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Massachusetts health care – wonky with a dose of reality

May 31, 2017

During the Senate budget debate last week, the Senate approved an amendment that extended the Prevention & Wellness Trust Fund (PWTF).  HCFA strongly supports the PWTF, and we are working closely with the lead advocacy organization, the Massachusetts Public Health Association (MPHA), to make sure the provision is part of the final budget. 

 

The Prevention & Wellness Trust Fund is a first-in-the-nation effort that supports evidence-based community interventions that keep Massachusetts residents healthy, avoid preventable health care costs, and reduce health disparities. PWTF supports community-based partnerships including municipalities, healthcare systems, businesses, regional planning organizations, and schools. These partnerships have had success in reducing rates of the most prevalent and preventable health conditions, increasing healthy behaviors, and supporting the adoption of workplace-based wellness or health management programs. Funding for the program ends this July, if it is not extended by the legislature.

 

The amendment will increase taxes on flavored cigars, equalizing the tax to other tobacco products. This not only helps to indefinitely fund PWTF community programs, but also works as a prevention strategy, decreasing consumption of flavored cigars, which are often marketed to youth.
 
The House did not include a similar provision in its budget version. The final budget will be worked out in the next few weeks by a 6-member conference committee, and we do not expect a smooth ride.
 
We ask that you join MPHA and HCFA at the State House on June 6th at 10:30am to show our support to the entire legislature – and especially the members of the conference committee. Please make every effort to attend and please help us spread the word! Please invite your colleagues, patients, partners, and friends to join us! HCFA will also be testifying in support of the bill that afternoon.

 

                                                                                                                                              Nina Rossiter

May 23, 2017

This is devastating: A new study estimates that the House-passed bill to repeal the ACA would result in as many as 445,000 people in Massachusetts losing health care coverage. The uninsurance rate, now around 2.8%, would soar to 10.3%. To keep these people covered would the cost state $7.8 billion between 2017 and 2026.

The study comes from the Urban Institute, and was commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, which is the co-convenor, along with HCFA, of the state's Coalition for Coverage and Care. You can read the press summary here, and get the full package of materials here.

Here's what HCFA interim executive director, Stephen Rosenfeld, said about the report:

“The study’s results detail a very bleak set of outcomes, all of which have serious repercussions. We can calculate the impact in terms of dollars and statistics. However, behind each number there is a story of a neighbor or a family who will struggle to access the care they need.”

We object. The bill has passed the House, but can be stopped in the U.S. Senate. Join us in our campaign to get the word out to friends and family in states with key swing Senators. We must preserve the health coverage under the ACA.

 

 

May 19, 2017

(Photo Credit: Alastair Pike, Office of Governor Charlie Baker)

Governor Charlie Baker sent a strong letter to U.S. Senate leaders today, calling on them to reject the House-passed American Health Care Act, and defending Massachusetts' progress on health coverage made possible by the ACA - or Obamacare.

The letter (read it here) urges the Senate to scrap the massive Medicaid cuts that are the centerpiece of the House bill, and warns that thousands will lose coverage in Massachusetts if it became law. Massachusetts would lose over a billion dollars in federal funding starting in 2020, with losses increasing in following years. He writes, "The recently passed American Health Care Act by the House of Representatives poses a significant threat to Massachusetts, from both fiscal and health care coverage perspectives. ... I urge the Senate not to pass any bill that threatens the loss of existing health care coverage or makes it more unaffordable for Americans."

Governor Baker puts the health coverage expansions pioneered by our state in a broader perspective:

…our state believes strongly in health care coverage. Coverage provides a foundation to tackle underlying complex health care issues such as: affordability; skyrocketing drug costs; the opioid epidemic; historic segregation of behavioral and physical health care; and health disparities.

