We were going all out in the last few days, contacting voters in key districts outside Massachusetts, urging them to call their Representatives. The bill that was pulled would have been devastating to Massachusetts, likely leading to some 600,000 Bay Staters losing coverage over the next 8 years.
A few quick observations, looking back and forwards:
Following the vote, Congressman Joe Kennedy III spoke at an impromptu celebration outside the Capitol, saying:
This fight is not over…There are still hundreds and thousands and millions of Americans out there that need access to affordable, quality care everywhere for their loved ones. Yes, we had a victory today, but this does not end when you pull a bill. This ends when every single American can wake up in the morning…knowing that our society is there for them…Because I know, uniquely in healthcare, that there will be some point in my life when I will need to draw on that very same safety net that I hope is there for you. And I hope that you are willing to make that same investment in me.
That is what this fight is about, not about actuaries and spreadsheets and numbers, but about the commitment that we make to each other that goes to the very heart of what I believe this nation great, the promise we make to our neighbors and our friends. We had an incredible day today because of the thousands of people who stood up over the past several weeks and told their members that this was a bad bill. It was going to hurt people. And today, America, we won. And tomorrow, we fight on.
Thanks also to Governor Baker and his team, who showed true leadership by letting analysis, not partisanship, guide their approach. We understand he was an effective mostly behind-the-scenes force pushing against the rush to take away MassHealth funds and care from Massachusetts.
2. Much credit goes to the public activism. While the hard-right "Freedom Caucus" grabbed most of the attention, as their demands kept getting met, more and more Republican moderates began peeling away, leading to the bill's demise. Vox dubbed this group the "Coverage Caucus," and they worried about people losing coverage because people in their districts were loudly letting them know how important the ACA was. Many were from states that expanded Medicaid. They were made acutely aware of the political risks of voting for Ryan's bill, starting in the loud town hall meeting protests earlier this year. The stunning growth of explosive grass-roots energy, guided by projects such as the Indivisible movement, and many others, made a real difference.
3. It's far from over. The Trump administration still has many ways to sabotage the operations of the ACA, particularly for the marketplaces, like our Health Connector. Last week Politico reported on a number of already-moving actions:
A new report details the positive impact the Affordable Care Act (ACA) has had in Massachusetts. The report (read it here), issued by Senator Elizabeth Warren along with Senator Ed Markey and almost all of the state's Congressional delegation, provides example after example of people whose lives were directly affected by the help offered through the ACA.
More than 100 hospitals, community health centers, behavioral health organizations, insurers, patient advocates, health care providers, and individuals share their perspectives, including Health Care For All and our legal affiliate, Health Law Advocates. Their stories reveal the importance of high-quality, affordable insurance coverage and how the ACA has improved health care and access to health care in Massachusetts. In the report, voices from across the health system in Massachusetts speak of the need to maintain the protections and coverage provided by the ACA. Hospitals, insurers, and health care providers from across the Commonwealth explain what it means to them to participate in a health system that provides near-universal coverage, and the difference it has made to them or to the individuals they cover, care for, advocate with, or work with to have access to the ACA’s protections. These voices also highlight the unique and innovative ways that Massachusetts has been able to provide services and programs that have improved the health and wellbeing of its residents and communities.
The Health Care For All contribution focuses on our HelpLine, and on a mother who called us because her daughter had pulmonary hypertension. Their daughter was able to get all the care she needed through the law's forbidding of lifetime caps on insurance coverage.
HCFA congratulates Senator Warren on the amazing resource, and hopes its message will be spread far as the debate continues on the ACA.
Three brand new resources to help people understand the impact of the House-proposed Republican bill to repeal and replace the Affordable Care Act - an infographic summary of coverage losses; a 1-page summary of the impact on Medicaid (MassHealth); and a more comprehensive chart we prepared comparing the ACA with the Republican AHCA, and the impact on Massachusetts.
On Monday, the Congressional Budget Office (CBO), the legislative branch’s nonpartisan policy analysis arm, released its analysis of the Republican health plan put forward to replace Obamacare. As expected, the CBO report showed that the Republican’s American Health Care Act (AHCA) would result in drastically reduced health coverage, rising health care costs, and disproportionate harm to the old, the poor, and the sick. Specifically, the report found that 24 million Americans would lose coverage by 2026 and that nationally, premiums would rise anywhere from 15% - 20% in 2018 and 2019.
This authoritative data fueled further analysis that looked at the state-by-state impact of the proposal. We naturally looked at the forecasts for Massachusetts.
