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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

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.

 

December 11, 2018

On Saturday, November 17th, HCFA hosted a successful health care enrollment and education session at the Waltham Public Library. This effort was part of the Health Connector's Stay Covered Campaign that aims at ensuring that Massachusetts residents utilize the Open Enrollment period to apply for health insurance or change plans.

In October, the HelpLine noticed an uptick in calls from the Waltham area particularly on the Spanish line. We found out that there were no longer any Certified Application Counselors at the Charles River Community Health Center. From the increased call volume, it was clear residents of Waltham would need additional support during Open Enrollment. Because we had not previously worked closely with community leaders in Waltham, we had to lay the groundwork to find a location and get the word out to the appropriate organizations.

Within a few weeks we found a location, met with community organizations, flyered businesses on main streets in Waltham, sent information through the school system, and outreached with Charles River. Due to the fear in immigrant communities about changes to public charge and what that means for health coverage, we wanted to have immigration counselors available at the event. We had immigration counselors from the Irish International Immigration Center and Catholic Charities along with a public benefits lawyer from Health Law Advocates. We had a Certified Application Counselor from Partners Newton-Wellesley Hospital as well as a Navigator from the Fishing Partnership assisting attendees alongside Health Care For All's Certified Application Counselors. A Community-Health Outreach worker from Charles River Community Health was on site for attendees that needed help finding a primary care physician.

As our team of volunteers arrived to set up, a line of folks already awaiting enrollment and immigration services at the Waltham Public Library greeted us. While our counselors put together the final touches in their respective work spaces, we began to welcome the Waltham community. Family by family we listened to needs and proceeded accordingly. The services sought after varied from first time medical insurance coverage, to renewals, and immigration consultations. The room was filled with parents with newborns, children at play, grandparents waiting patiently, and adults chatting with friends who came to the event together seeking to have their questions answered. Over the span of five hours, we saw people come and go, hopeful to be assisted with health care and immigration support.  

We ended up serving 82 households with help getting health coverage. 70% spoke Spanish, 14% spoke Portuguese, 13% primarily spoke English and 3% spoke Haitian Creole.  Of the 82 attendees, 14 households opted to speak with one of the immigration lawyers. 60% were referred by Charles River, 29% heard about the event from a friend or relative, 6% heard from school, 4% heard about the event from the library, and 1% specifically mentioned seeing a flyer.

Many thanks to the Health Connector for their tremendous support and their efforts to get people covered this Open Enrollment season through their #StayCovered Campaign. Thank you to all volunteers and Health Law Advocates, Catholic Charities of Boston, and Irish International Immigrant Center for partnering with HCFA to address questions regarding the impact of the use of benefits for immigrants. Thank you also to The Fishing Partnership Support Services and Partners Health Care for your continuous support and for offering to assist HCFA's HelpLine in enrolling individuals into health insurance at the event.

 

December 5, 2018

In 2016, the rate of uninsured children in the United States hit an historic low of 4.7 percent. In a report released last week, the Georgetown University Health Policy Institute’s Center for Children and Families finds that number increased to 5 percent in 2017, marking the first rise in the number of uninsured children nationally since comparable data was first collected nearly a decade ago. 

Here in Massachusetts, we boast an uninsured rate significantly lower than the national numbers. Nevertheless, this report gives us pause because it shows that the Commonwealth joined eight other states in experiencing a statistically significant increase in its rate of uninsured children, with the numbers increasing by 0.5% from 15,000 children in 2016 to 22,000 children in 2017. The reasons for this are not clear, but the findings should be a wake-up call to all of us.

Nationally, the report attributes these shifts in large part to “strong national currents” that include the ultimately unsuccessful effort to repeal the Affordable Care Act (ACA) and cap federal Medicaid funding, a Congressional delay that caused a temporary lapse in funding for the Children’s Health Insurance Program (CHIP), and efforts to undermine ACA Marketplaces which includes reducing outreach and enrollment grants as well as shortening the enrollment period. The authors caution that “…there is every reason to believe the decline in coverage is likely to continue and may get worse in 2018.” At the heart of this warning is worry about the recently proposed changes to the federal “public charge” rule which creates new tests on income and use of public benefits for lawfully present immigrants seeking to adjust their immigration status. The report cites a recent study that found that “implementation of the proposed rule could lead to a reduction in Medicaid enrollment of between 2.1 million to 4.9 people and posits the likelihood that children would “make up the majority who are disenrolled.”

