"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

October 6, 2017

On Monday and Tuesday this week, the Massachusetts Health Policy Commission (HPC) held its 5th annual Health Care Cost Trends hearing. Government officials, health care providers, insurers, and advocates came together to provide testimony and answer questions from the HPC commissioners on strategies to contain health care costs.

Below are some of the major themes from the hearing, a number of which were also reflected in Health Care For All’s testimony to the HPC. You can read our full testimony here.

Massachusetts is below the state benchmark for spending growth, but there is more work to be done:

Massachusetts successfully remained under the state benchmark for health care spending growth in 2016. As of 2014, Massachusetts health care spending growth was the fourth lowest in the nation. In 2015 and 2016, Massachusetts remained below the US average in health care spending growth.

However, major problems remain in our health care spending. In 2014, Massachusetts still spent the second most in the country on health care per person, exceeded only by Alaska. It is estimated that about 26% of an average Massachusetts family’s wages go towards health care costs. Families with a greater number of health issues tend to pay even more, and often have a difficult time affording care.

Commissioners emphasized that, while lowering growth rates to below the benchmark has been a success, much more work is needed to lower costs. Commissioners also made it clear that cost cutting measures shouldn’t impact access to care for Massachusetts residents.

Unnecessary Hospital Use and Readmissions:

One cost containment method identified repeatedly at the hearing was reducing unnecessary hospital use, particularly hospital readmissions. A readmission is when a patient returns to a hospital within 30 days of being discharged from a previous hospital stay. Data presented at the hearing showed that Massachusetts readmission rates grew between 2015 and 2016.

While decreasing readmissions would help to decrease overall spending, several panelists at the hearing pointed out the challenges of preventing readmissions. Particularly for patients with chronic conditions, readmissions may be a result of the illness and do not necessarily indicate errors on the part of the hospital. The question was also raised if reducing readmissions is the best strategy to support vulnerable populations. Some panelists cautioned against any strategies that would financially penalize patients who make multiple hospital visits within a short time period, as this could end up preventing these patients from accessing needed care.

Those suffering from addiction and those with behavioral health conditions were identified as groups more likely to have a readmission. Because of this, improving treatment for addiction and behavioral health was identified as one way to help lower readmission rates. One panelist commented that, when a patient is in the hospital for an overdose, they can be provided detox services, “but where do they go after?” Without adequate resources invested in treatment and recovery programs, people suffering from addiction may repeatedly return to the hospital. Commissioners also identified improved care coordination and engaging patients more actively in their care as a way to decrease unnecessary readmissions.

Social Determinants of Health:

Both commissioners and panelists identified social determinants of health as a key contributing factor to high health care costs. Several commissioners noted that there has not yet been enough done to invest in programs that focus on these social determinants.  

The importance of ensuring that communities have access to necessities such as nutritious food, transportation, housing and infrastructure was repeatedly stressed during the hearing. These resources allow communities to maintain better health overall and to access health care services when needed. One community health center CEO mentioned that a lack of transportation and infrastructure are major issues for patients, and that the health center provides transportation services to some patients to ensure they are able to access care. While a number of panelists and commissioners agreed that providers and payers should be doing more to invest in addressing unmet social needs, they also expressed concerns about how to do this without adding more money to the system.

One specific program mentioned during the hearing was the Prevention and Wellness Trust Fund. This fund promotes healthy behaviors, which helps to prevent illness and hospitalizations and improve health outcomes. The fund’s authorization expired this summer, and it has not been reauthorized in the current state budget. Health Care For All believes that allowing funding to lapse for this program is a shortsighted approach to containing cost, as the program will reduces overall cost in the long term by creating a healthier population which has less need for costly medical care.

Keeping Care in the Community:

September 26, 2017

The Graham-Casidy proposal to repeal the Affordable Care Act seems to have stalled, with Republican senators expressing public opposition, but the defeat of repeal isn't guaranteed

Public pressure needs to be maintained to keep these senators accountable and to pressure other senators to join in opposing the Graham-Cassidy plan. 

