"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

November 19, 2013

Connector enrollment 11-12-13

The Health Connector Board met this past Wednesday (Nov. 14) to discuss open enrollment, broker commissions, and progress in getting ready for the ACA.  Materials from the meeting are here, and click on for our full update.

November 17, 2013

The Obama administration's decision to permit insurers to continue to offer plans they otherwise would have cancelled (here's some good place-it-in-context background from The New Republic's Jon Cohn) is still subject to state insurance market rules.

Already a number of states, including Washington, Arkansas, Vermont and Rhode Island, have ruled that they will continue to insist that all new plans offered in the state comply with the consumer protections in the ACA. Note that "grandfathered" plans, in existence before the ACA was signed in 2010, were always still allowed to be offered to people who wished to renew those plans.

Massachusetts has not yet announced its decision (see the Monday morning UPDATE below), although we understand the Division of Insurance is looking closely at the issue. On Friday, HCFA sent a letter to DOI urging them to reject this option. Here's our letter:

November 15, 2013

Joseph G. Murphy, Commissioner
Kevin P. Beagan, Deputy Commissioner, Health Care Access Bureau
Massachusetts Division of Insurance

Re: Transitional Policy for Carrier Compliance with Federal Market Reforms

Dear Commissioner Murphy and Deputy Commissioner Beagan:

We are writing regarding yesterday’s letter from Gary Cohen, Director of the Center for Consumer Information and Insurance Oversight (CCIIO), to state Insurance Commissioners, which provides information on the “transitional policy” allowing health insurance issuers to choose to continue coverage that would otherwise be terminated or cancelled due to requirements under the ACA market reforms, and allowing affected individuals and small businesses to choose to re-enroll in such coverage.

We urge you to formally reject allowing carriers in Massachusetts to continue coverage under this transitional policy.

Health Care For All has received no calls from consumers complaining about losing coverage due to the ACA. As you know, we’ve long had virtually all of the protections that the ACA extends nationally. All insurance in Massachusetts has met the 2014 federal requirements around covering pre-existing conditions and not discriminating based on health status or gender since the 1990s. People in Massachusetts are subject to minimum benefit requirements that are very similar to those in the upcoming federal law. For example, under minimum creditable coverage standards, Massachusetts residents have had prescription drug coverage since 2009. Similarly, we have had state mental health insurance mandates for years.

We are concerned that the transitional policy would unnecessarily disrupt the existing ACA transitions in Massachusetts, create consumer confusion, and unsettle premium rates, which have been finalized for plans starting on January 1, 2014.

While the majority of Massachusetts plans were already in compliance with the federal market reforms, there are some benefit improvements under the ACA that will improve coverage for families. The President’s decision may make sense in a national context; however, for Massachusetts there is no need to turn the clock back.

A number of other states have already determined that this transitional policy would not be in the public interest, including Arkansas, Washington and Vermont. We urge Massachusetts to join these states in protecting consumers and the insurance market.

Sincerely,

Amy Whitcomb Slemmer, Esq.
Executive Director
Health Care For All

We'll update this post when there's a decision from DOI.

UPDATE:

Were very pleased that on Monday morning, Division of Insurance Commissioner Joseph Murphy sent this letter to federal officials, rejecting the option:

Mass letter to CCIIO 11-18-13

November 7, 2013

Last week, on a day full of victories, the President of the United States visited Boston to defend the Affordable Care Act. He began his historic appearance at Faneuil Hall with the self-deprecating and not altogether untrue observation that his visit was not the biggest event of the day, given the Red Sox World Series game that night.

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The President’s appearance was capped off with a wonderful introduction by Governor Patrick, who, with the President waiting in the wings, suggested that he would take the opportunity to introduce all of us to the President (watch the video above to see both the Governor’s and the President’s speech).

We thank Governor Patrick for detailing some of the remarkable consumer stories represented in the audience, mentioning the hard working and often unsung advocates who worked tirelessly for reform’s success, and telling the unvarnished truth of some of the challenges of implementing reform. Governor Patrick discussed the challenges of bringing various stakeholders to the health care reform table to hammer out a shared vision and set of goals founded on the rock solid certainty that health care is a human right and a public good.