Among the recommendations Governor Baker made to the Senate were these points:

Medicaid

  • Keep the ACA Medicaid expansion, which covers some 300,000 low-income adults in Massachusetts
  • Oppose the per-capita cap funding formula in the House bill, which would require massive cuts to our MassHealth program
  • Maintain state flexibility for Medicaid "Section 1115" waivers. Massachusetts just began implementing its innovative waiver program which allows for MassHealth ACOs that include a focus on social determinants of health
     

Employers

  • Allow state employer mandates. HCFA supports the legislature's proposal on this, now moving as part of the state's budget process

Insurance

  • Premiums assistance should be based on income, not age. The AHCA transforms the ACA's sliding scale assistance based on income to an age-based formula that ignores the affordability of plans.
  • The legislation should also address soaring drug costs

The Governor also states that, “Finally, Massachusetts has gone on record as opposed to federal sanctions regarding family planning and efforts to diminish support for behavioral health and the opioid epidemic.”

Health Care For All strongly applauds the Governor for taking a strong stand in support of effective health reform.

 

May 16, 2017

This blog was originally published on Community Catalyst’s blog Health Policy Hub

The rise in opioid misuse has continued to receive attention across the country, and only more urgently in recent months as Republicans continue to press forward toward a repeal of the ACA with a disastrous replacement bill that makes deep cuts to the Medicaid program and would reduce or eliminate care for many people with substance use disorders. Often, the majority of this attention is on adults, who are the primary users of opioids. Less attention has been directed toward infants exposed to substances during pregnancy and who, as a result, may be born with an opioid use disorder. This condition in newborns is termed neonatal abstinence syndrome (NAS). 

Opioid misuse is a multi-generational issue that requires supports along the lifespan. Massachusetts is disproportionately affected, placing it second in the nation for prenatal exposure (13.7 per 1,000) after the East/South Central region of the U.S. Nationally, the rate is about five babies out of every 1,000 births. The average duration of inpatient treatment for NAS is 19 days with an average cost of $30,000, placing severe strain on health systems to support affected infants and their families. Through this lens, the Massachusetts Interagency Task Force on Newborns with Neonatal Abstinence Syndrome published a highly anticipated report that provides key recommendations about how to address the current gaps in care and more deliberately address the needs of infants and parents through collaboration and coordination across health and human services.

It is worth noting that this Task Force is the product of robust advocacy by a Community Catalyst-led workgroup on NAS that included a broad array of members ranging from early intervention providers, legal advocates, child welfare advocates and children’s mental health advocates to physicians –pediatricians, obstetricians/gynecologists and medical residents. The lead children’s health advocacy partner, Children’s Health Access Coalition (CHAC), helped develop and champion legislative language in the last hours of the state’s budget deliberations in 2016 to include the revenue-neutral task force.

May 16, 2017

We hear over and over again criticism that MassHealth comprises 40% of the state budget. This ignores two key realities:

1. MassHealth provides critical health care to over a quarter of state’s population – very low income people with no other source of health care. The majority of expenses are to provide care to very sick people, particularly seniors and people with disabilities getting long-term care and support services. Seniors and people with disabilities account for 24% of the enrollees, but 56% of the spending. The 595,000 non-disabled children are just 16% of the spending (source).

2. A new report from the Massachusetts Budget and Policy Center makes clear that, because of federal funding, the cost to state taxpayers is much less than is portrayed. The 40% number bandied about (it’s actually 37%) is the total cost of the program, including federal funds, compared to the entire state budget. But if one just looks only at state taxpayer funds, the cost of MassHealth is just 24% of the state's tax revenue  - certainly a bargain. Moreover, the federal funds we get as a result are spent in the local economy, paying salaries for medical care provided by community health centers, nurses, lab technicians, and many more. Those wages are then used to pay for food, rent, entertainment and other local services, fueling the economy even further.

These graphs, from the MassBudget report, illustrate this conclusion:

State Net cost of MassHealth

Please feel free to share this message to everyone concerned about the state budget. With Congress considering deep cuts in federal Medicaid funding, which would have a devastating impact on the state budget, we need to come together to defend Medicaid at the state and federal levels.

                                                                                                                                       -- Brian Rosman

 

May 4, 2017

The US House of Representatives just voted in favor of repealing and replacing the Affordable Care Act (ACA). The American Health Care Act will make massive cuts to Medicaid and rip up the insurance protections in the Affordable Care Act (ACA) - but we're not giving up. Now the bill moves to the Senate, where we can still win this fight. 

