"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

October 24, 2018

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

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

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

October 18, 2018

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 At least 22 Senators have already opposed the rule in a letter to DHS, asking for it to be withdrawn altogether.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

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

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

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

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

September 24, 2018
You may have heard about proposed policy changes that could affect immigrants’ use of public benefits (government programs that may help you pay for food, housing, health care such as MassHealth and other living expenses). New federal regulations are proposing to change the definition of who is a “Public Charge,” a person who is likely to become dependent on the government for financial and material support. This change could affect the ability to adjust status or petition for a family member. 

HCFA wants to make sure that you have the most accurate information about these changes, so that you can make the best decision for you and your family. 

  • There has been no change to the “public charge” rules at this point if you are in the US and contemplating adjusting your immigration status or sponsoring someone who is already here. These are proposed regulations that still need to go through a formal federal review process before changes are made.
  • Currently, the only benefits considered under “public charge” are cash benefits (Supplemental Security Income or Transitional Assistance for Needy Families (TANF) or payment for long-term care institutionalization).
  • Over the next several months, the proposed rule could potentially impact other benefits, including: MassHealth (except MassHealth Limited); Supplemental Nutrition Assistance Program (SNAP/food stamps); Medicare Part D Prescription Drug Subsidy; Section 8 Housing Choice Voucher Program; Section 8 Project-Based Rental Assistance; and Public Housing. There is no need to disenroll from these programs at this time. If the regulations are approved, individuals will have 60 days to withdraw from them before they impact people. After that time, the use of these benefits is dependent on other factors that should be discussed with an immigration counselor or attorney.
  • If you are sponsoring a family member who is currently living outside the country, you should check with an immigration counselor or attorney about whether receiving public benefits could affect your pending petition.
Health Care For All (HCFA), the Massachusetts Immigrant Refugee Advocacy Coalition (MIRA), Health Law Advocates (HLA) and many other organizations work to protect Massachusetts immigrants and ensure they have the right to access public benefits, including health care.

To learn more about changes regarding the “Public Charge” determination and how to be part of the campaign to oppose these changes, you can send an email to organizing@hcfama.org.

Attached here is a list of organizations that are trusted in the community and provide free immigration services. Some of these organizations may have limited capacity and may not accept new cases, please call first to ensure that they can help you. 

August 23, 2018

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

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

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

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

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

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

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

-Leah Dreyfus



July 16, 2018

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

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

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

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

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

-Louis Pratt

July 10, 2018

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

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

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

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

June 6, 2018

The Massachusetts Senate recently approved their version of the Fiscal Year 2019 (FY19) state budget. The Senate version and the House version must now be reconciled through negotiation between the two chambers. Health Care For All (HCFA) has a number of budget priorities related to health care that have made it this far and should continue on to the final budget.

To find HCFA’s full FY19 Conference Committee letter with detailed explanations of our positions, please click here. You can find summaries of each budget priority that HCFA supports below:

  1. Restore Coverage for Periodontal Care For Adults on MassHealth

We urge the Conference Committee to direct MassHealth to reinstate coverage for periodontic services for adult MassHealth enrollees so that they are able to get the appropriate care that they need to maintain good oral, and overall, health.

  1. Establish a strong Office of Health Equity within EOHHS, and provide funds for the Office’s operation

We urge the Conference Committee to include Section 7 and line item 4000-0009 of the House budget, which would establish and fund an Office of Health Equity to reduce the serious racial and ethnic health disparities that exist in Massachusetts.

  1. Provide expanded authority to MassHealth to negotiate for fair prescription drug prices

We urge the Conference Committee to include authority for MassHealth to seek supplemental prescription drug rebates, and require pharmaceutical pricing information from manufacturers if reasonable rebates are not provided to MassHealth. The provision should also allow EOHHS to assess penalties on manufacturers who refuse to provide the required information, or who do not offer fair rebate amounts to MassHealth.

  1. Direct MassHealth to provide information on ACO outcomes and activities addressing social determinants of health

We urge the Conference Committee to include language in the MassHealth line item (4000-0500) directing MassHealth to provide information on ACO outcomes and performance, particularly data on ACO activities addressing the social determinants of health.

  1. Fund critical children’s mental health programs

We urge the Conference Committee to fund the MHAP for Kids program at $50,000 (within line item 4800-0200).

We urge the Conference Committee provide level-funding for Return to School “Bridge” Programs at $250,000 (within the School Health Services line item 4590-0250).

  1. Preserve Sunset on Prescription Drug Marketing Coupons on Rebates

We urge the Conference Committee to maintain the state’s prohibition on drug industry marketing “coupons” by 2019 and direct the Health Policy Commission to engage in a substantive study of the long-term costs and benefits of drug coupons on the Massachusetts health care market.

