"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 15, 2019
Prescription drug prices continue to rise, placing a considerable burden on families and the state's budget. Over the past five years, prescription drug spending has nearly doubled in MassHealth, twice the rate of other spending in the program.
 
The Senate Ways and Means Committee recently included strong language in their proposed FY20 budget that would give MassHealth critical new tools to negotiate lower prices for unreasonably priced drugs.
 
Senator Boncore has filed an amendment that would significantly weaken this provision. Amendment #654 would keep drug price negotiations behind closed doors and prevent MassHealth from being able to hold drug manufacturers accountable.
 
Drug manufacturers should be able to make a profit on their life-saving products, but patients and the state should understand how much these drugs cost and be able to negotiate a fair price. Drugs only work if people can afford to buy them.
 
Beginning next week, the Senate will hold its budget debate. Please call or email your Senator this week to urge them to oppose Amendment #654 and maintain their commitment to address rapidly rising drug costs.
 
Find out who your Senator is and their contact information hereand you can use the email and call scripts below. 
 
We appreciate you taking action on this critical issue to address high drug costs in the MassHealth program. Please contact Yaminah Romulus at yromulus@hcfama.org or 617-275-2935 if you have questions about how to oppose this amendment.
 
Thank you,
Yaminah 
 
Phone Script Opposing Amendment #654:
 
Hi, my name is ______.
 
May 9, 2019

Just as the mouth is part of the body, oral health is a part of overall health. People cannot be healthy unless they have access to the dental services they need.When dental disease is left untreated it can lead to systemic infection, hospitalization, and the worsening of other medical conditions. For years, Health Care For All has worked on issues related to oral health, including public awareness about the importance of oral health, and access to comprehensive dental care for everyone.

 

Last Tuesday, HCFA and our allies in the Oral Health Advocacy Taskforce took to Beacon Hill to testify before the Joint Committee on Public Health in support of An Act to Improve Oral Health For All Massachusetts Residents (S.1215/H.1916) legislation that authorizes an additional dental professional, called the dental therapist, to work with a dentist to provide oral health care to more people. HCFA also testified on behalf of An Act Relative to the Restoration of MassHealth Adult Dental Benefits (S. 1212/H. 1917) A bill that will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. HCFA also provided key testimony to the committee in support of An Act to Promote Public Health Through the Prevention and Wellness Trust Fund (S. 1293/H. 2012) This bill would maintain the solvency of the Prevention and Wellness Trust Fund (PWTF) which funded successful clinical-community partnerships focused on childhood asthma, falls among older adults, hypertension, and tobacco use.

 

The room at the hearing was packed on Tuesday. A wide range of stakeholders, including: The Better Oral Health in Massachusetts Coalition, the MassLeague of Community Health Centers, the Mass Dental Hygienists Association, the Forsyth Institute, Massachusetts Senior Action Council, Rosie’s Place, and the ARC of Massachusetts, to name a few, testified in support of the two oral health bills.

HCFA’s Oral Health Program Director, Dr. Neetu Singh, led the charge in providing expert testimony for both bills. Dr Singh made the case that restoring full MassHealth adult dental benefits would not only benefit the Commonwealth’s oral health, but the state’s financial health as well, pointing out that patients who have to skip the dentist’s office are far more likely to end up in the emergency room. Dr. Singh shared research showing that MassHealth members disproportionately use the Emergency Department (ED) for preventable oral health conditions at a cost 4-7 times that of a community-based dental office visit. In just one year, there were over 36,000 preventable oral health ED visits in Massachusetts, costing the health care system between $15 million and $36 million.

April 12, 2019

Prescription drugs don’t work if people can’t afford them, and too many people in Massachusetts can’t afford the high cost of prescription drugs. Here at Health Care For All (HCFA), we know all too well – from real-life stories and statistical data alike – that this is true. That’s why HCFA is a leading member of the MA Prescription Drug Affordability Coalition, a broad-based coalition representing a wide range of stakeholders, including consumer advocates, seniors, children, individuals with disabilities, providers, provider groups, unions, faith-based groups, mental health organizations and health policy experts.

