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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

April 12, 2015

Administration officials from the Governor on down have been repeating the mantra over the past few months - MassHealth is "unsustainable."  Last Monday, EOHHS held a big public input session, titled, "Creating a Sustainable MassHealth Program."

Yes, MassHealth takes up a large portion of the state budget (but not as large as you think). And yes, MassHealth has seen spending increases over the years (but what part of the health care system hasn’t)?

But, does that make the MassHealth program unsustainable?

Let’s look more closely at the facts.

MassHealth is the foundation of the Massachusetts health care system. The program covers approximately 1.9 million low-income Massachusetts residents – providing access to critical medical, behavioral health and community-based services. It brings in about 80% of all federal revenue the Commonwealth receives and has a large impact on the economy.

MassHealth’s spending increases have been primarily driven by enrollment. The Commonwealth wisely expanded coverage through several reforms over the years, most recently by implementing the Affordable Care Act (ACA) Medicaid expansion to cover low-income adults. Many of these new enrollees were simply switching to MassHealth from Connector-based programs. So MassHealth spending grows, as Connector spending goes down. And, as a bonus, we collect more federal revenue.

While these points were acknowledged at last Monday’s MassHealth stakeholder meeting, the conversation was framed around a single focus: MassHealth is unsustainable. The centerpiece was this complex chart, which mixes lots of disparate numbers:

EOHHS chart - MassHealth "Unsustainable"

While this chart seems to be all bad news, with costs soaring, that's not what it says.

From a state fiscal point of view, the key number of consequence is the net state cost - the actual cost of the program to the state budget. That's the total cost, minus the federal revenue, shown in the dark blue line at the bottom of the chart. And the growth rate in net state costs is declining sharply. The dark blue circles above, isolated in the chart below, is good news:

MassHealth Net state cost growth rate declining

Here's what's happening in the charts. Due to the ACA, we're covering more people in MassHealth. But increasingly, more of the added cost is coming from federal sources, not the state budget. So MassHealth is becoming more, not less sustainable from a state budget point of view.

And, the increasing federal share is a big bonus for the overall state economy. Many studies have looked at the multipler effect of Medicaid spending. They all show that Medicaid spending increases leads to increased economic activity, including more jobs and increased state and local revenues.

This is not say MassHealth should not look for efficiencies. Of course - it must always. And improving overall health and patient outcomes through more care coordination, by changing how providers are paid to reward value, and by imtegrating mental and behavioral health as appropriate for patients are the right things to do regardless of the impact on spending. We strongly support these initiatives started by the Patrick administration and being carried forward now.

But when one looks at the ability of the state to afford, say, full restoration of dental benefits for adults on MassHealth, it's clear that the "MassHealth is unsustainable" catchphrase does not add any clarity to the analysis.

        - Suzanne Curry and Brian Rosman


April 9, 2015

Today, the Health Connector Board welcomed two new members: Dr. Michael Chernew, a health economist from Harvard Medical School, and Dimitry Petion, a small business owner. With these additions, the Connector Board membership is complete.

Connector Executive Director Louis Gutierrez provided an overview of health and dental enrollment through the Health Connector as well as priorities moving forward. Approximately 142,000 individuals are enrolled in non-group health plans and 35,000 in non-group dental plans. The Connector is intensely focused on improving operations, including call hold times and abandonment rates, back-end IT problems, and payment system upgrades.

Gutierrez also stated that corrected 1095-A tax forms have been mailed to 28,000 Health Connector enrollees who previously received forms with inaccurate federal advanced premium tax credit (APTC) information. 1095-A forms are filed with one’s federal taxes to ensure receipt of the correct level of Affordable Care Act (ACA) premium subsidies. Due to the technological difficulties, only 711 Massachusetts residents received APTCs in 2014.