As part of an ongoing effort to prevent the passage of this damaging bill, on Monday, September 25, Health Care For All submitted comments to the Senate Committee on Finance detailing why this bill would be harmful for health care consumers in Massachusetts and throughout the country. The bill would undermine protections for people with pre-existing conditions, lead to millions of people becoming uninsured, and greatly reduce federal funding for health care. The proposal would be particularly damaging for states such as Massachusetts that have expanded Medicaid, as these states would see large cuts to federal funding, placing massive financial strain on state budgets.

The Oral Health Advocacy Task Force which HCFA leads also submitted a letter focusing on the alarming oral health aspects of the Graham-Cassidy bill. That letter is available here.

Read our full letter below

 


Dear Chairman Hatch and Ranking Member Wyden:

On behalf of Health Care For All (HCFA), thank you for the opportunity to submit comments on the Graham-Cassidy-Heller-Johnson health care proposal. HCFA is a Massachusetts nonprofit advocacy organization working to create a health care system that provides comprehensive, affordable, accessible, and culturally competent care to everyone, especially the most vulnerable among us. We achieve this as leaders in public policy, advocacy, education and service to consumers in Massachusetts.

We write to voice our extreme opposition to the Graham-Cassidy-Heller-Johnson proposal. We are very discouraged that instead of continuing down a bipartisan path and working on issues to improve the strength and stability of the Affordable Care Act’s (ACA) marketplaces, the sponsors of this legislation have put forward a proposal that will:

  •  Eliminate the financial assistance that helps low- and moderate-income families purchase health care coverage;
  •  End expanded Medicaid coverage that helps millions of low-income adults;
  • Gut Medicaid through deep, permanent cuts that would grow over time and threaten care for millions of low-income seniors, children, and people living with disabilities and shift massive costs and risks to states;
  • Jeopardize access to life-saving and effective treatments for addiction and weaken states’ efforts to address the current crisis of drug overdose deaths
  • Undermine essential protections for people with pre-existing conditions; and 
  • Resurrect - and worsen - the devastating cuts in coverage and benefits that the American public and the majority of Congress have already rejected.

The Graham-Cassidy-Heller-Johnson proposal threatens the health and financial security of millions of Americans including older adults, low-and moderate-income families, people living with disabilities, children, seniors, veterans and people with pre-existing conditions. It does nothing to improve affordability or availability of coverage for consumers and will likely result in approximately 665,000 Massachusetts residents losing coverage by 2027.1 This proposal will undermine the financial stability of our health care system and place additional fiscal strains on our state budget. We have come so far in Massachusetts, extending health coverage to 97.5% of our residents.2 To build support for the proposal, some have specifically singled out Massachusetts due to our state allegedly receiving a disproportionate amount of federal health care funds.3 Yet federal funds provided to Massachusetts mostly reflect the success we have had in our outreach and enrollment efforts, which have resulted in the lowest uninsurance rate nationally.

The Graham-Cassidy-Heller-Johnson proposal disproportionately impacts Massachusetts and other states that have expanded Medicaid. The bill would unravel this success in Massachusetts and devastate the lives of people in our state and across the country. Below we lay out in more detail our concerns with this proposal and the devastating impact it will have on consumers.

Eliminates programs that serve as a lifeline for low- and moderate-income families.

September 18, 2017

The effort to repeal the Affordable Care Act is back.

A legislative proposal introduced by Senators Lindsey Graham and Bill Cassidy to repeal Obamacare may go to a vote before the end of the month.

The Graham-Cassidy bill would end subsidies to help consumers pay for private insurance and would roll back the Medicaid expansion. States would receive lump-sum payments to put towards health care instead, but overall funding would greatly decrease. The effects of this bill would be similar to that of the other failed repeal attempts: millions would lose health insurance and health care costs would increase. This proposal would also remove important federal protections for consumers that require insurers to cover essential health benefits and to provide coverage regardless of preexisting conditions.

