September 2018

September 24, 2018
You may have heard about proposed policy changes that could affect immigrants’ use of public benefits (government programs that may help you pay for food, housing, health care such as MassHealth and other living expenses). New federal regulations are proposing to change the definition of who is a “Public Charge,” a person who is likely to become dependent on the government for financial and material support. This change could affect the ability to adjust status or petition for a family member. 

HCFA wants to make sure that you have the most accurate information about these changes, so that you can make the best decision for you and your family. 

  • There has been no change to the “public charge” rules at this point if you are in the US and contemplating adjusting your immigration status or sponsoring someone who is already here. These are proposed regulations that still need to go through a formal federal review process before changes are made.
  • Currently, the only benefits considered under “public charge” are cash benefits (Supplemental Security Income or Transitional Assistance for Needy Families (TANF) or payment for long-term care institutionalization).
  • Over the next several months, the proposed rule could potentially impact other benefits, including: MassHealth (except MassHealth Limited); Supplemental Nutrition Assistance Program (SNAP/food stamps); Medicare Part D Prescription Drug Subsidy; Section 8 Housing Choice Voucher Program; Section 8 Project-Based Rental Assistance; and Public Housing. There is no need to disenroll from these programs at this time. If the regulations are approved, individuals will have 60 days to withdraw from them before they impact people. After that time, the use of these benefits is dependent on other factors that should be discussed with an immigration counselor or attorney.
  • If you are sponsoring a family member who is currently living outside the country, you should check with an immigration counselor or attorney about whether receiving public benefits could affect your pending petition.
 
Health Care For All (HCFA), the Massachusetts Immigrant Refugee Advocacy Coalition (MIRA), Health Law Advocates (HLA) and many other organizations work to protect Massachusetts immigrants and ensure they have the right to access public benefits, including health care.

To learn more about changes regarding the “Public Charge” determination and how to be part of the campaign to oppose these changes, you can send an email to organizing@hcfama.org.

Attached here is a list of organizations that are trusted in the community and provide free immigration services. Some of these organizations may have limited capacity and may not accept new cases, please call first to ensure that they can help you. 

September 21, 2018

CHIA Report cover

Last week’s release of the Annual Report on the Performance of the Massachusetts Health Care System by the Center for Health Information and Analysis (CHIA) tells us that while total health care expenditures grew much more slowly, patient spending increased significantly in 2017.

In what was heralded as good news, the growth rate of Total Health Care Expenditures (THCE) in 2017 fell below the 3.6% benchmark set by the Health Policy Commission (HPC). Nevertheless, THCE did grow by 1.6% to $8,907 per resident.

While that’s unequivocally good news, not all is well. What does the report show for consumers across the Commonwealth as they try to access the care they need to live healthy lives? Digging in, the report includes the following findings:

  • Pharmacy and hospital outpatient spending remained the largest drivers of THCE growth. Prescription drugs are still skyrocketing in price, compared to other health spending. Drug costs went up 5%.
  • Annual growth in fully-insured premiums accelerated – from 2.0% in 2016 to 4.9% in 2017.
  • Between 2016 and 2017, member cost-sharing continued to grow at a faster rate (5.7%) than inflation, average wages, and premiums.
  • By 2017, 28.2% of members with private commercial insurance were enrolled in high deductible health plans.

In short, while total expenditure growth is down, patients are spending more – to pay for prescription drugs at the pharmacy, to pay their monthly premiums, and to cover co-pays for care before they meet their deductibles.

Health Care For All (HCFA) is deeply concerned about the implications this increased spending has on the ability of individuals and families to access the comprehensive, high-quality care they need when they need it. HCFA’s Director of Policy and Government Relations Brian Rosman told the Boston Globe, "We know that people with high cost sharing, high co-pays, high deductibles end up delaying care that they need and that leads to worsening of their conditions and higher costs later on.”

We need to take more aggressive action to control the growth of drug prices and to contain out-of-pocket costs so that access to equitable, affordable, and comprehensive health care is a reality for ALL Massachusetts residents. Stay tuned to learn more about HCFA’s priorities for the upcoming legislative session and how you can get involved.

