April 2016

April 18, 2016

Last week, the state House of Representatives unveiled their draft proposed budget for fiscal year 2017 (which begins this July 1). Like the Governor's proposal, the House budget proposes spending just under $40 billion, with about $15.4 billion going to MassHealth, a increase of below 5% (note that in figuring the cost to the state for MassHealth, one needs to subtract from the $15.4 million appropriation the some $7 billion in federal Medicaid revenue that we receive as a result of our MassHealth program). The budget proposes no major cuts in eligibility or benefits for MassHealth, though it also does not restore adult dental benefits eliminated a number of years ago. A major House initiative funds expanded steps to combat opiate abuse, with a 65% increase in funding for these services over the past 5 years.

Representatives have proposed over 1300 amendments to the budget, which will be voted on the week of April 25. HCFA is supporting a number of these amendments. We urge you to contact your Representative and urge support for the amendments on this fact sheet (pdf), or listed below:

Protect Health Safety Net Eligibility & Funding

The Health Safety Net (HSN) reimburses hospitals and community health centers for providing care to low-income uninsured and underinsured Massachusetts residents. Recent eligibility cuts and funding reductions impose barriers to care for individuals without access to affordable health coverage.

  • Support Rep. Barber’s amendment (#1119) to protect Health Safety Net eligibility and continue investing $30 million in the program, ensuring continued access to care for low-income uninsured and underinsured residents.

Close the SNAP Gap

Most MassHealth recipients are eligible for SNAP (food stamps), but the number of MA residents that get SNAP is just 41% of those with MassHealth.  A common application will reduce application barriers and help close the “SNAP Gap” in Massachusetts.

  • Support Rep. Livingstone’s amendment (#1041) to create a common application portal to allow MassHealth applicants and recipients to also apply at the same time for federal SNAP nutrition assistance.

Healthy Food for Families in Motel Shelters

Even when a family is eligible for food assistance, they often do not have access to cooking devices other than the microwave, no cold storage, and no convenient way or healthy place to purchase food.

  • Support Rep. Scibak’s amendment (#943) to create a working group to find ways to provide meals to homeless families temporarily housed in hotels and motels.

Ensure Access to Oral Health Services for People with Disabilities

Individuals living with disabilities have particular oral health needs, including adaptive facilities and equipment, as well as providers with specialized training.

  • Support Rep. Garlick’s amendment (#571) to allocate an additional $500,000 for the dental program for individuals with intellectual and developmental disabilities (line item 4512-0500). 

Invest in the Office of Oral Health

Charged with preventing dental disease and improving oral health in all Massachusetts communities, the Office of Oral Health at the Department of Public Health (DPH) is an essential component of our state’s public health infrastructure.

  • Support Rep. Scibak’s amendment (#1057) to adequately fund the DPH Office of Oral Health (4512-0500).

Provide Unbiased Prescription Drug Information to Doctors

Drug company promoters market their drugs directly to doctors by providing biased information touting their most expensive drugs. To counter this, trained educators can offer objective evidence-based information to educate doctors on cost-effective uses of prescriptions, lowering the cost of health care.

  • Support Rep. Benson’s amendment (#698) to fund "Academic Detailing," the physician education program on cost-effective prescription drugs.

Ban Drug Company Marketing “Coupons”

April 12, 2016

According to the leading crowd-sourced online encyclopedia, the traditional gift for a tenth anniversary is tin. So here's a brief bulletin on how folks marked the tenth anniversary of Governor Romney's signing of Chapter 58, the Massachusetts health reform law.

WBUR's Martha Bebinger was one of the go-to reporters covering health reform in 2005 and 2006. Today, she produced a 6-minute report on people's reactions to the law, talking to ordinary people, including Madelyn Rhenisch, the first enrollee in Commonwealth Care, who calls her insurance coverage "a lifesaver."

Also from Bebinger and WBUR is a handy list of "12 Things to Know" on the law's anniversary, with source links. My favorite: "Three-hundred and twenty fewer people died in each of the first four years of mandatory health insurance in Massachusetts." Appended to the list are 13 short essays on law's birthday, from across the spectrum of views. Among those writing are Nancy Turnbull of the Harvard School of Public Health, Jon Hurst of the Retailer's who critiques the merging of small groups with the individual market, and Elizabeth Browne, of the Charles River Community Health Center, on the need for a renewed focus on primary care. And, WBUR's Radio Boston included a discussion on the legacy of the law, with HCFA Executive Director Amy Whitcomb Slemmer lined up with Jon Hurst.