The bill has been picking up steam in the Senate. Senator Cassidy claims that there are already 48 Republican senators supporting it and Senate Majority Leader Mitch McConnell has reportedly announced that he will bring the bill to a vote if he believes that 50 senators back the effort.

However, there is an important timeline restriction. At the end of the month, the Senate can no longer use the reconciliation process to pass repeal; a process that currently allows the Senate Republicans to pass a bill with only 50 votes, assuming a tie-breaking vote by the Vice President. After this period, they would need 60 votes to avoid being blocked by a Democratic filibuster. 

The last repeal attempt hinged on a single vote. Putting enough pressure on key senators can completely change the outcome of repeal, so we need to apply as much pressure as possible before the end of the month. 

How you can help as a Massachusetts resident: 

Our congressional delegation is with us in the fight to protect the ACA. Senator Ed Markey and Senator Elizabeth Warren firmly oppose any attempts to repeal the ACA. You may wonder if there is anything you can do as a Massachusetts resident to block this new effort to take coverage away from millions of people nationwide. The good news is that you can still make a difference by joining our friends and family campaign!  We are urging residents in the Commonwealth to contact friends and relatives in other states and have them reach out to their own senators.

Below is a list of some of the major senators to target, and numbers to their D.C. offices. You can also tell friends and family in other states to use the dialer on https://www.savemycare.org/ They can just click on the box labeled “call your senators” and provide their zip code and phone number, and they’ll get a call that will connect them directly to their senator’s office. 

Important targets:
Alaska: Senator Lisa Murkowski: (202) 224-6665

Arizona: Senator John McCain: (202) 224-2235

Colorado: Senator Cory Gardner: (202) 224-5941

Kansas: Senator Jerry Moran (202) 224-6521

Maine: Senator Susan Collins (202) 224-2523

Nevada : Senator Dean Heller (202) 224-6244

North Carolina: Senator Thom Tillis (202) 224-6342

North Dakota: Senator John Hoeven (202) 224-2551

Ohio: Senator Rob Portman (202) 224-3353

West Virginia: Senator Shelley Moore Capito (202) 224-6472

You can also access this website www.trumpcareten.org and use the call scripts there as a guide to contact these and other senators. There is also a general call script for any senators for which the website does not have a specific script. 

We have blocked similar efforts before, and we can stop this new attempt to repeal the Affordable Care Act. Call Now!

Republican Governors can also play a major role in influencing Senators. People who live in two states in particular are urged to call their Governor's office and ask that they express their opposition to the Graham-Cassidy bill. They are:

Maryland: Governor Larry Hogan (410) 974-3901
Vermont: Governor Phil Scott (802) 828-3333

 

September 6, 2017

Last week, both Senator Chandler and Representative Scibak spoke on WWLP news on the importance of passing legislation to ensure full dental coverage for adults on MassHealth. 

Adults on MassHealth lack coverage for several important oral health treatments, including treatment for gum disease and root canals. Legislation introduced by Rep. Schibak would restore these benefits, ensuring that Massachusetts adults relying on public insurance would have coverage for the oral health treatment they need.

Senator Chandler and Representative Schibak are committed oral health advocates in the Massachusetts legislature. 

Watch the interview here

The bill referred to in this interview, The Act to Relative to the Restoration of MassHealth Adult Dental Benefits (H. 1225), filed by Rep. Scibak, will have a hearing on September 12th from 1 – 5PM in room A-2 at the Massachusetts State House. Other important oral health-related legislation will also be heard. The public is welcome to attend this hearing, and we would appreciate your presence and support. 

August 16, 2017

August 16th - Statement on Health Care For All's Commitment to Combating Injustice

(Boston, MA) - " Health Care For All is a social justice organization committed to defending the rights of all people to affordable, quality health care regardless of race, religion or gender identity. We condemn the violence and fear mongering propagated by hate groups this past weekend in Charlottesville, Virginia, as well as any discussions that stop short of calling out acts of discrimination and hatred for what they truly are.