Yesterday marked a significant milestone in our fight to reduce prescription drug costs as we headed to the State House to testify before the Joint Committee on Health Care Financing, chaired by Senator Cindy Freidman and Representative Jennifer Benson. HCFA submitted both written and oral testimony in support of An Act to Ensure Prescription Drug Cost Transparency and Affordabilty (H.1133 / S.706), sponsored by Senator Jason Lewis and Representative Christine Barber. The legislation aims to make prescription drugs more affordable and available to consumers, make pharmaceutical costs more transparent, and contain costs for MassHealth, employers, and across the health care system.

The hearing room was packed as individuals and groups on both sides of the debate converged to testify on this and other bills related to prescription drug costs. Mary Mack came all the way from Nantucket to share her story as someone who lives with advanced heart failure and muscular dystrophy as the result of a genetic defect. When she started a new cardiac drug, it made “a significant difference” in her life. At $150, however, the copay was the equivalence of a car payment or a trip to the grocery store to feed her family. In order to afford the copay, she was forced to neglect other doctors appointments, accrue credit card debt and fall behind on bills. When the copay increased even more, Mary had to stop taking the drug in order to meet her car payments. Now that Mary has paid off her car, she is taking the medication again, but in order to afford the monthly $225 copay, Mary and her family must make other sacrifices.

Panels included consumers who have struggled with the cost of insulin to treat their Diabetes, seniors and representatives from Health Law Advocates, the Massachusetts Medical Society, MASSPIRG, 1199SEIU, the Disability Policy Consortium, the Greater Boston Interfaith Organization, and AARP-MA.

HCFA Executive Director Amy Rosenthal drew on the stories of callers to our consumer HelpLine as she emphasized the importance of a crucial element of this legislation: giving state regulators the authority to set an Upper Payment Limit (UPL) on prescription drugs deemed unreasonably expensive. This would create an upper limit on what anyone, including doctors, pharmacies, insurers and patients, could be required to pay for a drug. Amy also placed the fight for increased transparency and lower costs in the broader context of health care access. “Health reform worked because of shared responsibility among the state, consumers, employers, payers and providers.” Of the current efforts, she said, “It’s time for the pharmaceutical industry to step up.”

Chairwoman Cindy Freidman seemed to agree. "You all have had a long time to be transparent," she told Bob Coughlin, president and CEO of MassBio, a pharmaceutical industry trade organization. "Pharmaceutical companies have had a long time to come to the table and say let us be as transparent as our insurance companies are and as all the other parts of health care that we patrol. You have had that opportunity, and you haven't done it. With all due respect, we want you at the table but we need you to be equal partners and be willing to understand that you have skin in the game, we have skin in the game, everybody in this room does."

Multiple panels featured the testimony of those who have the most “skin in the game” – Massachusetts consumers who, for too long, have been forced to make unfair decisions between the necessities of life and the prescription drugs their lives often depend on. HCFA and the MA Prescription Drug Affordability Coalition invite you to join our fight for #AffordableRxNow. This is just the beginning.

-Natalie Litton

April 5, 2019

The immigrant community has always been at the core of much of the work that Health Care For All (HCFA) does. HCFA’s HelpLine handles over 20,000 calls each year, and 50% percent of these calls come from individuals who do not speak English as a first language. Many of our callers are immigrants. Over the years, we have implemented outreach and educational activities in areas of Massachusetts with a higher concentration of foreign-born populations, such as Framingham, Chelsea, Lowell, Waltham, and Somerville. Even though health disparities persist, we have made great strides in connecting foreign-born communities to health coverage and care. Some of that progress is now on the line.

Soon after the presidential election in November 2016, we started hearing from providers about immigrant patients who were delaying care or skipping doctors’ appointments altogether due to fear and mistrust. The constant attack on our communities, the anti-immigrant rhetoric coming from the Trump Administration and newly introduced policies, were leading a part of the population back into the shadows. These policies include the end of programs such as the Temporary Protected Status (TPS) and Deferred Action for Childhood Arrivals (DACA), the changes to public charge regulations (a proposed rule that can prevent immigrants who use specific public benefits from adjusting status or becoming permanent residents), a surge in immigration enforcement activities, detention and deportation raids, news about immigrant children detained at facilities at the border, and other policies.