Vicki Coates, the Health Connector’s new Chief Operating Officer, is conducting a top-to-bottom review of the Health Connector's back office functions. Patricia Wada, the Special Assistant to the Governor for Project Delivery (aka health reform czar) is working with Coates and looking to broadly build an implementation schedule for the eligibility and enrollment system within three categories of work:

  • Better solutions to back office errors;
  • New functionality for May (for example, ability to easily re-enroll in a plan, payment system improvements); and
  • Prioritization of defects.

Mark Gaunya, the broker representative on the board, asked whether this work includes development of decision support tools. Gutierrez responded that yes, there is some work happening in this area, but the final product will be very modest for 2016.

Board member and 1199SEIU Vice President Celia Wcislo asked when the provider search tool would be up and running. She had heard from the Attorney General’s office that consumers who chose Tufts – Network Health were surprised to find out their providers were not in the network. Gutierrez stated that that provider search capabilities are in mind when thinking about user interface, although the Connector will not have a robust provider search tool ready soon.

The meeting then turned to the repeal of some obsolete regulations, and an important discussion of risk adjustment regulations (honest, this actually is important). Meeting materials are posted here, and our full report on the rest the meeting just takes one easy click.

April 9, 2015

A huge crowd packed a MassHealth open meeting on Monday, April 6 to talk about fundamental reforms of the MassHealth program. There were seats for maybe 100 people at the DPH Council room, but some 200 people showed up, resulting in lot of folks standing, with some trailing down the hall outside the door, straining to hear. Inside, EOHHS Secretary Sudders and Assistant Secretary/MassHealth Director Tsai announced the beginning of a public discussion process on the challenges facing MassHealth, looking at restructuring how systems work and how care is paid for and delivered.

The slides from the presentation are posted here, and you should bookmark the new MassHealth site that we were told will be the hub for the ongoing reform discussion, www.mass.gov/hhs/masshealth-innovations.

After going over some background on the financial picture and opportunities for improvement, they listed the state's priorities and principles:

MassHealth principles for restructuring 4-6-15

The state speakers were open about the need for focused improvements, and broke up the discussion into four topics:

  • Member and provider experience
  • Payment reform
  • Integration of physical and behavioral health
  • Approaches for improving care/ sustainability for LTSS (long term services and supports)

 Audience members brought up other issues as well, with many comments focusing on how MassHealth can address social determinants of health such as housing and social supports, and better use community resources to combat poverty. A MassHealth member raised the issue of the program not providing a full dental benefit.

Tsai announced that MassHealth will be holding multiple sessions on the four topic areas, and then plans to synthesize comments and produce a timeline for public comments this summer. He warned that not everything would be able to be accomplished right away. He urged everyone to be engaged in what he called a "collaborative mindset." Stay tuned!

        - Brian Rosman

April 8, 2015

Coverage for 130,000 children and pregnant women. A $166 million hole in the state budget. Those are the stakes for Massachusetts in the upcoming Congressional vote to extend federal funding for the CHIP program.

For over 17 years, CHIP has helped millions of children get the health care they need. CHIP keeps children healthy, allowing them to get consistent care and timely, appropriate treatment. The outline of CHIP was born in Massachusetts. In 1996, the state, with a strong advocacy push from Health Care For All, passed legislation expanding Medicaid and transforming it into the MassHealth program. Among the provisions was a substantial increase in coverage for children, funded by an increase in our cigarette tax. After the legislature overrode Governor Weld's veto of the bill, our law came to the attention of Senator Edward Kennedy, who took the idea and formulated the original federal CHIP law in partnership with Republican Orrin Hatch.

But, federal spending authorization for the CHIP program ends this fall. The U.S. House passed a bi-partisan bill in late March to extend funding for the program for an additional two years, attaching it to a fix of the Medicare physician funding system. The law also extends funding for community health centers, the Maternal Infant Early Childhood Home Visiting program, and family to family information centers. All Massachusetts Representatives voted for the bill. The U.S. Senate is expected to vote on the bill when it returns next week.