"The effects of fear, racism and discriminatory policies have drastic and negative impacts on the health and well-being of some of our most vulnerable communities. Health Care For All is committed to combating racial disparities and injustice, and we will continue to promote inclusion, equity and compassion as both an organization and as a group of citizens working to protect the rights of all people in every way we can."

August 2, 2017

State Senate Majority Leader Harriette Chandler of Worcester, co-chair of the Massachusetts Legislature’s Oral Health Caucus, is a longtime advocate for oral health and a strong supporter of Health Care For All. Today, she published an op-ed in the Worcester Telegram and Gazette. In her article, Senator Chandler highlights the barriers currently preventing many Massachusetts residents from accessing necessary oral health care services, and encourages the state legislature to take action to address these issues. We are deeply grateful to Senator Chandler for her ongoing leadership on all health care issues, particularly her deep devotion to improved oral health. Here is her op-ed:

As I See It: Closing MassHealth gap in oral health coverage

First as a representative and later as the senator for the First Worcester District, one of my priorities has always been to make sure that people have access to the health care they need and deserve. I know that many are paying close attention to what’s happening in Washington where the future of the Affordable Care Act is on the line – and with it the access to insurance and care for hundreds of thousands of residents of the Commonwealth. We are all worried, yet access to coverage doesn’t solve all the health care problems we face in the state.

There are many other battles that we need to fight to ensure that people can get the treatments and preventive care they need. Even with more than 97 percent of the Massachusetts population covered by medical insurance, many still struggle to access oral health care – which is just as important. They struggle because our fragmented system of care separates the mouth from the rest of the body. For too many, health coverage stops short of comprehensive dental care. Quite simply for them, dental services are out of reach.

Those who are lucky have two insurance cards: one to see a medical doctor and another to see a dentist. However, even with the right card, many people cannot afford the out-of-pocket expenses that accompany much needed dental services, leading many to forego this care altogether.

I recently read an “As I See It” column published in this section written by a well-respected member of our community highlighting the challenges immigrants face when accessing oral health services. In her article, Anh Sawyer, executive director of the Southeast Asian Coalition, rightfully points out the need for increased awareness and for better integration of services, although cost remains a problem.

I agree. Educating consumers about the link between oral health and chronic conditions is critical.

Under the Affordable Care Act, Massachusetts has expanded Medicaid through the MassHealth system. The new MassHealth Accountable Care Organizations are a great opportunity to integrate dental and medical services. ACOs focus on community health, and are expected to lower prices and incentivize a healthier population. However, we must do more. I see people around Worcester every day facing high barriers to getting the care they need, especially those with limited resources. Many dentists don’t accept MassHealth due to low reimbursements. Even if they can find a dentist, many critical services are not covered because of previous state budget cuts.

MassHealth has progressively restored dental benefits, piece by piece, since they were stripped a decade ago. Yet today, 800,000 individuals – including 120,000 seniors and 180,000 people living with disabilities – still do not have coverage for the treatment of gum disease, known as periodontal treatment. They also lack coverage for specific services like root canal treatments (endodontic services), crowns and bridges (prosthodontic services), and some oral surgery procedures such as the removal of benign lesions, which are currently only available to MassHealth members under age 21 or those who are eligible for Department of Developmental Services. Unfortunately, the lack of comprehensive adult dental coverage (which would include all of the services just noted) leads to pain, tooth loss and preventable high-cost emergency department usage, to name a few.

We need to restore those benefits as soon as possible, as they are causing needless pain, suffering, and illness. The legislature has an opportunity to start the process now. I am pleased that the provision to prepare a schedule and cost estimate for restoring MassHealth adult dental care was approved as part of the final Fiscal Year 18 state budget. In addition, Representative John Scibak and I filed legislation to effectively restore all full dental benefits for adults on MassHealth. He and I also co-chair the Legislature’s Oral Health Caucus – the first such legislative caucus in the nation, focusing solely on oral health issues.

