November 2017

November 20, 2017

Funding for the Children’s Health Insurance Program (CHIP) expired on September 30. CHIP provides health insurance for children and pregnant mothers who are low-income but are not eligible for Medicaid. States have a limited amount of funds left to maintain the program, but without federal reauthorization, these funds will soon run out. CHIP has been responsible for a massive decrease in the number of uninsured children throughout the country. When CHIP became law in 1997, 14 percent of people below the age of 18 were uninsured. By 2015, this number had decreased to less than 5 percent. In Massachusetts, CHIP covers about 160,000 children, including 7,000 expecting mothers. CHIP has helped the Commonwealth reach the incredible rate of 99 percent insurance coverage for children, which is the highest in the nation. According to updated estimates provided by MassHealth, without Congressional action, Massachusetts will exhaust its federal CHIP funding in mid-January.

Federal funding for community health centers expired on the same day. Community health centers are a vital part of the health care system, and a lack of federal funding will throw these health centers into a finical crisis, affecting a massive portion of the population. Many community health centers, uncertain when funding may reauthorized, are already experiencing considerable financial stress, which is hampering their ability to function effectively. In Massachusetts, community health centers provide primary care to one in seven state residents, or about 1 million people. Community health centers tend to serve large amounts of patients without private insurance, including those covered through Medicaid and those who are uninsured. The most vulnerable members of our society will be disproportionately affected if community health centers are forced to cut services due to a lack of federal funding.

Senator Elizabeth Warren recently posted a video calling for the reauthorization of funds for both CHIP and community health centers. Health Care For All commends Senator Warren for her commitment in fighting for these vital programs. HCFA calls on Congress to work together to forge a clean bipartisan agreement on funding of both CHIP and community health centers, two essential components of our health care system. 

November 17, 2017

Last week, the state Senate considered over 150 amendments proposed to their comprehensive health care cost control package, titled the HEALTH Act, for Health Empowerment and Affordability while Leveraging Transformative Health care (see our initial thoughts on the bill here). After spending two full days discussing and voting on amendments, the Senate approved the bill right at midnight on November 9. The final Senate bill, incorporating all the amendments, is expected to be numbered S. 2211, and so should be available online here.

The wide-ranging final bill includes over 150 sections, concerning many aspects of the state’s health care system. The bill now goes to the House. House leaders have said they will be reviewing the bill and preparing their version sometime in the new year.

HCFA was active during the amendment process, working on a number of proposed improvements to the bill. As you can see from the brief summaries below, among the many provisions are a number of long-standing HCFA priorities. Below is an outline of some of the key issues included in the bill; we apologize for the length, but this is a very large bill.

MassHealth reforms: We are thankful to the Senate for not including a package of proposed reforms to MassHealth that reduces eligibility for non-disabled adults which would limit benefits and impose barriers to keeping coverage and continuity of care. Most of these proposals also need federal approval; the Centers for Medicare and Medicaid Services is currently reviewing the 1115 waiver amendment Massachusetts submitted in September.

Oral Health: The bill allows dental therapists to practice in Massachusetts. Allowing dental therapists to work in Massachusetts would expand access to oral health. Low income children and families, older adults, people with disabilities and communities of color face the substantial barriers to accessing needed dental care. Dental therapists are licensed midlevel dental providers, working under a dentist’s supervision. As community-based providers who understand the history, culture, and language of their patients, they enable the dental team to deliver culturally competent, patient-centered care, mobilizing the strengths of underserved communities. Dental therapists could bring much needed care to underserved people and address oral health disparities.

Academic detailing: The Senate bill requires the Health Policy Commission to implement Academic Detailing, which is an evidence-based prescriber education program that focuses on the therapeutic and cost-effective utilization of prescription drugs. Academic Detailing supports prescribers to make informed decisions based on balanced research data rather than biased promotional information from drug companies. The Senate considered an amendment supported by HCFA that would have included an assessment on pharmaceutical companies to fund the program, but this amendment was not adopted.

Prevention: The Senate bill renews authorization for the Prevention and Wellness Trust Fund (PWTF) , which expired in June. PWTF is an innovative approach to address social determinants of health. It was set up as a pilot program in 2012, with the goal of reducing health costs by increasing access to community-based prevention. The pilot phase focused on hypertension, childhood asthma, elderly falls and tobacco use reduction, and operated in nine communities. PWTF is unique in addressing community factors that lead to poor health. HCFA worked with other public health advocates to add a funding mechanism to the provision, which originally had no source of funds. An amendment to the bill increases the tax on flavored cigars to fund the program.

Medicare Savings Programs: The Senate considered an amendment filed by Senator L’Italien that would leverage federal and existing state funds to expand eligibility to Medicare Savings Programs (MSPs), which help lower costs for Medicare beneficiaries with limited incomes. In the end, the Senate approved a redrafted amendment that directs the Executive Office of Elder Affairs and the Executive Office of Health and Human Services to develop plans to utilize Prescription Advantage program funding and expand MSPs, respectively, by September 2018.