HCFA is in regularly in contact with community leaders who have told us about residents not attending English classes or showing up at community events. We also heard about people not renewing their health care coverage, skipping vaccinations, not seeing a doctor before flu symptoms got out of control that turned into pneumonia, and other instances where our neighbors were not accessing the preventive services they need to get healthy and stay healthy. This places our public health system at risk.

We knew it was time to step up work in this area and with the support of several foundations, we developed and implemented a project to educate community members, leaders, advocates, providers and other stakeholders about the rights that immigrants have to health insurance and access to health care services. These efforts have helped bring important information to our communities and, as a result, we have conducted trainings throughout the region, with a particular focus on the Greater Boston and Greater Framingham areas.

In 2018, HCFA, in collaboration with the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) and Health Law Advocates (HLA) held “Democracy School: Building Health Care Power in Immigrant Communities”. At this event, 65 activists, immigration and service providers, and volunteers improved their understanding of how immigration issues relate to health care and public health. Participants were then able to bring the lessons learned in this training back to their agencies and communities. These three organizations are partnering again in 2019, and we are inviting those interested to attend a new edition of the Democracy School that will take place in downtown Boston on Saturday May 18th, from 9:30AM to 2 PM. You can be part of the solution by joining us that day. Please contact Rosana Gijsen, HCFA’s Outreach Coordinator at  rgijsen@hcfama.org  to confirm attendance by April 20th.  

- Maria Gonzalez, Strategy and Communications Director, Health Care For All

 

 

This blog is part of HCFA’s 2019 Public Health Awareness Week series.

April 4, 2019

Well-baby and well-child visits, vaccines, eyeglasses, and dental services are the building blocks of a healthy childhood and provide an essential foundation for wellness throughout the life-span. Data shows that comprehensive Medicaid coverage facilitates access to this care in childhood, and although children’s health insurance coverage in Massachusetts is strong, gaps still exist. While we can be proud that 98% of the Commonwealth’s children have some form of health insurance, we must address the inequities that remain.

Today in Massachusetts thousands of low-income children meet every requirement for MassHealth eligibility except for their immigration status. As a result, these children can access only the bare-bones Children’s Medical Security Plan (CMSP) as their primary coverage. This provides preventive care but places strict annual caps and limits on other benefits such as prescription drugs, outpatient mental health visits and durable medical equipment. As a result, many children are left without the full range of care that they need to live, learn and thrive here in the Commonwealth.

This is why Health Care For All (HCFA) and our Children’s Health Access Coalition (CHAC) are teaming up with partners across Massachusetts to pass An Act to Ensure Equitable Health Coverage for Children (HB 162 / SB 677) with lead sponsors Senator Sal DiDomenico and Representative Dave Rogers. The legislation would expand full comprehensive MassHealth coverage to all income-eligible children regardless of immigration status because all kids deserve an equal start at building a healthy life and preventing long-term health problems.

Real stories guide our campaign. Stories of children like seven year-old Sonya who has Type-1 Diabetes. Her doctors had great difficulty regulating her blood sugar levels until she got an insulin pump, which changed her life. However, the medical supplies to keep Sonya’s pump operable cost approximately $1,000 each month. In less than one month, she exceeded CMSP’s $500 coverage limit on durable medical equipment. Sonya’s mother has to rely on charity care and donations to pay for the supplies, and Sonya’s health was at risk.

Data grounds our campaign and shows us that investments in comprehensive coverage for children today means healthier adults tomorrow, too. Research shows that children with comprehensive coverage are more likely to receive preventive care and are less likely to have unmet medical and dental needs. The benefits of comprehensive coverage extend beyond the doctor’s office and show that children with comprehensive coverage have increased success in school and higher educational attainment than kids who don’t have comprehensive coverage. Finally, comprehensive coverage in childhood has been linked to better overall health in adulthood, including lower prevalence of high blood pressure, diabetes, heart disease or heart attack, and obesity.