At Health Care For All, we know that health insurance coverage is at the foundation of ensuring that children can access the health care services they need to grow, learn and thrive. Massachusetts is doing well, but we must remain vigilant in our efforts to enroll children and families in high-quality, affordable coverage and to protect, improve and expand the coverage that is available.
 
Our efforts must include active and vocal opposition to the proposed changes to the public charge rule during the public comment period. Join us now by learning more about the proposed changes and submitting your own comment of opposition before December 10th.

-Natalie Litton

November 5, 2018

The Department of Homeland Security (DHS) officially posted the "public charge" regulatory proposal that would significantly expand the list of public benefits that will pose barriers to immigrants' ability to obtain permanent residence via family or employment channels and prevent many from switching between non-immigrant statuses.
 
As part of the national Protecting Immigrant Families (PIF) campaign, the Massachusetts Law Reform Institute, Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), Health Care For All and Health Law Advocates are working together to make sure that we in the Commonwealth of Massachusetts respond to these administrative actions effectively and strategically.

Since its publication in the Federal Register on October 10, 2018, a 60 day comment period has opened for the public to oppose the rule. The public comment period is open until December 10, 2018. We've launched a public comment drive, with a goal of 3,000 comments from Massachusetts. No special expertise is needed: Whether you're an immigrant yourself, a community advocate, a service provider, a business owner, an elected official or just a concerned citizen, you can help us ensure that the government is overwhelmed with opposition to the "public charge" proposal.

MIRA has put together guidance and helpful resources on their website; and they also have an easy-to-use comment submission form with questions to guide you.

For more information, please view this public charge statement on behalf of Massachusetts Protecting Immigrant Families Campaign (PIF-MA: MIRA, HCFA, HLA, MLRI).

Please also see these resources for advocates available in English, Spanish, and Portuguese.

October 24, 2018

Health Care For All and Health Law Advocates represent the needs of consumers in the health care system. As organizations focused on coverage, access, and affordability, we are concerned that Ballot Question 1 could have unintended consequences. Our goal is to ensure that consumers can make an informed decision about this question.

Meeting the proposed nurse staffing ratios could be particularly challenging for community-based hospitals, community health centers, and safety-net hospitals that disproportionately serve people of color, immigrants, and low-income families. It could put pressure on our behavioral health system, which is already experiencing significant staffing shortages, and could further reduce access to care. In addition, the Massachusetts Health Policy Commission projects an additional $676 million to $949 million annual cost to the health care system if the initiative passes. These costs may ultimately be passed on to consumers in the form of higher premiums and out-of-pocket expenses.

Health Care For All will continue to advocate for health justice in Massachusetts by promoting health equity and ensuring coverage and access for all. Health Law Advocates will continue to provide pro bono legal representation to low-income residents experiencing difficulty accessing or paying for needed medical services.

October 18, 2018

The Department of Homeland Security released the public charge rule for public comment. It was published in the Federal Register on Wednesday, October 10, 2018, marking the beginning of the 60-day comment period. At least 22 Senators have already opposed the rule in a letter to DHS, asking for it to be withdrawn altogether. After DHS considers public comments received on the proposed rule, DHS plans to issue a final public charge rule that will include an effective date at least 60 days after the date the final rule is published. In the meantime, and until a final rule is in effect, federal immigration officials will continue to apply the current public charge policy.

As part of the national Protecting Immigrant Families (PIF) campaign, the Massachusetts Law Reform Institute, Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), Health Care For All and Health Law Advocates are working together to make sure that we in the Commonwealth of Massachusetts respond to these administrative actions effectively and strategically.

The public comment period is open until December 10, 2018. We've launched a public comment drive, with a goal of 2,000 comments from Massachusetts. No special expertise is needed: Whether you're an immigrant yourself, a community advocate, a service provider, a business owner, an elected official or just a concerned citizen, you can help us ensure that the government is overwhelmed with opposition to the "public charge" proposal.

MIRA has put together guidance and helpful resources on their website; and they also have an easy-to-use comment submission form with questions to guide you.

For more information, please view this public charge statement on behalf of Massachusetts Protecting Immigrant Families Campaign (PIF-MA: MIRA, HCFA, HLA, MLRI).

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. 

August 23, 2018

Much of the increased attention on immigration has been fueled by the belief that immigrants are a financial drain on the American economy, particularly on the health care system. A recently published study finds this claim to be false. 