All Senators, regardless of their public position on AHCA, need to hear from their constituents now.

In Massachusetts, we are fortunate that our Senators Edward Markey and Elizabeth Warren are firmly opposing this effort, but we can still play an important role in stopping this madness.

We are asking residents in the Commonwealth to reach out to friends and family in other states and tell them to call their Senators.

Numerous senators have expressed reservations about the legislation - they need to hear from their constituents that this bill is bad for consumers. Our calls, emails and rallies make a difference and remain critical. You can use Community Catalyst’s Take Action Page to find the phone number for your Senators.

Talking Points for Senate:

The American Health Care Act is terrible for consumers – especially for kids, older adults, people with disabilities and low- and middle-income families. It would strip coverage from 24 million people and raise costs for millions more, and impose $839 billion in Medicaid cuts. The Senate should reject this bill and any bill that cuts coverage and raises costs.

The AHCA would:

  • Take us back to the dark days when people with pre-existing conditions like diabetes and cancer couldn’t get health insurance. The plan would allow insurers to charge more to people who are sick, leading to premium increases upwards of tens of thousands of dollars for coverage that is unlikely to meet their health care needs.

  • Allow states to get rid of the essential health benefits, which would roll back the clock to the days of skimpy plans without coverage for maternity care, substance use disorders or mental health services. This means, for example, that women would have to pay more for coverage that actually meets their health care needs.  

  • End the Medicaid expansion and slash $839 billion from Medicaid, jeopardizing care for millions of low-income seniors, people living with disabilities, children and low-income parents.

  • Hit older Americans with an age tax that would force them to pay thousands of dollars more for the health care they need.

  • Be especially bad for kids. The Medicaid block grant option would reverse a long- standing commitment to protect low-income children – it would impose $839 billion in Medicaid cuts that would put pressure on states cut benefits, roll back eligibility and deny children comprehensive preventive care needed to stay healthy.

  • Undermine efforts to address our state’s crisis of drug overdose deaths.

  • Weaken the ACA’s protections against catastrophic costs for people with employer-sponsored coverage.

  • Mean fewer people covered, weaker protections and higher costs for consumers – all to give a tax break to millionaires and corporations. This is not what your constituents want.

(Thank you Community Catalyst for your leadership!)

April 27, 2017
 
The American Health Care Act (AHCA) was first introduced by House Speaker Paul Ryan on March 20th, 2017. The latest proposal keeps all of the bad features of AHCA, such as the $880 billion cuts to Medicaid and plans to strip more than 20 million people of their health insurance. Added to that it would allow states to gut the main consumer protections of the ACA and return to a time when insurers could discriminate against those living with preexisting conditions – charging them higher premiums and selling them plans that don’t meet their health needs by limiting benefits and increasing out-of-pocket costs.
 

Even though Congress is trying to avert a government shutdown, the health care debate remains critically important as Speaker Ryan roams the halls looking for votes in support of his bad bill.

We have a real chance to stop this. 
 
In Massachusetts, our congressional delegation has already committed to defend our gains in health care, but we can still make a difference in this battle. 
 
We're asking everyone to please contact your friends and family who live in states with Republican US representatives. You need to ask them to get in touch with their members of Congress to ensure that they don't support this dangerous bill!
 

 

Tell them how health reform has been a success, and direct them to http://bit.ly/CallCongressCC

Thank you to our partner organization Community Catalyst for the information, resources, and leadership they provide in this fight. 
April 25, 2017

Yesterday, the full House began the FY 2018 budget deliberation process on Beacon Hill. As the amendment process moves forward, we at HCFA are working with lawmakers, advocates, providers, faith groups, consumers, and other health stakeholders to protect funding for consumer based health care programs in the state budget and to protect MassHealth and other critical pieces of the Commonwealth’s health infrastructure.