HCFA advocates for health justice by working to promote health equity and ensure coverage and access for all. Equitable, comprehensive coverage for all kids is a crucial piece of the health equity puzzle. To share your story, learn more about the campaign or to get involved, please contact Natalie Litton at nalitton@hcfama.org or (617)275-2897.

- Natalie Litton, Policy & Project Coordinator, Health Care For All

 

This blog is part of HCFA’s 2019 National Public Health Awareness Week series.

April 3, 2019

As many of us have experienced first-hand, taking a regular regimen of medication prescribed by a provider can have remarkable effects on the quality of our daily lives and our ability to build a healthy future for ourselves and those around us. Prescription drugs are critical to curing disease, managing medical conditions, controlling debilitating symptoms and helping us avoid the need for more serious and expensive care. In short, prescription drugs bring hope and improved health to individuals and families and contribute to the public health of the Commonwealth every day.

But there is more to the story: Prescription drugs don’t work if people can’t afford them, and too many people in Massachusetts can’t afford the high cost of prescription drugs. Consider John, who reached out to Health Care For All (HCFA) for help. John had suffered a stroke and a heart attack but was forced to wean himself off of most of his medications because he could not afford the co-pays under his wife’s insurance plan. After his wife passed away, John was working part-time and staying at friends’ homes and in hotel rooms. HCFA helped him complete an application for MassHealth, but while he was trying to find a doctor and waiting to receive verification of his income for his coverage, he ran out of medication. John ended up in the emergency room and, because of all this, he lost his job. The good news is that HCFA’s HelpLine counselors were able to finalize John’s MassHealth enrollment, and helped him fill the prescription while he was in the hospital. The reality is that the unaffordability of his prescription drugs had a negative impact on John, his health, and his life multiple times over the course of this time period.

Stories like John’s are common – and such anecdotal evidence is backed up by multiple studies that show that high cost-sharing for prescription drugs leads patients not to take the drugs their doctors prescribe. The affordability of prescription drugs goes to the core of health justice. Access to life-changing and life-saving prescription drugs must be a right for all who need them – not a privilege reserved for those who can afford them.

As a result, HCFA is leading the charge here in Massachusetts to make prescription drugs more affordable for consumers and increase the transparency surrounding what it actually costs to produce a drug. Along with lead sponsors Representative Christine Barber and Senator Jason Lewis, HCFA filed An Act to Ensure Prescription Drug Cost Transparency and Affordability (HB 1133 / SB 706). This bill seeks to:

  • Make drugs affordable and available to consumers
  • Make pharmaceutical costs more transparent and affordable for the health care system
  • Contain costs for MassHealth
  • Require the pharmaceutical industry to do their fair share to control health care costs

This legislation uses a number of strategies that include providing transparency around the underlying costs to produce prescription drugs; restraining abuses of pharmacy benefit managers (PBMs); authorizing the HPC to set upper payment limits for unreasonably high-priced drugs; requiring pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using health insurance; providing tools to strengthen MassHealth’s ability to negotiate lower drug prices; and permanently authorizing and funding “academic detailing,” an evidence-based prescriber education program.

Personal stories are a powerful tool when advocating for change. If you or a family member have struggled to afford prescription drugs, and want to share your story, please contact Yaminah Romulus at yromulus@hcfama.org.

- Natalie Litton, Policy & Project Coordinator, Health Care For All

 

This blog is part of HCFA’s 2019 Public Health Awareness Week series.

April 2, 2019

Everyone should have the opportunity to have good health; oral health is an important component of this. In honor of National Public Health Week, we are highlighting the importance of oral health in maintaining the overall health of all people.

For far too long, oral health has been kept separate from overall health. The truth of the matter is that an infection of the mouth can affect the rest of the body. Dental infections and disease can lead to significant long-term effects on a person’s general health such as pain, systemic infections, hospitalizations, worsening of other medical conditions such as diabetes, heart disease and pre-term births. Poor oral health can also be associated with a lower quality of life in the form of poor self-esteem and mental health, poor nutrition and sleep disruption. Oral disease is directly responsible for an estimated 164 million work hours lost in the U.S. each year. Preventing tooth loss, decay, and gum disease can reduce the risk of these challenges and complications.