August 2, 2017

Yesterday, the D.C. Circuit Court granted the motion of Massachusetts Attorney General Maura Healey and 15 other state attorneys general to intervene in the Affordable Care Act (ACA) cost-sharing reduction (CSR) lawsuit. We truly appreciate the Massachusetts Attorney General’s work on this, and we are proud of our HCFA HelpLine Director Hannah Frigand, whose affidavit submitted to the court helped prove a dispositive issue, that states could intervene because residents would be harmed by the increase in premium costs that would flow from the termination of CSRs.

AG Healey issued a statement on the importance of this case:

The D.C. Circuit Court’s ruling is a win for states and a major hit to the Trump Administration’s efforts to sabotage the Affordable Care Act. With the court’s decision, the states won the right to defend payments that help millions of Americans access affordable health insurance. As long as the Trump Administration keeps playing politics with the health of our residents, we will be there to defend access to care in Massachusetts and across the country.

As in other cases, the court took note of “accumulating public statements” by the Trump Administration threatening to withdraw from the litigation and eliminate CSRs, and so the states were permitted to intervene to protect the public interest.

Although the ACA requires insurers to provide discounts on cost-sharing (i.e., deductibles, co-pays, co-insurance), CSRs are critical to reimburse the health plans for these discounts, keeping health insurance affordable. This is particularly important for those who are not eligible for premium assistance. Their elimination would drastically increase the price of health insurance and, as a result, the uninsured rate would climb. The states demonstrated to the court that this would present a substantial monetary burden on states. After all, state-funded hospitals must provide emergency care for individuals regardless of their coverage status or ability to pay.

So while the war to maintain the ACA and improve market stability continues, we are reassured by the tireless Massachusetts Attorney General, Maura Healey, whose work helped ensure that consumer advocates will not go down without a fight.

                                                                                                                                                                          - Ben Agatston

July 25, 2017

Oral health matters. Adequate oral health reduces emergency department utilization and enhances health equity. Knowing these benefits, Governor Baker included an amendment in the proposals he sent to the legislature in connection with his budget vetoes that authorizes dental therapists in Massachusetts, a proposal we strongly support. By allowing mid-level dental therapists (DTs) to deliver basic but critically necessary care, this amendment would increase access to dental coverage for underserved Massachusetts residents. At Tuesday's hearing on the health provisions of the budget veto amendents, we urged the legislature to support the Baker administration and approve this much-needed reform:

Oral health is integral to overall health, and poor oral health is a risk factor for diabetes, heart disease, stroke and low-birthweight children. Yet, one in ten Massachusetts residents lives in a dental shortage area. As a result, about half of our children do not get annual dental care, and some 60% of our seniors in long-term care have untreated tooth decay. Qualified, trained, professional dental therapists can fill this gap by providing basic oral care in vital locations such as in schools, in senior centers, and in community health settings, all under a dentists’ supervision. Dental therapists would increase access to oral health care, improve overall health and save money.

Although almost everyone in Massachusetts has medical coverage, many struggle to access dental care. Common obstacles include the inability to find a dentist that accepts public insurance, the prohibitive cost of dental care, or challenges in traveling to a dentist’s office. Dental Therapists can help with all of these issue. Access to good dental health is major problem for low-income people in Massachusetts. Dr. Don Berwick outlined oral health disparities in the Boston Globe:

Kids on Medicaid visited emergency departments for preventable oral health problems six times more often than commercially insured children; for MassHealth adults, the figure is seven times. Over half of the residents in Massachusetts nursing homes have untreated dental decay. In 2014, low-income seniors in Massachusetts were seven times as likely to have lost all their teeth as those with means. Nearly a third of adults with special needs are missing six or more teeth.”