  1. Provide Unbiased Information about the Cost and Efficacy of Prescription Drugs

We urge the Conference Committee to provide funding for Health Policy Commission to operate the Academic Detailing program (line item 1450-1266 of the Senate budget) at $150,000.

  1. Require data collection on pediatric continuous skilled nursing services

We urge the Conference Committee to include Section 16 of the Senate budget, which directs the Center for Health Information and Analysis and MassHealth to regularly report data about pediatric patients requiring Continuous Skilled Nursing services.

  1. Fund pediatric palliative care programs

We urge the Conference Committee to fund Pediatric Palliative Care Programs (4590-1503) at $3,816,053, to ensure that all children and families who need these services can get them.

  1. Adequately fund DPH’s Office of Oral Health and the successful ForsythKids Program

We urge the Conference Committee adequately fund the general operations of DPH’s Office of Oral Health, and continue to earmark $300,000 for the ForsythKids program (line item 4512-0500).

Each of these provisions serve important purposes in supporting health care in Massachusetts. As always, HCFA is committed to advocating for affordable and quality health care coverage. All ten of these proposals do just that.

-Brian Rosman and Davis Jackson

May 23, 2018
In the worlds of health care policy and delivery, there is increasing recognition that addressing the social determinants of health (SDOH) –access to nutritious foods, affordable housing, safe neighborhoods, dependable transportation, well-paying jobs and safety from violence—is essential to improving health outcomes, containing health care costs and addressing health inequities across race and income. In other words, health care is about even more than having insurance coverage and receiving traditional medical care. 
The Massachusetts Budget and Policy Center (MassBudget) recently released issue briefs on the health effects of the Earned Income Tax Credit (EITC) and Paid Family & Medical Leave (PFML). MassBudget presents research showing that both policies improve the health of individuals, families and communities by addressing economic hardship and promoting the family and social support that contribute to better health. 
These are live issues now. The Senate budget being debated this week includes an increase in the state EITC, as did the House budget and Governor’s Baker’s budget proposal. In addition, PFML is a proposed initiative to be before state voters this fall.
Each year over 400,000 Massachusetts tax filers claim the EITC, a refundable tax credit that goes to families and individuals, primarily workers with children, who have income from paid work. The Massachusetts EITC partially matches the EITC at the federal level which “keeps administrative costs and complexity to a minimum, while rewarding and encouraging work.” MassBudget found that increases in EITC payments are associated with:
Reduction in occurrences of low birthweight
Increased gestation time for pregnant women
Increased educational attainment for children – which is linked to better health outcomes
Improvements in children’s behavioral index scores which measure behaviors such as peer conflict, anxiousness and depression
Avoidance of the early onset of disabilities and other illnesses associated with low family income
Increased in the self-reported health of mothers  and improved blood pressure, heart rate, cholesterol and inflammation levels for these mothers
Increased prenatal care
Increased spending on healthy foods such as fruits and vegetables
Increased economic  activity in neighborhoods with a high concentration of households receiving the credit
A policy that allows workers to take paid time off from work to care for themselves, a new child, or a family member with a serious illness or injury, PFML influences the ability of individuals and families to live healthy lives. The MassBudget report shows that access to PFML can have both short-term and longer term health benefits across the lifespan, including:
A decline in infant mortality
Increased rate and duration of breastfeeding
Improved physical, cognitive and behavioral outcomes for children – including higher rates of vaccination
Decreased likelihood of behavioral and adjustment problems for adolescents and adults
Faster recovery from both inpatient and outpatient procedures for children
Fewer depressive symptoms for new mothers in the short-term and the long-term
Reduced  nursing home utilization by elders
Tackling the complexities of social determinants of health is essential to realizing our vision of a Massachusetts in which everyone has the equitable, affordable, and comprehensive care they need to be healthy. While we must always stand firm in protecting and expanding coverage and care, we must also identify and champion policy solutions that extend beyond this classic framework to address the multitude of factors that so powerfully affect the health of the Commonwealth.
-Natalie Litton
May 17, 2018

Just last week, the Massachusetts Senate released their budget proposal for fiscal year 2019, which begins on July 1 of this year. Senators will be debating and voting on many amendments in the short term, including a number of important health care related amendments. 

HCFA is supporting a number of amendments that will improve access to affordable and quality health care coverage; there are also some proposed amendments we oppose that would move our state backwards.

With debate in the Senate starting, it is critical that your Senator knows how constituents feel about these critical health care related amendments. To find your State Senator's contact information, click here. A summary of these key amendments is below:

[For full explanations of each amendment, see our complete budget amendment fact sheet here]


HCFA Supports:

Health Insurance:

Amendment #599 (Monitoring Accountable Care Organization Use & Efficacy of Non-Medical Services): Sponsored by Senator Welch, directs MassHealth to work to report data on ACO activities to address social determinants of health.