Health Care For All (HCFA) is working toward improving oral health and reducing barriers to care in the Commonwealth through various policy initiatives led by its long-standing oral health coalition, the Oral Health Advocacy Taskforce (OHAT). A key policy priority is to integrate dental care into the current health care delivery system and through new models of care delivery such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs) that are specifically designed to focus on patient-centered, whole-person health. One of the first steps in this integration work is advocating for medical providers to ask patients if they have a dentist and to apply fluoride varnish to the teeth of patients who are at high risk of developing cavities.

Additionally, we also understand that many in Massachusetts struggle to access dental care because of difficulties finding dentists who accept public insurance, the prohibitive costs of dental care, and the challenge of travelling to a dentist’s office. Historically, we also know that when residents don’t have access to appropriate and timely dental services, they are likely to forgo care until significant pain forces them to seek medical treatment in hospital emergency rooms. Sadly, medical providers can often prescribe only pain medications, including opioids, and antibiotics, leaving the underlying dental disease untreated. This is particularly concerning at time when we continue to grapple with the opioid crisis locally and nationally.

To address these challenges, HCFA and OHAT are championing two key oral health bills in MA this year. We thank our legislative champions, Senator Emeritus Chandler, Senator Hogan and Representatives Honan and Pignatelli for their support and leadership. One bill is for the restoration of full dental coverage for adults on MassHealth (S.1212/H.1917), and the other is the authorization of an additional type of dental professional, called a Dental Therapist (S.1215/H.1916) who would work with a dentist, similar to the way a nurse practitioner works with a physician. We encourage you to advocate for these bills by calling your state legislators to let them know why improving access to oral health is important to you. Oral health matters to HCFA because we believe that people cannot be healthy unless they have the access to the dental services they need. Oral health is public health and a health justice issue we are committed to overcoming by increasing the dental access of marginalized populations such as older adults, immigrants, and communities of color. 

For additional information please contact Chrystel Murrieta at cmurrieta@hcfama.org or 617-275-2928

- Dr. Neetu Singh & Chrystel Murrieta, Oral Health Team, Health Care For All

 

This blog is part of HCFA’s 2019 National Public Health Awareness Week series.

April 1, 2019

Today marks the first day of National Public Health Week (NPHW) organized by the American Public Health Association (APHA) to celebrate the importance of public health in protecting the health and well-being of all Americans. The theme for this year’s NPHW campaign is “Creating the Healthiest Nation: For science. For action. For health.” and Health Care For All (HCFA) is excited to join the campaign by sharing consumer health advocacy efforts underway in Massachusetts which, we believe, have direct impacts on improving public health in our state. More specifically, every day this week, HCFA will highlight a key consumer health advocacy topic that we are currently championing by publishing a blog on the issue and sharing information on social media.

According to the American Public Health Association “Public health promotes and protects the health of people and the communities where they live, learn, work and play.” We believe a big part of our work is promoting public health and we this as a fundamental way to promote health justice in the Commonwealth.

For over 30 years, HCFA has run campaigns that are driven by the information we hear directly from consumers who call our HelpLine or attend community-based events. Our HelpLine fields over 20,000 calls every year from people who need assistance gaining health coverage. We proudly offer these services because we know that health insurance coverage is a vital component of ensuring access to health care, related services and resources that keep individuals and communities healthy. We also know that high levels of health insurance coverage do not guarantee access to affordable, quality health care. In 2018, the Massachusetts Health Reform Survey found that despite near-universal coverage (96.0%) for adults in Massachusetts, almost half (49.1%) reported difficulty obtaining health care over the past year. The survey also found that almost 40% (38.1%) of adults refrained from seeking necessary health care services, with half (18.6%) 38.1% siting the cost of care as primary reason for deferring their care.  Not surprisingly, low and moderate income adults were more likely than higher-income adults to report difficulties obtaining care and unmet need for care.