There was poetry in the choice of Faneuil Hall for the President’s speech, as many in attendance were also present in April 2006 for the Chapter 58 signing ceremony. I hope that the President enjoyed being surrounded by people who are living with and grateful for the benefits of the Affordable Care Act. I am also hopeful that this event will be part of what turns the tide in favor of the ACA. Plenty of comments can be made about the national website snafu. We know that health care reform is more than a website. The truth is that there is power in gathering people who have had their lives improved by this law, and there is no better balm to quell the fears of patients and health care consumers than hearing directly from people just like them. People who have navigated the system, have been living with health reform for more than 7 years, and can sleep better at night knowing that they will not have to choose between bankruptcy and a needed operation, or between paying rent and taking their child to a check-up.

President Obama speaks

Our system and the Affordable Care Act are not perfect, but they are a huge improvement over the status quo in most states. Change is tough but the President and the insured people of Massachusetts invite our friends in other states to try it, and like it. Sign up for health insurance. Find a doctor or health care provider with whom you feel comfortable and then take your insurance for a spin, either for an annual preventive check-up, or to address a problem or concern.

Health Care For All can boast credit for delivering more than 20 consumers to the White House staff members who were responsible for organizing the event. Most of the people we suggested were incorporated either on the stage or in the audience. Of the people on stage, 17 were HCFA staff, partners, or consumers. Even a week later, we are still walking a bit above the ground after the President’s historic appearance, and we hope that he will return again when he needs to be reminded face to face of what the successful implementation of Obamacare looks like. Thank you Mr. President.

-Amy Whitcomb Slemmer

November 7, 2013

Jon Stewart talks about who is telling the truth about the ACA

Last night Jon Stewart, of course, put the latest newsblork in the proper context. Go watch it.

One more thing that should be mentioned in this whole "if you like your plan, you can keep it" thing is the disruption that chapter 58 caused to private health coverage in Massachusetts. Lots of people with substandard plans (remember MEGA Life? We still do) had to change their coverage in 2007 as part of the introduction of minimum creditable coverage (MCC) - specifying minimum benefit levels to meet the individual mandate. A lot more people's coverage was disrupted in 2009, with the additional requirement that prescription drugs had to be included as part of MCC.

Yet Massachusetts seemed to take it all in stride, even though there was (and still is) serious opposition to the prescription drug requirement. Nobody was accused of any bad faith. There were no accusatory hearings or posturing, just some bills filed that die in committee every year.

Like I said, go watch this.
-Brian Rosman

November 5, 2013

http://www.youtube.com/watch?v=656bbzXAZsk

At today's Obamacare hearing before the Senate Health, Education, Labor & Pensions Committee, Senator Elizabeth Warren brought in the voice of experience - the Massachusetts health reform experience.

In her question to federal CMS adminstrator Marylyn Tavenner, Senator Warren repeated a line from last week's Faneuil Hall event with President Obama and Governor Patrick: "Health reform in Massachusetts, like the Affordable Care Act, is not a website, it’s a values statement."

She pointed out that enrollment in Massachusetts started slow and closed fast, with very few enrollments in the early months, and a surge in late 2007, right before the individual mandate took effect.

What I can tell you all from the experience is that getting everyone into a new health care system wasn’t easy and it wasn’t quick....

But because we were committed to making the law work, and making sure people had affordable health care, we kept working on it. We fixed the problems, we hit the pavement , we did whatever it took to get people signed up.

What we learned in Massachusetts is that when it comes to enrolling in health care, many of us wait until the end to get it done.

She also reminded Washington about our initial website glitches and other enrollment snafus. But that did not result in delaying or closing down the program. "We kept working on it because we stayed focused on what mattered – our conviction that no one deserved to be bankrupted or shut out of the health care system when they got sick."