One study, by the Center for American Progress (CAP) looked at the impact of the proposed changes in help available through ACA insurance marketplaces, like our Massachusetts Health Connector. The bill would end the ACA's system of sliding scale assistance based on income, and instead substitute flat subsidies based solely on age. In addition, the bill would eliminate help for the co-pays and deductibles in these plans.
The CAP study found that the impact of these changes would be particularly harsh on vulnerable residents of Massachusetts getting help through the Connector. Here’s the projected increase in total costs for Massachusetts, compared to the ACA:
In 2020: Low-income individuals: $1,404 increase
Low income families: $3,172 increase
CAP also estimated the impact on coverage, looking at each Congressional District in the country. For Massachusetts, they projected a decline of 539,800 non-elderly people with coverage in 2026, including 87,800 fewer children, and 55,200 fewer people with disabilities with MassHealth coverage. In addition, some 50,000 seniors will lose their MassHealth coverage as well.
Another report from the Democratic staff of the Congressional Joint Economic Committee looked at the impact on private premiums, private coverage and hospital uncompensated care. Combining CBO data with other key data, they found that private premiums would increase in Massachusetts next year an additional $445 to $593 if the proposal was passed. They project an additional 147,616 Bay Staters losing coverage, and an eye-popping increase in hospital uncompensated care in Massachusetts of $132,854,730.
The results are in, and the Republican plan, simply put, would cover fewer people and cost all Americans more for health care. Additionally, low income people, seniors, people living with disabilities, and other vulnerable populations would be singled out for the greatest harm.
The Republican ACA legislation being moved through the House contains Medicaid provisions that, if passed, would fundamentally alter the program that provides health care for over 70 million vulnerable Americans. National estimates are that millions of Medicaid recipients would lose coverage under the proposal.
In Massachusetts, the impact would be particularly devastating. This was the conclusion of a recent presentation issued by the Blue Cross of Massachusetts Foundation, based on research done by the national law/consulting firm, Manatt.
Their presentation (linked here) analyzes the various Medicaid-related provisions of the proposal that would impact Massachusetts. The proposal freezes enrollment in the Medicaid expansion starting in 2020. The expansion provides comprehensive coverage to around 300,000 adults here. In 2017, Massachusetts received some $1.7 billion in federal matching funds for the expansion population. The bill also freezes a scheduled increase in our federal matching rate for this population, costing Massachusetts an additional millions over the next two years.
Congressional Republicans also propose to restructure Medicaid payments to states by imposing “per capita” caps. Currently, states spend what is necessary to provide medical care to people eligible for Medicaid, which include low income adults and children, pregnant women, seniors, and people with disabilities. If per capita caps are implemented, the federal government would give each state a fixed quantity for Medicaid spending annually, based on state Medicaid costs in previous years.
The goal is to cut federal Medicaid spending, at the expense of state budgets and the health of our most vulnerable populations. The Republican proposal uses 2016 as the base year for determining how much to appropriate each state and that amount would only be adjusted each year according to the Consumer Price Index for medical care (CPI-Med). However, in a high-cost health care state such as Massachusetts, CPI-Med will not adequately capture the rising cost of healthcare. The result is a compounding effect, in which every year the gap widens between the funds Massachusetts needs to maintain basic Medicaid coverage and benefits for residents and the funds it receives. Over time, the state would lose billions, at an accelerating rate.
In addition, by capping Medicaid this way, states would be left helpless in the face of major health care crises, such as a major flu breakout, or an economic downturn that pushes more people onto the Medicaid rolls.
Although the wording is not completely clear, it appears the Republican language would also preclude the state from receiving funds under the MassHealth Waiver agreement with the federal government, finalized last year. The waiver supports the restructuring of MassHealth, the state’s Medicaid program, to promote integrated behavioral and long-term care, and innovative support for focusing on the social factors that keep patients healthy. The waiver also addresses the opioid addiction crisis by expanded access to recovery-oriented substance abuse services. This could mean loss of hundreds of millions of dollars for Massachusetts health care.
In addition to installing per capita caps, the Republican proposal includes other provision designed to weaken Medicaid. Essential health benefits for Medicaid recipients codified under the ACA would be revoked, making it easier to cut benefits. Legal immigrants and naturalized citizens would lose an up to 90-day coverage period allowing them time to submit citizenship or immigration documents. And finally, the Medicaid expansion authorized under the ACA would be rolled back starting in 2020, jeopardizing coverage for millions of Americans and over 300,000 Massachusetts residents.