While improving access to affordable health insurance coverage is an essential aspect of HCFA’s work, we are also active on several other consumer health advocacy projects that directly impact public health in Massachusetts. Throughout this week, we will feature a blog on one HCFA project area and share its challenges, solutions and potential opportunities for consumer engagement. Tomorrow, the blog will focus on our oral health advocacy work which is based on the understanding that oral health is a necessary component of overall health. On Wednesday, we will highlight the important education and outreach we have been conducting around immigrant health issues and how supporting the health and well-being of our immigrant communities promotes public health. Thursday’s blog will focus on children’s health and discuss our Cover All Kids campaign that is working to ensure comprehensive coverage for all children in Massachusetts regardless of immigration status. Finally, on Friday we will discuss our prescription drug campaign which seeks to reign in the high cost of prescription drugs in Massachusetts to ensure affordability for all residents.

HCFA genuinely values each of the consumers health issues we work on and are committed to building a strong health justice movement in Massachusetts that promotes health equity and ensures coverage and access for all. However, we know that partnering with health care consumers to uplift the health care issues that you care deeply about and building collective grassroots power is the most important way to make meaningful change to our health care system! Please follow/share our blog series and social media campaign as we participate in NPHW and bring attention to the importance of health justice and public health efforts underway in Massachusetts! Please reach out to Chrystel Murrieta at cmurrieta@hcfama.org with any questions or suggestions.

Amy Rosenthal, Executive Director, Health Care For All

This blog is part of HCFA’s 2019 National Public Health Week series.

January 29, 2019

Prescription Drugs

  • Reduce Prescription Drug Costs (H. 1133/S. 706, Representative Barber & Senator Lewis)
    • Prescription drug prices are the leading factor in driving up health care costs across the system, impacting the budgets of individuals, families, employers and the state. An Act to ensure prescription drug cost transparency and affordability will: provide transparency around the underlying costs to produce prescription drugs; restrain abuses of pharmacy benefit managers (PBMs); authorize the Health Policy Commission to set upper payment limits for unreasonably high-priced drugs; require pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using insurance; provide tools to strengthen MassHealth’s ability to negotiate lower drug prices; and support a permanent authorization and funding source for “academic detailing” to ensure doctors get accurate information to counter biased drug manufacturer marketing.
  • Limit the wining and dining of doctors by drug marketing sales personnel: (S. 703, Senator Lewis)
    • Research has shown that the provision of meals is effective in influencing a doctor’s prescribing practices. In 2008, HCFA was instrumental in passing a Massachusetts law that limits these promotional efforts to “modest meals.” However, under strong pressure from drug companies and the restaurant industry, the state’s regulatory definitions have loose restrictions on meals and permit alcoholic drinks at these educational programs. An Act to define modest meals and refreshments in prescriber education settings will put reasonable limits on meals and ban all alcohol in these settings.

Children’s Health Access

  • Expand Health Coverage for Children (H. 162/S. 677, Representative D. Rogers & Senator DiDomenico)
    • Currently, low-income immigrant children who are not otherwise eligible for MassHealth can access only very limited health coverage, which leaves them without adequate access to many services, including prescription drugs, mental health services, durable medical equipment, dental services, and emergency care. An Act to ensure equitable health coverage for children would expand MassHealth coverage to low-income children whose only barrier to accessing comprehensive coverage is their immigration status. Other states, including California, Washington, Oregon, Illinois and New York have already enacted this policy.

Dental Care Access

  • Expand Access to Dental Care through Dental Therapists (H. 1916/S. 1215, Representatives Hogan and Pignatelli & Senator Chandler)
    • The most vulnerable populations in Massachusetts often forgo their oral health needs due to the lack of easy access to a dentist. An Act to improve oral health for all Massachusetts residents authorizes an additional dental professional, called the dental therapist (DT), to work with a dentist to provide oral health care to more people. DTs present a critical opportunity for Massachusetts to close gaps in dental access for seniors, low-income families, children, and people with special needs.
  • Restore Full MassHealth Dental Benefits (H. 1917/S. 1212, Representative Honan & Senator Chandler)
    • An Act relative to the restoration of MassHealth adult dental benefits will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. Important dental services that are vital for good oral health and saving teeth are not currently covered by MassHealth. Left untreated, dental disease can lead to systemic infection, hospitalization, and the worsening of other medical conditions. Oral health is an integral part of overall health and should be included in health coverage.