Now, the Mass Medicaid Policy Institute of the Blue Cross Blue Shield of Massachusetts Foundation released a report analyzing the impact of the federal CHIP program for Massachusetts. The report was written by Robert  Seifert of the Center for Health Law and Economics at University of Massachusetts Medical School.

The report lays out the stark impact on Massachusetts if CHIP funding were to end:

All told, if federal CHIP funding is not continued and Massachusetts opts to continue to provide coverage to all of the 130,000 children currently covered, it will do so at an additional cost of about $166.3 million in SFY 2016.

Alternatively, fiscal pressures could lead Massachusetts to amend its 1115 waiver to eliminate MassHealth coverage for as many as 58,000 CHIP children and to choose not to cover the 7,000 unborn children. Some of these children might obtain more expensive, less comprehensive coverage through an employer or the Health Connector, but a significant number of them could become uninsured. This would reverse a long-running trend in Massachusetts and tarnish what has been one of the state’s great health policy triumphs: reducing the number of uninsured children in the state to a minuscule level.

Today, there were some rumblings that the law that was overwhelming passed by the House (the vote was 392 to 37) may be in trouble in the Senate, mostly from conservative Republicans. We strongly support the federal extension proposal, and urge the Senate to support the bill. CHIP is critical for kids' health in Massachusetts, and for our state budget.

     - Brian Rosman

March 23, 2015

Today marks the fifth anniversary of the ACA.

Conceived out of Massachusetts health reform, the law has been an enormous success nationally. It's also made a huge difference here, with more people being covered with better coverage, due to the ACA's improvements over Massachusetts' reform.

The best piece we've seen so far on taking stock of the ACA at 5 years is this, "Obamacare is 5 years old, and Americans are still worried about death panels," by Vox's Sarah Kliff. The article is based on new polling results, which shows lots of misinformation and myths still present among Republicans, and low information overall. One of the biggest misperceptions is that the costs are going up. In fact,

the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it's less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare's subsidies would cost 20 percent less over the next decade than initially expected.

The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn't include any Affordable Care Act spending at all.

A modern birthday is celebrated with infographics, of course. And a video. Here's some celebrating:


Five reasons to celebrate

Peace of Mind from Obamacare

UPDATE: One more great White House video:



March 18, 2015

Join the I MassHealth Campaign!

I Heart MassHealth because it has provided me and my family with continued access to health care

Sharing people’s stories is a compelling way to demonstrate the importance of the MassHealth program and make complex health care policies easier for people to understand and relate to.

Today, we are launching the I Heart MassHealth campaign. We are collecting statements and photos that bring to life why MassHealth is a critical program for the health of millions of the Commonwealth’s residents. Here's what you can do to particpate:

  1. Please download this template to share your story with us and encourage your friends, family and colleagues to do the same. Write in why MassHealth matters to you. Include your first name and hometown for an even more effective message.
  2. Take a picture of yourself holding your sign! We will be posting these photos to our Facebook page and sharing them with Twitter. If you are not comfortable showing your identity, feel free to keep your face out of the photo.
  3. Email your photo to us at iheartmasshealth@hcfama.org.
  4. Invite your friends and colleagues to participate as well.
  5. Track the I MassHealth campaign! Look for your picture and learn why MassHealth matters to others by following us on Facebook and Twitter.

I Heart MassHealth because they provide services for children with mental health difficulties

Personal stories are the most powerful tool we have in our fight to protect and expand access to quality health care. Thank you for sharing yours.

                - Suzanne Curry

March 13, 2015

To kick off yesterday’s Connector Board meeting, EOHHS Secretary and Connector Board Chair Marylou Sudders introduced two new Connector Board members appointed by Governor Baker. Mark Gaunya replaces George Gonser as the broker representative, while Rina Vertes replaces John Bertko as the actuary representative. Sudders said that the two additional open board positions – the economist and small business representative – will be announced in April.

Louis Gutierrez, the new Executive Director for the Health Connector, shared non-group health and dental plan enrollment numbers. As of March 1st, 124,215 people are enrolled in health coverage aand the Connector continues to see enrollment for April 1st.