Yesterday, HCFA, along with dozens of advocates, providers, faith leaders, and consumers gathered in Boston’s historic Old South Church to protest the proposed Republican plan to dismantle Medicaid and the Affordable Care Act (ACA). Speakers included:
Rev. John Edgerton, Associate Minister, Old South Church of Boston; Member, Greater Boston Interfaith Organization
Hannah Frigand, Associate Director, HelpLine, Enrollment and Education, Health Care For All
Sheila Belin, Health Care Worker at Boston Medical Center, 1199SEIU Member
Eric Fleegler, MD, MPH, Boston Children’s Hospital
Kathy Paul, Massachusetts Senior Action Council
James S. Gessner, MD, President, Massachusetts Medical Society
Nassira Nicola, Boston Center for Independent Living
Elizabeth Mooney, Southeast and Metrowest Regional Coordinator for the Massachusetts Organization for Addiction Recovery (MOAR)
Dennis Heaphy, Disability Policy Consortium
Jennifer Childs-Roshak, MD, MBA, President and CEO of Planned Parenthood League of Massachusetts
Both in Massachusetts and across the nation, a broad coalition of stakeholders has emerged in fierce opposition to the Republican plan, entitled the American Health Care Act (AHCA). The opposition includes health insurers, hospitals, nurses, doctors, patients, consumer advocates, community organizations, faith organizations, groups representing people with disabilities, senior groups, and even an executive from the Center for Medicare and Medicaid Services. The unanimous opposition of all these groups, which represent the full spectrum of health care stakeholders, is stunning – and telling.
The fact is that the AHCA would have devastating consequences across the entire nation, and Massachusetts would be particularly hard hit. The provisions in the Republican legislation would decrease coverage and increase health care costs for consumers and the Commonwealth. The AHCA reduces federal assistance to low and middle income people for purchasing health insurance, eliminates cost-sharing protections included in the ACA, and rolls back the state’s Medicaid expansion, threatening coverage for over 300,000 Massachusetts residents.
Additionally, the Republican plan calls for capping Medicaid funds, which would result in the loss of billions of federal dollars used by the state to offer health coverage to the state’s most vulnerable residents. This radical change to Medicaid would place an enormous financial burden on Massachusetts and directly threaten benefits and coverage for 650,000 Massachusetts children, 170,000 seniors and 280,000 people with disabilities.
Much of what is contained in the Republican proposal is outrageous, but there is no doubt that most egregious of all is the theft of health care from the poorest Americans to line the pockets of the very richest among us. Reverend John Edgerton, an Associate Minister at Old South Church, a Greater Boston Interfaith Organization member, put it best yesterday, “This plan disregards the right of poor people to access care they can afford, while slanderously claiming that if they lose coverage it will be because of irresponsible spending. If this plan is passed, it will ruin people financially. But worse than that, people who might have remained healthy will get sick. People who might have survived will die."
Every voice counts in this fight to defend Medicaid and the ACA. We urge Massachusetts residents to call Governor Baker, Senators Markey and Warren, and your Representative in Congress. Thank them for all they have done to protect health coverage for the people of Massachusetts. Click here for more ways to get involved.
HCFA testified before the Health Policy Commission in support of lowering the state's "Cost Growth Benchmark." The hearing was held on March 8, 2017. The benchmark sets a goal for the limit of overall growth in medical spending in the state. Entities such as insurers or hospitals that exceed the benchmark may be subject to specific sanctions under the state's health care cost containment law (summary).
In our testimony, HCFA supported allowing the benchmark - the goal for the maximum allowable increase in health costs - to go down to 3.1%, from its current 3.6% annual rate.
"We think it's important to signal to the health care community on all sides that our job of reducing health care cost growth has to be strengthened and intensified, and therefore we support allowing the benchmark to go down," Health Care For All policy director Brian Rosman said.
HCFA also urged the Commission to support concrete steps to reduce health care cost growth, such as:
"Dentists still drill and fill teeth and physicians still look at the body from the tonsils south."
Julie Beck from The Atlantic just wrote an article that highlights the importance of dentists working alongside physicians. Read the article here.
At Health Care For All, our Oral Health Integration Project (OHIP) promotes the health of all Massachusetts residents by building a broad-based coalition advocating for the integration of dental and medical care.
Our current objectives are to include oral health and dental services as a requirement of new state standards for Medicaid and commercial Accountable Care Organizations (ACOs). Given ACOs’ focus on whole-person health, the inclusion of oral health is critical to fully realize the potential of integrated care. For more information on OHIP, click here.
HCFA was proud to play a leading role in today's big State House Campaign Kick-Off in support of Prevention and Wellness Trust Fund. PWTF is a unique Massachusetts program that works in partnership with community organizations to keep people safe and healthy. Almost one million people benefit from the program, which is currently active in nine regions, and focuses on four priority health conditions: pediatric asthma, hypertension, tobacco, and falls among older adults.