Senator Warren got it right. In fact, over the past 7 years, under both the Romney and Patrick administrations, and several Health Connector leaders, state officials worked closely with advocates and stakeholders on a number of enrollment issues that arose. Poorly-worded questions on enrollment forms were fixed, or eliminated, and over time enrollment issues got better and easier. With the implementation of the ACA in Massachusetts, new challenges have arisen, and state and Health Connector staff are working extraordinarily hard to meet these challenges.

We commend and thank Senator Warren for her history lesson today.
-Brian Rosman

October 30, 2013

Medically Induced Trauma Support Services (MITSS) will be holding its annual fundraising dinner the evening of November 14 at the Westin Copley Place Hotel (event details here).

This year they are also doing something new and adding a free educational forum that is taking place prior to the dinner. The forum, “Supporting Patients and Families Following Medical Harm - Are We Missing the Boat?” will take place at the Westin Copley Place Hotel from 1pm until 4:30pm. Learn more about the forum and how to register here.

MITSS continues to lead the way in supporting patients and families who have been impacted by medical errors, and with this event they will bring much needed attention to this area. Thank you to MITSS for all of your important work.
-Deb Wachenheim

October 29, 2013

Enroll America Blog - title

Enroll America is the national non-profit working to to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act. They are focusing on states with the highest numbers of uninsured, as you would expect. But a number of their senior staff members were in Boston last week to learn about our success in Boston and share ideas and strategies. We also discussed what we are doing now to pick up the remaining uninsured and help those transitioning to ACA coverage.

They just published a blog post written by Ari Fertig, HCFA's Information and Marketing Coordinator, about HCFA's aggressive education work to get the word out about the ACA  in Massachusetts:

When we talk with folks around the country about Massachusetts health reform, we’re proud to boast that over 97 percent of our residents—and 99.8 percent of children in the state—have health insurance. Sometimes, many people think that Affordable Care Act (ACA) implementation must not mean much here since we had our own health reform back in 2006 -- but that is not really the case.

Implementing the ACA here in Massachusetts requires a lot of outreach and education—people need to know how things will be changing. The analogy we like to make is that we’re renovating a house, rather than building the house from the ground up—so there are bound to be some challenges.

In partnership with the Health Connector—the Massachusetts Marketplace or “exchange”—and local community organizations across the Commonwealth, Health Care For All launched a public education campaign targeted to individuals, families and small businesses—paying special attention to the Spanish- and Portuguese-speaking communities—about the affordable health insurance options available in Massachusetts.

There’s a lot for Massachusetts consumers to know. People who were not on subsidized health coverage before may be eligible now for MassHealth, our Medicaid program, thanks to the Medicaid expansion. There are new dental options available on the Health Connector. Small businesses qualify for new tax credits. More people will be eligible to get help paying for health insurance. The Marketplace will offer more health plan options for residents.

We still have work to do to make sure that residents in Massachusetts know about their options. So here’s our grassroots approach:

  • We’re launching a door-to-door canvassing effort to knock on 40,000 doors across Massachusetts.
  • We’re reaching out to 1,000 minority-owned small businesses to talk with them about their health care options under the ACA.
  • We’re distributing door hangers, brochures, and other materials to make sure individuals and families know about their health care options and have updated information—this will help us enroll the uninsured.
  • We’re working with regional partners from cities like Worcester (the second-largest city in New England) to small towns to make sure that even in places where there are no navigators or other kinds of in-person assistance available, people know about their health coverage options.

But we know that we need both a bottom-up and a top-down approach to reach everybody. So we placed advertisements in ethnic media outlets across the state and engaged with key stakeholders garnering a number of front page media stories in newspapers and magazines.

Health Care For All’s HelpLine has already seen a significant uptick in the number of consumers calling to request our assistance due to these efforts. Our HelpLine is a free service that can answer any Massachusetts resident’s questions about health insurance and connect people with public programs. You can call our HelpLine at 1-800-272-4232.

We'll have further updates about our campaign soon.
 

 

October 28, 2013

The Statewide Quality Advisory Committee met last Monday and approved its year 2 final report. The report should be posted on the website soon, and you can see last year's report and meeting materials here.