Total enrollment thus far includes:

  • 128,000 non-group health plan enrollees, including 91,000 with subsidized coverage
  • 31,104 non-group dental enrollees
  • 479 (109 groups) small group dental enrollees
  • 4,248 (901 groups) small group health plan enrollees

Gutierrez pointed out the significant and growing interest in dental coverage. He also said that the Connector will continue to study how members transitioned and why people did or did not move into new coverage through MassHealth or the Health Connector.

Lastly, Gutierrez announced two new staff:

  • Vicki Coates will start as the Connector’s Chief Operations Officer on March 16th
  • Patricia Wada who replaced Maydad Cohen as the Special Assistant to the Governor for Project Delivery on the Health Insurance Exchange (HIX) project.

Materials from the meeting are here, and our full report is coming up after the break .

March 10, 2015

March 4, 2015

Governor Baker released is first budget proposal today, for Fiscal Year 2016, which starts this July 1. You can read the budget bill and supporting materials here, and see the video of the press briefing.

Like any budget, there's a lot to digest, and we'll have more to say in the coming weeks. Here's our initial statement distributed to the press:


Statement from Health Care For All's



BOSTON -- "Health Care For All welcomes Governor Baker's budget proposal. In his budget, the Governor maintains the Commonwealth's long-standing commitment to providing access to affordable health care, and we look forward to the proposal's consideration in the coming weeks as it moves to the legislature.

"We are particularly pleased that the budget extends this year's decision to restore MassHealth coverage for full dentures. We continue to call on the legislature to restore full dental benefits for adult MassHealth members. Many benefits were cut in 2010, and only some have been restored so far. Having access to comprehensive oral health is important for everyone and is particularly critical for pregnant women, diabetics, and people living with HIV/AIDS and other chronic diseases who are vulnerable to serious dental complications.

"The budget also expands services available to children with autism. This long-overdue coverage will allow families to receive the comprehensive services necessary for an improved quality of life. We applaud the Governor for this investment.

"The Governor's budget assumes significant savings based on the re-evaluation of every MassHealth member's eligibility. Health Care For All will work diligently to ensure that the redetermination process is fair and responsive to the needs of the over one million people who rely on MassHealth for their health care.

"We are encouraged by the initiatives put forth by the Baker administration that address some of the key social determinants of health by investing in economic self-sufficiency. Doubling the funding dedicated to the Earned Income Tax Credit (EITC) and initiatives that provide more permanent housing options are critical tools that promote stability for hard-working families. These programs represent the foundation of health vitality and long-term economic opportunity."



March 2, 2015

Health Care For All is offering free trainings to assisters and groups serving MassHealth and Health Connector members in Massachusetts.

At the sessions, you will learn who needs to take action for their coverage, and how to help MassHealth members complete their renewal forms.

There will be both webinar and in-person trainings. If the trainings below are not good for you, and you would like to host your own training, contact Kate Bicego at kbicego@hcfama.org or 617-275-2912.

The webinars will be on March 6th, 10 a.m. - 11:30 a.m., and on March 13th, 1 p.m. - 2:30 p.m. For information or to RSVP, also contact Kate.

The in-person sessions will be:

  • Springfield
    March 20th, 9:30 a.m. - 11:30 a.m.
    Springfield Partners for Community Action (721 State Street)
  • Boston
    March 23rd, 10 a.m. - 11: 30 a.m.
    ABCD (178 Tremont Street, 3rd Floor)
  • Fall River
    March 24th, 9:30 a.m. - 12 p.m.
    SSTAR Family Health Care Center (400 Stanley Street)
  • Pittsfield
    March 25th, 10:30 a.m. - 12 p.m.
    Country Club of Pittsfield (639 South Street)
  • Lowell
    March 27th, 9:30 a.m. - 11:30 a.m.
    Community Teamwork, Inc. (17 Kirk Street)

See this flyer for more details.

NOTE: Updated 3/16/15.