EOHHS Secretary Sudders also testified in favor of the proposal, pointing out that in addition to improving care, dental therapists would provide savings to the state by reducing inappropriate use of emergency rooms for preventable oral health issues:

The Health Policy Commission (HPC) has been examining some of these cost drivers including avoidable emergency department visits.  The most recent data published by HPC indicates that 40% of all ED visits could be avoided if there was greater access to care.  In 2014, there were more than 36,000 visits for preventable oral health issues, costing the state upwards of $36 million.  MassHealth was the primary payer of these oral health emergency department visits that year, paying upwards of $17 million.  Emergency department visits for oral health complaints represents suboptimal use of a very costly setting. 

DTs would work under the general supervision of a dentist, using technology to share X-rays and patient records with the dentist and consult on complicated cases. This would allow DTs to deliver critical dental services directly to people in schools, nursing homes, and other community settings.

Moreover, DTs offer low-cost interventions that could prevent more costly illnesses. They would be reimbursed by MassHealth, which would expand access to dental care for people who have some coverage but are still unable to receive appropriate oral health care.

We urge the state legislature to follow Governor Baker’s lead and prioritize the oral and overall health of Massachusetts residents by adopting the DT amendment included in the Governor’s recommended budget amendments. 

                                                                                                                                                   -- Ben Agatston

July 25, 2017

Health Care For All testified today, Tuesday, July 25th, during the public hearing held by the Joint Committee on Ways and Means and the Joint Committee on Health Care Financing on Governor Baker's proposed package of reforms to MassHealth.

We provided testimony in support for some of the Baker administration's proposals, including the authorization of dental therapists and the re-instatement of employer responsibility. However, we also expressed opposition to several reforms we found concerning, particularly policies that would disqualify over 140,000 Massachusetts residents from MassHealth, shifting them onto more expensive and less comprehensive coverage.

We have created a fact sheet detailing the specific effects these proposals would have on Massachusetts residents, which can be accessed here:

HCFA Fact Sheet

July 11, 2017

HPC Chart: Oral Health ED Visits

We smiled brightly during the Health Policy Commission’s (HPC) July 5 meeting because the agency highlighted one of our top priorities, the lack of access to oral health care. In their first DataPoint analysis, HPC found 11.5% reduction in oral health-related hospital Emergency Department (ED) visits from 2013 – 2015.

But despite this overall reduction in costly and preventable care, there was a substantial increase in oral health ED visits for elementary school aged children and adults age 55 to 84. Moreover, and perhaps most concerning, is that low-income populations accounted for a disproportionate rate of oral health ED visits.

It is unclear whether the overall decrease in ED utilization is attributable to certain demographics receiving better quality preventive care or increased access to dental services. What is clear, however, is that glaring inequities exist in dental care access, causing low-income populations to over-utilize hospital EDs.

This costly outcome occurs because we neither equip EDs to treat dental conditions nor train emergency room physicians to resolve these issues. And even if EDs could provide proper dental care, these visits are preventable and burdensome on hospitals.

Ultimately, this data suggests that that access to dental care remains elusive in Massachusetts even though coverage may in fact be increasing.

This is why we agree with Governor Baker, Secretary Sudders, and the Executive Director of the HPC, David Seltz, in their support of legislation to authorize dental therapists. This common sense policy would expand quality and access to preventive oral health care to vulnerable populations.

Dental therapists, who would reach out to patients, providing care in places like schools or nursing homes, can greatly reduce oral health-related ED utilization. After all, the patients most likely to utilize ED for dental care – children and seniors – are society’s least mobile. Dental therapists meet their needs by going to them  where they are and providing the care they need at a lower cost.

Dental therapists offer low-cost interventions that can prevent more costly illnesses. They would be reimbursed by MassHealth, expanding access to people who have some coverage, but are still unable to receive appropriate oral health care.

Legislation is pending that would allow dental therapists to practice in Massachusetts. Hearings should occur this fall. This is a key HCFA priority for this fall, and we urge you to join our campaign.

                                                                                                                                                                           - Ben Agatston

Pages