with the new IT system – over 325,000 Massachusetts residents enrolled in MassHealth and Connector coverage since the beginning of open enrollment (November 15th). As of yesterday, the 102,169 are enrolled in Health Connector health plans and 22,769 people enrolled in dental plans.

Gutierrez also thanked Maydad Cohen, whose last day as special assistant to the Governor for Project Delivery is March 6th, his team and the Health Connector team for their work in getting to this point. Gutierrez also said that the Connector will continue to have the same dedication to getting health coverage for Massachusetts residents as they have had during open enrollment, and hopes the changes to the Board structure will enable the “Health Connector and MassHealth to independently work seamlessly toward coverage.”

With all that taken care of, the meeting materials are here, and click on for our full report:

Health Insurer cost estimation sites
February 12, 2015


Imagine shopping where you can't see the price tag. 

Would you buy something with a credit card if you didn't know the cost until your bill arrived? 

That's exactly what often happens when you "buy" a health care service. 

Massachusetts law allows you to see the price tags of different health care providers - before you choose them to provide your health care service. Your health insurance company must have an online cost estimator that you can use to find out in advance what you will have to pay for your health care service. 

Health Care For All wants to make sure that these cost estimators are available and helpful to you as a health care consumer

To do that, we need your help! 

First, go online and find your insurance company's cost estimator. Check it out, and then answer these brief questions to tell us about your experience. We'll compile the responses, and issue a "report card" on how well these sites meet consumer needs.

The questions can be found here: https://www.surveymonkey.com/s/cost_estimator

Thank you so much for your help! 

 If you have any questions, contact Emily Boardman at eboardman@hcfama.org

February 11, 2015

Sunday's Last Week Tonight With John Oliver included a brilliant take-down of appalling drug marketing tactics aimed at influencing physician prescribing, a long-time concern of HCFA and the Massachusetts Prescription Reform Coalition we lead.

Some of the language may not be quite safe for work, but we can't resist this:

"Drug companies are a bit like high school boyfriends. They're much more concerned with getting inside of you than being effective once they're in there."

The piece included an interview with Jerry Avorn, who has worked closely with us on these issues over the years.

As you watch the clip below (and you must watch it), remember these points:

  1. Massachusetts passed a comprehensive law regulating drug industry marketing to doctors, that included provisions banning gifts and requiring all meals as part of mearketing sessions to be "modest."
  2. Under intense pressure from the pharmaceutical industry and after a very contentious meeting, the Public Health Council voted to define a modest meal as whatever a doctor would order on his or her own, including alcoholic beverages, essentially gutting the legislation.  
  3. HCFA is supporting legislation for 2015 that would shine more light on prescription drug marketing by the pharmaceutical industry, and allow the state to regulate unreasonably expensive prescriptions.

Watch, then ask you state Senator or Representative to co-sponsor our bill, SD 1726:

(This, too:

“Pharma reps are like the cast of Grey’s Anatomy. They’re young, they’re hot, and they have virtually no medical training whatsoever.”  )


-  Brian Rosman

February 6, 2015

The Health Connector released their Weekly Open Enrollment dashboard report, which rolls up the week's daily dashboards and shows additional details (all the dashboards are eventually posted here, and today's full dashboard is also here). Here's the data on eligibility determinations:

2-6-15 Enrollment dashboard

The complicated chart shows that over 440,000 people have been determinded eligible for MassHealth or Connector coverage using the new eligibility system. With open enrollment going through February 15, wer'e on track to easily beat 450,000 total eligibles - a remarkable achievment. The colored bars above show where people are coming from (indicated by the colors), and where they are going to (shown by the bars on the left).

(UPDATE: Despite more snow, as of Wednesday, 2/11. the Connector and MassHealth report 459,618 determinied eligibile!)

However, not everyone determined eligible has enrolled yet. Enrolling includes choosing a plan and making an initial premium payment (if required). Around 326,000 people have enrolled so far. Another 24,000 have selected a plan or placed one in their "cart," but not yet completed their enrollment.

With yet another storm coming, we urge people looking for coverage to contact our Helpline if they need assistance. Also, we want to get word out that though open enrollment for Connector Plans ends on February 15, people eligible for MassHealth, our Medicaid program, can apply at any time. You may also be able to enroll in Connector plans after February 15 if you meet one of the special circumstances, like a change in income or marriage status.