Prescription Drug Price Transparency: The Senate bill includes a number of provisions to increase transparency of prescription drug pricing. The bill requires the Center for Health Information and Analysis to collect pricing information from pharmaceutical manufacturers and pharmacy benefit managers, including research and development costs, marketing and advertising costs and annual profits. The bill also requires these entities to take part in the Health Policy Commission’s annual health cost trends hearings where the Commission can solicit sworn testimony from the industry on factors driving drug price increases. An amendment supported by HCFA strengthened the reporting requirements and allows the Attorney General to compel pricing information from industry officials, subject to a financial penalty and other legal action for noncompliance.

November 16, 2017

The Massachusetts legislature recently passed legislation, called the Contraceptive ACCESS bill, to ensure access to birth control in Massachusetts. The bill now needs the signature of the Governor to become law.

The Affordable Care Act mandates coverage of birth control without copayments. However, the Trump administration recently moved to roll back this requirement by allowing employers to request exemptions from this requirement based on religious or moral beliefs. This could result in some employers choosing to no longer cover birth control in the insurance plans they offer to workers.

The ACCESS bill ensures that, even with this action on the federal level, employers in Massachusetts will continue to provide employees with coverage for birth control without copayments.

This bill also increases access to birth control in several other ways. It allows women to receive a 12- month supply of oral contraceptives at once, instead of requiring women to repeatedly return to the pharmacy to renew their prescription throughout the year.

This legislation further allows for women to access emergency contraception without a copayment or new prescription, which is vital to ensure timely access. Before this legislation, a woman would need to get a prescription to receive emergency contraception without a copayment. Emergency contraception is meant to be taken immediately, so being forced to wait for a prescription could undermine the effectiveness of the medication.

Access to contraception is critical to the health and wellbeing of women and their families. Health Care For All believes birth control should be available to all who need it, regardless of economic status. HCFA supports this legislation as a measure to increase access to birth control in Massachusetts and to protect against attacks on access to affordable birth control from the federal level.  

(Image courtesy of NARAL Pro-Choice Massachusetts

November 14, 2017

Despite being completely preventable, dental disease is a major cause of illness in the US. Millions suffer from painful untreated dental issues due to an inability to access dental care, which impacts their ability to eat, talk, gain or retain employment and maintain good overall health. Low income children and families, older adults, people with disabilities and communities of color face the greatest barriers to accessing care.

Dental access is a severe problem in Massachusetts. A 2016 Massachusetts Health Policy Commission study highlighted the severe access problem for low-income people. It found that only 56% of low-income adults saw a dentist in the past year, compared to 82% of high-income adults.

The lack of access to dental care is also evidenced by the large number of ER visits for preventable dental issues. In Massachusetts, for example, ER use by children covered by Medicaid for preventable oral health conditions was 3.4 times that for kids with commercial coverage. For non-elderly adults, the rate of ER visits by Medicaid members was a stunning 16.6 times that of those with commercial coverage.

These disparities affect many – adults of color, people with disabilities and older adult communities face significant social, structural, cultural, economic and geographic barriers in accessing care and have high rates of oral health problems.  The current dental delivery system is not overcoming these barriers. This is why health care advocates across the country keep pushing to add dental therapists, licensed midlevel dental providers to the dental team. Dental therapists could immediately bring care to millions of underserved people nationwide and address oral health disparities.  In Massachusetts, the Senate’s recently passed health care bill includes authorization for dental therapists.

Dental therapists work with the dental team similar to the way physician assistants work on the medical team—they are early intervention and prevention dental professionals who are trained to provide a limited scope of services under the supervision of a dentist. They have been working worldwide since the 1920s and have been part of the US dental team for over a decade. Specifically designed to work in underserved areas, dental therapists are practicing safely, effectively and increasing access to care in Alaska, Minnesota, and the Swinomish Indian Tribal Community in Washington, and were also recently authorized in Vermont and Maine.

Several dental therapy programs are recruiting providers directly from the communities where oral health needs are the greatest. Utilizing community-based providers who understand the history, culture, and language of their patients enables the dental team to deliver culturally competent, patient-centered care and mobilizes the strengths of underserved communities.

In addition to delivering patient centered care, dental therapists are proving to relieve the financial burden on dental practices who have limited resources for oral health services for vulnerable and underserved populations. Since dental therapists are less expensive to hire, dental practices are able to provide care for more Medicaid patients, even with lower reimbursement rates, and still be profitable. These are critical components to being able to remove some of the systemic barriers that prevent underserved communities from accessing dental services, and building the community’s health care delivery capacity to improve oral health outcomes.

Access to dental services and good oral health should not be treated as novelties reserved for those lucky enough to live near a dentist, have dental insurance and afford to receive treatment. These are critical components to overall good health, and it is imperative that we address the structural barriers that cause oral health disparities. Dental therapists can address these disparities by expanding and bolstering the current dental delivery system to serve these underserved communities. Dental therapy is an evidenced-based solution that has increased access to care in Alaska and Minnesota, especially for hard-to-reach populations, and can do the same in Massachusetts.

                                                                                                                                       -- Kristen McGlaston, Community Catalyst