Before approving the final report, the group heard a presentation from Dr. John Wasson, the creator of www.howyourhealth.org, a tool for measuring patient confidence in care.

HCFA had proposed that patient confidence and measures of shared decision-making be considered for the Statewide Quality Measure Set. Dr. Wasson came to the meeting to inform the group in more detail about the patient confidence measure. Thanks to his presentation and discussion  with the members, the final report, while not approving patient confidence or shared decision-making measures right now, will recommend that they should continue to be examined and considered as they become more widely used in Massachusetts.

The one new measure that was added to the measure set relates to obstetric trauma during birth with instrumentation.  The final meeting of 2013 will be on December 16, 3:00pm, at CHIA, 2 Boylston Street, Boston, 5th floor. The group will revisit its 2013 priorities (behavioral health, care coordination, and patient-centered care), discuss whether or not they were addressed, and talk about priorities for 2014.
-Deb Wachenheim

October 28, 2013

Last week, the Office of Consumer Affairs and Business Regulation held its second community conversation conference on “empowering healthcare consumers.” Click here  to read more about the conference and the featured speakers and to see information about the first conference held last spring in Boston.

The bulk of the gathering involved a panel discussion on healthcare price and information transparency and, later, facilitated table discussions on health care choices.  Panelists included representatives from insurance carriers (Harvard Pilgrim, Fallon), purchasers (GIC), health care providers (Steward, Reliant Medical Group, MHA), government (Office of Consumer Affairs and Business Regulations) and an employer group (Associated Industries of Massachusetts).

The panel, moderated by reporter and anchor Susan Wornick, discussed cost transparency tools and what needs to happen for consumers to utilize the information in a meaningful way. A few panelists mentioned the apparently often-held belief among consumers that if something is more expensive it must be better, including in health care, and that websites should be set up in a way to allow for that myth to be busted. This can only happen if websites present cost and quality information side-by-side in an easy to navigate and understand format.  One panelist made the interesting point that there is no quality measure for when something (a procedure, test, etc.) is not done, though this should often be one of the options discussed by the patient and provider, and that discussion in actuality does not happen often enough (as more provider use shared decision-making tools, hopefully those discussions will happen more often). Another panelist pointed out that cost and quality information is useful not just for consumers but for referring doctors, who would like to have that information easily available when they are making referrals. Panelists also commented on the difficulty of asking the consumer to take on the role of making decisions when they are sick and/or vulnerable, which is why this needs to be a partnership conversation involving the provider and the patient/family.

The table discussions involved a scenario in which you are undergoing physical therapy for a rotator cuff injury and during that time you are researching your options among 5 different hospitals in case you have to have surgery. Nicely laid out on a sheet of paper (unlike what can be found on-line) was an easy-to-understand chart showing things like rate of infections/complications, length of stay, number of surgeries per year, patient satisfaction, total cost and total out-of-pocket cost.  Even when out-of-pocket costs were the same at all 5, nobody chose the hospital that had the highest overall cost because they saw that length of stay and the patient satisfaction and infection/complication rates were worse than at some others. So at least for these well-informed consumers, when given clear information on quality, they are able to make a choice based on something other than the alleged myth that more expensive is better. However, for the general population this is much less true.  Even with this information in front of us, we wanted more details so that we knew what it meant that one hospital had, for example, a low and another a medium complication rate.

We look forward to seeing how this statewide empowerment campaign, to quote Barbara Anthony, will evolve. These first two conferences were a great opportunity to explore the issues but most of the folks in the audience were not there purely in their role as consumers. We hope the next steps will reach more of the general public, and we are happy to be one of a number of partners in this effort.
-Deb Wachenheim

October 21, 2013

Goals and Methods of the Massachusetts SIM grant

The Health Policy Commission (HPC) met on Wednesday, October 16, 2013 for its ninth full meeting. Several important issues were discussed at the meeting, including trends that emerged from the Annual Cost Trends Hearing; updates on the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program; current activities under the federal State Innovation Model (SIM) grant program, and updates on cost and market impact reviews.

The consolidated meeting presentation is here (pdf), and our full report is below the fold.

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