Amendment #491 (Office of Health Equity): Sponsored by Senator Lewis, allows existing EOHHS funds to support activities of an Office of Health Equity.

Amendment #580 (Academic Detailing): Sponsored by Senator Lewis, increases funding for a physician education program on cost-effective utilization of prescription drugs to $500,000.

Amendment #515 (Smoking Prevention & Cessation Program): Sponsored by Senator Lewis, restores funding to the FY2007 level of $8,500,000 to provide adequate funding for this vital tobacco control program.

Children's Health:

Amendment #620 (Protecting Medically Fragile Children): Sponsored by Senator Friedman, provides an additional $16 million investment in the Continuous Skilled Nursing Program.

Amendment #414 (Mental Health Advocacy Program for Kids): Sponsored by Senator Crighton, increases funding by $150,000 for the Mental Health Advocacy Program for Kids, providing $200,000 to support this valuable program.

Amendment #614 (Return to School "Bridge" Programs): Sponsored by Senator Friedman, provides $250,000 to maintain and expand these Bridge programs.

HCFA Opposes:

Amendment #484 (Health Connector Coverage For Non-Disabled Adults): Opposing this amendment, sponsored by Senator Tarr, would prevent disruptions in coverage for 140,000 adult MassHealth enrollees.

Amendment #496 (Moratorium on Mandated Benefits): Opposing this amendment, sponsored by Senator Tarr, excludes a blanket moratorium on new mandated benefits from the FY18 budget.

Amendment #422 & #488: (Prescription Drug Copay Coupons): Opposing these amendments, sponsored by Senator Demacedo and Senator Tarr, prevents pharmaceutical companies from using rebates and coupons to influence consumer choice and drives up health care spending. 


Again, we strongly encourage each of you to contact your State Representative regarding each of these amendments. Make sure that your voice is being heard by those making the decisions!

-Davis Jackson

May 11, 2018

By Jake Murtaugh, Public Affairs Associate

Massachusetts Society for the Prevention of Cruelty to Children


The Children’s Mental Health Campaign began as a call to action to inspire mental health reform in Massachusetts and has evolved into a leading voice- so that children and youth get the right care, at the right time.

In 2006, The Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) and Boston Children’s Hospital (BCH) published “Children’s Mental Health in the Commonwealth: The Time is Now.” The study highlighted that the mental health system in Massachusetts was not providing appropriate care to children and teens and that “for too long the healthcare system, including its reimbursement structures, has minimized mental health as a core component of health care”. To answer the call for systemic reform, the Children’s Mental Health Campaign was born, and children’s health advocates created a broad-based mechanism to respond to an inadequate system of care for children and teens with mental and behavioral health needs.


On May 7th, 2007, the Campaign testified on increasing access to mental health services for children and teens before a State House audience. You may recognize some familiar faces!

The Campaign quickly gained support from providers, educators, consumers, and organizations, becoming an important driver for the passage of landmark legislation in the Commonwealth; Chapter 321, An Act Relative to Children’s Mental Health & Chapter 256, An Act Relative to Mental Health Parity. The Campaign grew from a collaboration of 34 organizations into a dynamic advocacy network of over 160 organizations dedicated to creating a system in which every child in the Commonwealth receives the highest quality mental health care, in the right place, at the right time.

The Children’s Mental Health Campaign continues its fight for mental health parity and for access to compassionate, effective care for children and teens in Massachusetts. Despite significant gains over the last decade, children and families continue to experience barriers to community-based behavioral health services in Massachusetts. The Campaign advocates for legislation and state budget funding in order to improve access to behavioral health care for children and teens across the Commonwealth.

The Campaign believes that Massachusetts must:

1. Support children in the community.

Because of the Children’s Behavioral Health Initiative (CBHI), children and teens in Massachusetts who have MassHealth coverage now have greater access to community-based treatment than their peers with commercial health insurance coverage.


Private insurers are not required to cover community and home-based care. This is a violation of mental health parity. Children and teens seeking mental and behavioral health support should have access to, and health coverage for, appropriate care, including community-based services. An Act to Increase Access to Children’s Mental Health Services in the Community (S.547) would mandate commercial insurers to cover community and home-based care, and would help strengthen parents’ ability to navigate the mental system and then access appropriate care for their children.


2. Make sure children and families know where to get care.

Too often health provider network directories are outdated and inaccurate. An Act to Increase Consumer Transparency About Insurance Provider Networks (S.538) will make sure parents know where to get the right services for their children. Provider directories should be tools for accessing the right care, and not a barrier.

3. Support young children- don’t expel them.