Private Health Insurance

  • Ensure Accuracy of Health Plan Provider Directories (H. 913/S. 610, Representative Barber & Senator Lewis)
    • Accurate provider directories are critical to ensuring that health coverage works for consumers.
      An Act to increase consumer transparency about insurance provider networks establishes a task force, chaired by the Division of Insurance, to make recommendations for regulations improving the accuracy of provider directories to ensure consistency across carriers. The bill also requires that provider directories be easily searchable, available to the public, and updated at least monthly.
  • Protect Consumers from Surprise Out of Network Bills (H. 967, Representative Farley-Bouvier)
    • Surprise billing occurs when patients receive out-of-network care that they did not or could not intentionally choose to receive, and then are faced with unexpected and unaffordable medical bills. An Act to protect consumers from surprise medical bills protects consumers by requiring health plans and providers to disclose comprehensive information to consumers about the network status of providers; requiring specific patient consent for out-of-network services; and prohibiting providers from billing consumers more than their in-network cost-sharing amount. Senator Welch filed legislation (S. 659, the PATIENT Act) that also includes provisions to protect consumers from surprise out-of-network billing.

Health Care Affordability

December 19, 2018

Last Friday, a federal judge in Texas ruled in favor of a lawsuit arguing that the federal individual mandate, and the entire Affordable Care Act (ACA) along with it, is unconstitutional. We are greatly disappointed about this ruling. The decision is misguided and we are hopeful that it will be appealed by a higher court. We have seen firsthand the impact of this life-saving law; this decision is a dangerous step back in the progress we have made towards universal coverage in Massachusetts and across the country. We will join any effort to prevent the ACA from being decimated any further, whether by legislative, administrative, or judicial attacks at the legislative.

We do, however, want to make clear that there is no impact for now. The ACA is still the law of the land. The Texas ruling will likely go to the Supreme Court and the process will take time. We know that the combination of the elimination of the individual mandate at the federal level, the different deadlines for open enrollment periods in some states, and now this ruling have made the current open enrollment period confusing for consumers. Nonetheless, the law is still in the books. In Massachusetts, open enrollment through the Health Connector started on November 1, 2018 and runs through January 23, 2019. People who want coverage beginning January 1, 2019 must apply, select a plan and pay their premium (if there is one) before December 23, 2018. After that, people who seek coverage must apply, select a plan, and pay their premium no later than January 23, 2019 for coverage beginning February 1, 2019.

While the Texas decision does not have an immediate impact on coverage for millions of people across the county, we recognize that it is important to monitor the situation and think about the future potential impact on Massachusetts and beyond. Although Massachusetts was the model for the ACA and we have many protections in state law, the Commonwealth is not shielded from what happens at the federal level. Massachusetts relies on a partnership with the federal government to provide the robust coverage options available to our residents. Regardless of what happens, some state protections will remain law, like the prohibition on denying coverage to people with pre-existing conditions, but federal funding is necessary to keep the subsidized coverage options through MassHealth and the Health Connector intact. If the ACA were to ultimately be deemed unconstitutional, many protections and affordable health coverage options would be in jeopardy, and the Massachusetts uninsurance rate would shoot up, reversing over 12 years of progress.

We must not let the attempted sabotage of the ACA deter consumers. Open enrollment continues in Massachusetts until January 23, 2019. People receiving health insurance, including those who receive premium and cost-sharing subsidies through the Health Connector or coverage through MassHealth will have no interruption in their benefits. Don’t wait! Head to https://mahealthconnector.optum.com/individual/ to apply for health insurance, select a plan and pay your premium by January 23, 2019.

To learn more about the ruling and its potential effect on Massachusetts, see this story from the Boston Globe, which features our Associate Director of Policy and Government Relations, Suzanne Curry.

 

Pages