[See our complete budget amendment fact sheet here]

HCFA Supports:

  • Investing an additional $5 million in the Children’s Medical Security Plan and directing EOHHS to plan for the lifting of caps on benefits for covered children (Amendment #1077/Rep. Barber)
  • Ensuring that MassHealth CarePlus enrollees continue to have access to non-emergency medical transportation (Amendment #100/Rep. Gentile)
  • Reinstating coverage for periodontal disease (a chronic bacterial infection of the gums and teeth) services for adult MassHealth enrollees (Amendment #439/Rep. Scibak)
  • Restoring full dental benefits for adult MassHealth enrollees (Amendment #419/Rep. Pignatelli)
  • Allocating $500,000 to fund academic detailing, a physician education program on cost-effective pain management medications (Amendment #797/Rep. Benson)
  • Increasing funding for the Department of Public Health’s Office of Oral Health (Amendment #117/Rep. Scibak)
  • Allocating $300,000 for the Forsyth Kids program, which provides school-based oral health care to 1,700 underserved children across the Commonwealth (Amendment #234/Rep. Crighton)
  • Establish the Prevention and Wellness Trust Fund as a permanent program with a dedicated revenue stream (Amendment #24/Rep. Vega)
  • Investing $301,500 to expand screening, brief intervention, and referral to treatment programs in schools targeted at addressing adolescent alcohol and drug use (Amendment #860/Rep. Khan)
  • Funding and maintaining the successful Mental Health Advocacy Program for Kids (MHAP) that helps children involved with the juvenile justice system (Amendment #351/Rep. Golden)
  • Creating a common application for SNAP and MassHealth benefits to close to SNAP Gap and expand access to benefits for low income residents (Amendment #31/Rep. Livingstone)

HCFA Opposes:

  • Creating a MassHealth Control Board charged with slashing MassHealth spending with no consideration for improving health outcomes for enrollees, no legislative oversight, and no MassHealth member/consumer representation (Amendment #876/Rep. Lyons)
  • Targeting low income residents by instituting MassHealth work requirements, charging premiums, and barring MassHealth eligible workers with employer sponsored insurance from enrolling in wrap around coverage (Amendment #878/Rep. Lyons)
  • Capping MassHealth spending at 30% of the total state budget, effectively forcing massive cuts in state Medicaid spending while only passing savings on to the federal government (Amendment #880/Rep. Lyons)

We encourage you to contact your state representative to express your support/opposition to the above amendments.

                                                                                                                                                                                                             Alec Lebovitz

April 17, 2017

The Blue Cross Blue Shield of Massachusetts Foundation has just released a detailed set of reports on uninsurance rates in the state, The Geography of Uninsurance in Massachusetts, 2011-2015. The report is based the five years of data from the census’ American Community Survey (ACS), which surveys 2 million households annually to identify uninsured residents.

Since the implementation of Chapter 58 our 2006 state health reform law, the insurance rate has increased dramatically. In 2015, 97.2% of the population had access to health care. However, “The Geography of Uninsurance, 2011-2015” highlights those areas in the state where the percentage of insured residents is much lower than the median. The wide variation is shown in this map:

Wide variation in insurance coverage in Massachusetts
The table below provides a list of municipalities ranked by the uninsurance rate (%) where HCFA has targeted our outreach and enrollment efforts:

Locations

Total Population (#)

Uninsured (#)

Uninsurance Rate (#)

Everett

43,714

4,413

10.1

Chelsea

37,110

3,605

9.7

Lawrence

78,108

6,216

8.0

Framingham

69,128

4,906

7.1

Brockton

93,441

4,800

5.1

Lowell

108,161

7,091

6.6

Lynn

91,294

5,575

6.1

Revere

52,858

3,248

6.1

Health Care For All’s HelpLine provides multilingual and culturally competent direct services as a navigator organization to improve access to health insurance and care for underserved communities such as the ones listed above. As part of this work, HCFA has deployed ethnic media campaigns and hosted successful enrollment events and sessions in towns with both high uninsurance rates and immigrant populations. We have also developed a partnership with the Edward M. Kennedy Community Health Center in Framingham to help residents navigate their health insurance options during Open Enrollment that will continue in 2017-2018, targeting Spanish and Portuguese speakers in the region.