                                                                                                                                                                                          -Natalie Litton

September 6, 2018

Massachusetts Health Connector

It’s hard to believe, but true. Massachusetts has among the highest costs for medical care in the country. Yet, paradoxically, for people who obtain their insurance through the Health Connector, we have the lowest average premium costs in the country. Our “benchmark plan” (explained below) is the second lowest nationally. And these findings apply to the unsubsidized cost of the plans, before the federal tax credits and state ConnectorCare subsidies.  As one expert analyst put it, “Which state has the least-expensive ACA policies? Take a guess. No, guess again.” (link)

A number of senior Connector staff members explore this in a blog post in Health Affairs. They point out that what makes this even more remarkable is that Massachusetts requires insurers to cover more benefits than national standards due to our extensive state benefit mandates. In addition, plans here must limit out-of-pocket costs as part of state health reform’s “minimum creditable coverage” requirements. Yet, our premiums are still the lowest. Robust consumer protections need not come at the expense of affordability.

Average state exchange premium levels are calculated based on premiums paid by all individuals purchasing coverage, at every metallic tier and for every carrier. For 2018, the Massachusetts average monthly premium was $385, compared to a national average of $600 a month, making us the lowest in the country. We were the lowest in 2017 as well.    

The benchmark premium is the premium for the second-lowest cost silver plan offered in a state’s exchange. The federal government uses that amount as the basis for setting federal tax credits offered to people eligible for subsidized coverage under the ACA. For this measure, we are the second lowest, at $316 per month for 2018. Rhode Island is a smidge less, with a $311 monthly premium (see this chart). Offering a low benchmark plan saves federal taxpayers money because it leads to lower tax credits APTC subsidies. Unsubsidized shoppers also save money, because they can choose from low-cost silver plans.

The blog authors emphasize that Massachusetts’ success in keeping premiums more affordable can provides lessons to other states. A number of factors contribute to our broad enrollment, which keeps premiums low. One of the Health Connector’s most unique features is the ConnectorCare program for individuals earning up to three times the poverty level. The program provides additional state subsidies to lower-cost silver tier plans by providing both premium and cost-sharing subsidies “on top” of Affordable Care Act subsidies. Enrollees have access to zero or low-dollar premium plans, zero or low-dollar co-pays, with no deductibles or co-insurance. Massachusetts’ extensive network of enrollment assisters reach out and help people enroll in coverage. ConnectorCare covers approximately 190,000 individuals, constituting about three-quarters of total individual enrollment in the Health Connector. This extensive membership rewards ConnectorCare plans that offer low premiums, encouraging them to keep administrative costs low and take advantage of their MassHealth managed care plan networks.

Massachusetts’ lower premiums are also a function of the competition in our marketplace, with multiple carriers offering plans and a structure that encourages comparison shopping. The Health Connector’s standardized plan requirement lets consumers make apples-to-apples comparisons among plans, rather than face a jumble of different deductibles, copays and benefit levels.  Affordability of health coverage is also helped by the large risk pool that includes plans offered by small employers as well as individual coverage. In addition, because Massachusetts has retained its state-level individual mandate, fewer healthy individuals are tempted to go without coverage.

The Massachusetts health care policy community should be proud of our collective work together, reflected in the success that the Health Connector has achieved in controlling premium growth over the past few years. Yet challenges will persist. In 2019, the continued withholding by the Trump administration of federal Cost Sharing Reduction payments to insurers will again force carriers to increase premiums, raising costs for unsubsidized individuals.

More broadly, there’s still much to do to make health care affordable for everyone in the state. Many people struggle with high deductibles and copays. Drug costs in particular continue to go up unabated and the state needs to take aggressive steps to rein in pharmacy costs. Lots of good ideas are being tossed around for states to consider.

States should look to Massachusetts as a laboratory for good policy ideas. Already, New Jersey, Vermont and DC have followed our lead and passed their own individual mandates. Other states are looking at this option as well. Ultimately, it will take a federal government supportive of increased insurance coverage and affordability to continue the progressive path interrupted by the 2016 election.