10 YEARS OF IMPACT: A LITERATURE REVIEW  OF CHAPTER 58 OF THE  ACTS OF 2006For the more wonky among us, the Blue Cross Foundation released a comprehensive bibliography of dozens and dozens of studies looking at Massachusetts reform. In addition to the detailed compendium of studies, prepared by Kelly Love and Robert Seifert of the Center for Health Law and Economics at the University of Massachusetts Medical School, there's a fact sheet summarizing the findings. Some highlights:

COVERAGE

  • Massachusetts became the state with the highest rate of insurance coverage soon after 2006 and maintains that status today.
  • The coverage gap among racial and ethnic groups narrowed post-reform.

ACCESS TO CARE

  • Coverage expansion led to overall improvements in access, but gains were uneven across different groups.
  • Unmet need among Latino, black, and middle-income individuals and those in fair or poor health continued to be a challenge post-reform.

HEALTH CARE UTILIZATION

  • The overall use of preventive care in Massachusetts rose, but increases in the use of specific preventive care screenings varied.
  • Hospital readmission rates rose slightly in the early years post-reform; readmissions for some diagnoses, such as substance use disorder treatment, grew while readmissions for others, such as psychoses, fell.

HEALTH OUTCOMES

  • Health care reform has been associated with overall improvements in health, particularly for people of lower incomes.
  • The greatest gains in health status were among racial and ethnic minorities, women, those with low incomes, and adults ages 60 to 64.

ECONOMIC IMPACTS

  • Chapter 58 helped reduce financial distress, most significantly among people who had limited access to credit markets pre-reform.

AFFORDABILITY FOR CONSUMERS

  • Immediately following 2006, increased coverage contributed to fewer reported problems paying medical bills, particularly for low-income adults.
  • Chapter 58’s individual mandate made insurance more affordable for those purchasing it individually, by bringing healthier people into the pool across which costs are spread.
  • Overall, however, Massachusetts has not escaped the long-term national trends in health care costs, and affordability challenges remain. A significant percentage of insured Massachusetts residents continue to report that health care spending causes them financial problems, that they go without needed care because of health care costs, and that they are worried about their ability to pay medical bills in the future.

Finally, former HCFA ED John McDonough blogged today with his take on the anniversary. John marveled at the strange evolution of conservative opinion on health reform, reminding us first, that the conservative Heritage Foundation spoke warmly of the policies embodied in our bill at the signing ceremony 10 years ago; and second, that this all changed with the advent of Obama and the ACA. He concludes,

April 11, 2016

Ten years ago today, April 12, 2006, we all made history in health care. Just look (and you can click on the picture for the video):

Romney signing the health care law - Click to see the signing ceremony video

Since 2003. HCFA had been working on assembling a broad coalition in support of what was originally known as just Chapter 58, and later “RomneyCare.” Looking ahead then, we figured that 2006 was going to be the year of opportunity. We built the ACT! (Affordable Care Today) coalition of religious activists, the health care industry (hospitals, doctors, community health centers, insurers, nurses and more), labor unions, citizen activists and political leaders that really did make history. What’s more, the coalition stayed together after the reform law passed (becoming ACT!! – or, Act 2), and continues to be a force for effective implementation of access programs.

RomneyCare and Obamacare as identical twins?This cartoon overstates it – RomneyCare and ObamaCare are not identical twins (contra an exuberant Jon Gruber, and more on this below). But there’s no question that our achievement became the template for the ACA, and we would not have over 20 million more people nationally with insurance, and additional millions with more affordable coverage, without our law's success.

Another Anniversary

Today also marks another important anniversary. Exactly nine years ago, on April 12, 2007, the Connector Board approved its premium schedule for subsidized people in Commonwealth Care (now called ConnectorCare). The fight over the level of premiums was the first major implementation battle. We worked closely with the Greater Boston Interfaith Organization to bring real family budgets to the discussion, demonstrating the tight finances of low-income people struggling with the high cost of living in Massachusetts. We were pleased that, in the end, on 4/12/2007, the Connector board ended up agreeing with us. As we said then, “We have achieved affordiosity.” These affordable premiums, along with no deductibles and modest copays in the subsidized plans, led to a surge of enrollment, bringing the coverage rate here up to around 97%.

But when the ACA was being designed, they deviated from the Massachusetts experience. Subsidized Obamacare plans have much higher premiums, and included deductibles and larger copays. In large part, this was due to the need for Congress to meet overall federal spending targets. The result is a stark difference in affordability:

Higher premiums under the ACA

We think this explains in part why Massachusetts enrollment has been better than the rest of the country - even states that have expanded Medicaid. The next frontier for Obamacare after Obama is more affordable coverage for low income people.

Still More To Do

We’re not done, though. This call from the Blue Cross Foundation points to continued challenges for all of us:

Health Reform at 10: Still must address access and affordability gaps