If you know someone who is uninsured or needs help navigating the complicated healthcare system, please connect them to HCFA’s HelpLine at 1-800-272-4232.

April 13, 2017

The state House of Representatives released their draft budget this week. The budget funds the state's MassHealth and other health programs, and includes many provision supported by HCFA. Our friends at the Massachusetts Law Reform Institute released an outstanding summary of the provisions affecting low income residents, including MassHealth and other health concerns. House budget debate starts on April 24.

Net state spending for MassHealth is just 14% of state budget

We want to offer an important correction to a misleading fact often cited in the press. It is claimed that MassHealth, our Medicaid program, consumes 40% or more of the total state budget, leading policymakers to decry out of control spending for Medicaid. Yet this statistic ignores the fact that that the vast majority of that spending comes from the federal government, and doesn't come out of state revenue. It's just a pass-through.

The real numbers are that Medicaid costs make up just 14% of state spending from state revenue. The rest is all federal money, that comes into Massachusetts, and is then spent in our economy, benefiting Mass residents. See the graphs on this presentation from the Blue Cross Foundation, chart 5, reproduced above. So, claiming that Medicaid costs us 40% of the budget is very misleading

HCFA is pleased that the House budget proposal includes a reinstatment of the state's employer responsibilty law. This will assess a fee on large employers who do not provide health insurance coverage to their workers. A similar fee was included in chapter 58, the 2006 health reform passed under Governor Romney, and was also part of the Affordable Care Act. The state fee was repealed several years ago, and with the ACA fee in danger of being repealed, or nor enforced, it's important for the state to step in and make sure that employers are prompted to provide coverage.

HCFA is supporting a number of important amendments to improve the budget. Please, call your state Representative, and urge him or her to support HCFA's budget priorities. Here's our list:

Improve Children's Health Coverage

Thousands of children who are not eligible for MassHealth and do not have access to private health insurance through their parents can get basic coverage through the Children's Medical Security Plan (CMSP). However, CMSP benefits have strict limits on coverage that are inadequate to keep a child healthy; for example, a $200 limit on prescription drugs and a 13-visit limit on mental health services. The FY2018 budgets proposed thus far cut funding for CMSP from $17.4 million to $12.4 million. Please support Rep. Barber's amendment to restore $5 million in funding for CMSP and to direct EOHHS to develop a plan to improve the scope of benefits (adding language and $5 million to line item 4000-0990).

Ensure Access to Transportation for Medical Appointments

Non-emergency medical transportation provides access to and from medical appointments for MassHealth enrollees who do not have other means of transportation. EOHHS has indicated it plans to seek a waiver to eliminate this benefit except for travel to substance use disorder (SUD) treatment services for MassHealth CarePlus (Medicaid expansion) enrollees. About 13,000 MassHealth CarePlus enrollees used non-emergency medical transportation for non-substance use disorders (SUD) services last year. Please support Rep. Gentile's amendment (#100) to ensure that MassHealth CarePlus enrollees continue to receive appropriate transportation to all necessary medical appointments (adding language to line item 4000-0940).

Restore Periodontal Treatment Coverage for Adult MassHealth Enrollees

Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss leading to eventual tooth loss and also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth. Therefore, coverage for the treatment of periodontal disease is critical to improving the oral and general health of the adult population. Please support Rep. Scibak’s amendment to restore coverage for periodontal services for adult MassHealth enrollees (adding language and $10 million to line item 4000-0700).

Plan for Full Restoration of MassHealth Adult Dental Benefits

More than 1 million people, including 149,000 seniors and 245,000 people with disabilities, are without access to dental care beyond cleanings, fillings, extractions, and full dentures. Without access to appropriate dental care, many people living with chronic illnesses such as diabetes or hypertension see their conditions worsen. Those with oral health issues that may have been easily resolved with a simple procedure may require far more invasive and costly treatments. Please support Rep. Pignatelli’s amendment directing EOHHS to develop a plan to fully restore dental benefits for adult MassHealth enrollees (adding language to line item 4000-0700).

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