The meta-analysis, Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review, written by Boston researchers Lila Flavin, Leah Zallman, Danny McCormick, and J. Wesley Boyd, focused on 16 peer-reviewed studies looking at medical expenditures of immigrant populations in the US. 

They found, contrary to popular belief, that immigrants consume less health care system resources compared to US-born individuals. Foreign-born persons make up 12% of the population, but only contribute to 8.6% of overall expenditures. Among immigrants with insurance, healthcare costs were 52% lower than American-born individuals.  They concluded that,  “Overall, immigrants almost certainly paid more toward medical expenses than they withdrew, providing a low-risk pool that subsidized the public and private health insurance markets.”

The study found that especially for Medicare, immigrants contribute more to the health care system financially than they use. This is particularly true for younger immigrants, found Cato Institute’s immigrant policy analyst, Alex Nowrasteh. Statistically, younger immigrants “pay more into the system than they take out over the course of their lives.” 

“Our review of the literature overwhelmingly showed that immigrants spend less on healthcare, including publicly funded health care, compared to their U.S.-born counterparts,” the authors of the study wrote. “Moreover, immigrants contributed more towards Medicare than they withdrew; they are net contributors to Medicare’s trust fund.”

Consensus seems to have been struck in the public health community: denying immigrants green cards will not fix America’s welfare system, and will increase burden for the federal government. These researchers concluded that government should remove nonfinancial barriers to enrolling in health insurance. In fact, they argue that the US should provide insurance to foreign-born individuals, particularly to newly arrived immigrants, since it would be financially sound to enroll those who (on average) contribute more than they withdraw from the health care system.

The Cato Institute recently conducted a cost-benefit analysis of the proposed regulation that would deny immigrants green cards and thus access to health care coverage, and found that it would cost $1.46 for every dollar saved. The research also showed that this proposed regulation will not protect taxpayer’s money, but will instead backfire and increase spending while negatively impact the health of individuals and communities. The current administration rejects any fiscal connection between immigration and public benefits, citing a lack of research, which is not accurate based on the already available data. Consumers and advocates alike need to continue to work to protect health care access as well as fact-based approaches to health care policy.

-Leah Dreyfus

 

 

July 16, 2018

Health Care For All, along with MassPIRG, Health Law Advocates, Community Catalyst and the Massachusetts Senior Action Council recently wrote a letter on the issue of drug transparency to the conferees meeting to work out a final health care bill. We urged the Conference Committee to include strong transparency measures to help tackle the problem of skyrocketing prescription drug prices.

Prescription drug costs are currently the fastest growing healthcare expense – by far. For both public and private plans, increases in pharmacy costs far outpace every other expense. Rising drug prices are increasing health care costs, placing significant burden on consumers and putting pressure on the state budget.

A major obstacle in controlling drug price growth is a lack of transparency on pricing trends, rebates, discounts, and pharmaceutical benefit managers. Actual prices paid for drugs are hidden behind a complex veil of intermediaries, and effective transparency provisions would allow the public and policymakers to understand the causes of high prices and cost growth.

We urge the Conference Committee to adopt the Senate language, which provide for more extensive disclosures and would strengthen the ability of policymakers and the public to judge if we are getting good value for our billions spent on prescription drugs. We believe that Massachusetts should join a number of other states that have enacted strong transparency requirements to further the goals of affordable care.

If you are interested in understanding the extent of these factors, read the complete letter here.

-Louis Pratt

July 10, 2018

With both the House and Senate having passed ambitious health care bills this session, now a joint House-Senate conference committee is hammering out the differences to reconcile the two bills for final passage. Health Care For All recently provided comments to the legislature on our recommendations for provisions  to reduce health care costs, protect consumers, and strengthen our state’s health care system.

While Massachusetts has the highest insurance coverage rate in the country, there is still progress to be made to improve the quality and affordability of health care in the Commonwealth. Some of the reforms that HCFA believes are important which were included in both the House and Senate bills are:

  • establishing an academic detailing program to provide independent evidence-based education that focuses on the therapeutic and cost-effective utilization of prescription drugs;
  • requiring the Center for Health Information and Analysis (CHIA) to develop and adopt a uniform methodology to communicate information on how health care providers are assigned to tiers;
  • requiring pharmacies to charge consumers the off-the-shelf price (the price people would pay with no insurance) if it is lower than their copay;
  • requiring insurers to continue coverage past age 26 for dependents with substantial disabilities.

For our full letter to the Conference Committee with detailed explanations of our positions, please click here. Here are summaries of HCFA’s recommendations regarding the legislation:

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