The rally was in support of legislation to extend and expand the program. Without legislative action, the program expires this June. HCFA, in collaboration with a coalition led by the Massachusetts Public Health Association, and including hospitals, community health centers, health care workers, faith organizations, and mayors across the state support S. 643, An Act to Promote Public Health through the Prevention and Wellness Trust Fund and a companion House bill. These bills will ensure continued funding for the fund, make available new revenue, and enhance the scope and depth of preventive care programs offered across the Commonwealth. We are particularly pleased to note that 112 state legislators have signed on to the bills as cosponsors; over half of the legislature!
Preventive care interventions supported by the fund are thorough and comprehensive, bringing community health centers, schools, housing authorities, and other entities together to address environmental causes of illness. The goal is to take a broader view, and promote healthy behaviors and community-clinical linkages. The result is effective interventions that leads to improved health outcomes for patients and a significant return on investment for our health care system.
We are dedicated to expanding access to quality and affordable health care for all Massachusetts residents. But the truth is, we would rather not need health care; we would rather people stayed healthy to begin with. In this spirit, we believe that investing in preventive care is vital for Massachusetts. Preventative care prevents future illnesses and hospitalizations, improves health outcomes, and offers financial relief for our health care system. For these reasons, it is critical that Massachusetts lawmakers continue to invest in preventive care by extending funding for the Prevention and Wellness Trust Fund.
The Boston Globe ran two opinion pieces yesterday on employer responsibility in health care and the need for increased transparency in prescription drug pricing, both of which Health Care For All supports
An editorial expressed support for the concept put forth in Governor Baker’s budget proposal to require a contribution for employers that provide inadequate health insurance coverage to employees, or do not provide coverage at all. Specifically, the Governor’s proposal would require employers with at least eleven full time employees (FTEs) to cover at least 80% of their workers or to pay a penalty of $2,000 per FTE. This assessment would be calculated on a sliding scale, meaning that the closer employers get to the 80% coverage benchmark, the less they would pay. HCFA agrees with the new employer contribution proposal. Governor Baker’s suggestion closely resembles the employer responsibility law that was originally included in Massachusetts’s 2006 health reform law. The state requirement was repealed in 2013 in preparation for implementation of the Affordable Care Act (ACA)’s employer responsibility provisions. However, especially with the ACA in jeopardy, it is critical that health coverage remains a shared responsibility between employers, employees, insurers, payers, and providers, and that Massachusetts employers continue to pay their fair share.
The second Globe article, an op-ed by Eric Schultz, the president and CEO of Harvard Pilgrim Health Care, lays out a compelling case for increased transparency for prescription drug prices. As Schultz points out in the article, prescription drug prices continue to grow at a furious pace and the United States continues to pay disproportionately high prices for both name brand and generic drugs. As an example, Schultz cites Harvoni, a drug used to cure hepatitis C, which costs $94,500 for a twelve week regimen in the United States, while it would cost essentially half that amount in the United Kingdom and only $900 in India. Schultz points out that it would be cheaper for Harvard Pilgrim to fly a member with hepatitis C (along with a guest) back and forth from the Cayman Islands twice, pay for the member to purchase Harvoni through a Cayman medical facility and receive follow-up testing and screenings, and treat the member to a nine day all-expenses paid vacation on the Cayman beaches– than it would to treat the member here in Massachusetts.
Clearly there is a problem with the way prescription drugs are priced in Massachusetts and across the United States. This is largely due to a lack of transparency. Health insurers routinely negotiate discounts and rebates with drug companies, yet insurers are not allowed to disclose publically the cost of those discounts. In addition, drug manufacturers do not disclose the amounts spent on administrative overhead, marketing, and research and development, all of which remain hidden from public scrutiny.
Health care costs continue to rise in Massachusetts, and a leading driver of cost growth is the rising cost of prescription drugs. From insulin to epipens, life-saving drugs have caught headlines and public attention for massive price increases (insulin prices have more than tripled since 2003, while epipen prices have increased six fold in the past decade). That is why HCFA is supporting a pair of bills recently introduced in the State House, H. 1228 and S. 652. Both bills would empower state agencies to collect information on costs of production from drug manufacturers and ensure that the Commonwealth is paying a fair price for prescription drugs. These legislative proposals are an important first step towards ensuring that Massachusetts consumers can afford critical medications, and that insurers won’t have to pay the equivalent of a Caribbean vacation to provide access to life-saving treatments here in the Commonwealth.