"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

November 22, 2005

HCFA, Health Law Advocates, and the Mass. Law Reform Institute are putting Governor Mitt Romney on notice: reinstate dental services for poor pregnant women and mothers or face a lawsuit.

In July, Governor Romney signed the fiscal year 2006 state budget with a legislative mandate to reinstate MassHealth dental services for pregnant women and mothers with children up to age three. After four and one half months of inaction, we are threatening legal action if the Administration drags its feet any longer.

In a letter to Governor Romney sent today, we asked Gov. Romney to “implement the legislature’s mandate to restore dental coverage to eligible women promptly to avoid legal action.”

Our demand letter describes the acute discomfort of a young pregnant mother who has been denied dental care required by law. "One of my clients, who is both pregnant and has a child under age three, has had two teeth pulled since July for lack of comprehensive dental coverage. Failing to provide basic dental care to pregnant women and new mothers is putting both the women and their newborns and toddlers at risk," wrote MLRI attorney Victoria Pulos.

“Implementing this legislatively mandated coverage is a straightforward administrative process’” notes HLA attorney Leslie Storm. “If the state does not comply with the law by December 6, 2005, we will file a civil action on behalf of Health Care For All and all mothers who are affected.”

November 21, 2005

From our friends at Families USA: (The Massachusetts delegation voted 100% the right way, against cuts to Medicaid. Say "thanks" if you have the chance.)

After a long, heated debated, the House approved a budget reconciliation bill early Friday with deep cuts to Medicaid and other social programs. The final vote was close: 217-215. No Democrats voted for the bill, but 14 Republicans voted against it. You can also thank your Rep by sending an e-mail through the FUSA site.

While we are disappointed, we are pleased so many moderate Republicans voted against this budget. It was due to your calls and e-mails—along with thousands from across the country—that made this a difficult vote for the House leadership.

Now the process moves to Conference Committee, where negotiators from the House and Senate will try to find a compromise between the two versions and send it to both houses for up-or-down votes. Because of the close votes (the Senate passed its version by 52-47) and the significant differences between the bills on Medicaid, we believe we have a chance to prevail in this phase. Our best chance lies once again in the Senate.

We need you to call your Senators and urge them to vote NO on any budget that hurts Medicaid recipients. Our toll-free number is up and running: Call your Senators toll-free:1-800-828-0498. The fight to save Medicaid isn’t over yet—it's just entered a new phase, and we can still prevail. With your help, we can do it!

November 20, 2005

The evidence of a national meltdown in employer sponsored health insurance continues to mount. Here's a piece from last week's Providence Journal (11/17):

The percentage of Rhode Island employers that offer health insurance to employees decreased from 79% to 75% between 1999 and 2005, and the percentage of employers that pay full premium for individual coverage declined over the same period, according to a new survey released by the state Department of Health and Human Services. The survey included responses from 1,444 for-profit, not-for-profit and government employers.

The survey found that 65% of respondents with 3 to 10 employees offer insurance, compared with almost all respondents with more than 100. About 71% of "low-wage" respondents -- those who pay more than half of their employees $21,000 or less annually -- offer health insurance, compared with 99% of other respondents. The percentage of full-time employees eligible for insurance at employers that offer coverage decreased from 92% to 87% between 1999 and 2005. Gov. Donald Carcieri (R) called the results "a huge concern," adding that health insurance "is becoming a significant obstacle to economic development and to job growth in the Ocean State."

November 18, 2005

Vote Now: Boston Business Journal: Log-on and vote on SURVEY QUESTION: Should businesses be required to offer health insurance? Right now it is 56% Yes and 41% No. By the way, the question could be worded better. The House plan does not mandate that businesses offer insurance – it requires employers who don’t cover their workers to pay an assessment to the state – far less than the cost of providing insurance – that can be used to finance affordable coverage. Vote Now!

Update from State House News (yesterday): Travaglini said work on legislation to increase access to affordable health care is also not being driven solely by a deadline, despite a letter this fall from the federal government urging lawmakers to show significant progress on health care reform by Jan. 15, 2006 or risk losing federal money. “I am being driven primarily by getting it right,” Travaglini said. “I’m not so preoccupied with the date that that occurs. If it occurs quickly, I’d be as happy as anybody. If it takes a little longer, I’m willing to do that.” In the waning minutes of formal sessions for this year, the House and Senate Wednesday night adopted orders to return for a special formal session to consider health care legislation if a conference committee completes its work. Travaglini said the Senate remains “mindful” of the Jan. 15 date and will try to respond in an “appropriate way.” “We understand that there’s only so much time,” he said. “I’d rather get it done sooner than later because then you have time to fix what needs to be fixed. I don’t like doing things rush, rush in the last minute. That’s when you seem to make mistakes, and the potential for making mistakes is heightened.”

Coming Event: Brookline Chamber of Commerce To Host Panel Discussion on Healthcare
Business Breakfast Series to highlight the rising cost of healthcare and its effects on individuals, businesses and the economy. On Tuesday December 6 the Brookline Chamber of Commerce will continue its Business Breakfast Series with a program that will include a panel of experts in an informative and lively discussion on the timely topic of rising cost of healthcare. Coolidge Corner Theater, 290 Harvard Street (at Beacon St.) Brookline MA.. Registration: 7:30 AM
Continental Breakfast: 7:45 AM – 8:15 AM Program: 8:15 AM – 9:15 AM; 617-739-1330
Mike Widmer (Massachusetts Taxpayers Foundation), John McDonough (HCFA), and Jay Curley (BCBS) on the panel.

November 17, 2005

House and Senate have appointed their respective members of the House/Senate Conference Committee (CC) to reconcile big differences between the health reform bills passed earlier this month in both chambers. For the uninitiated, CCs always have 6 members -- 3 House/3 Senate, two Ds and one R from each chamber. Final report must be signed by at least 2 members from each branch. Report then gets up or down vote in each chamber -- report is unamendable. If voted down by either branch, House and Senate leaders can form a new conference committee to try again -- I've never seen that happen in more than 25 years of watching.

Health Reform Conferees:
Senate Chair: Sen. Richard Moore (D-Bellingham, Blackstone, Douglas, Dudley, Hopedale, Mendon, Milford, Millville, Northbridge, Oxford, Southbridge, Sutton, Uxbridge, Webster) 617-722-1420
Sen. Therese Murray (D-Barnstable, Bourne, Falmouth, Kingston, Pembroke, Plymouth, Sandwich) 617-722-1481
Sen. Brian Lees (R-Belchertown, East Longmeadow, Grandby, Hampden, Longmeadow, Ludlow, Springfield Wilbraham) 617-722-1291
House Chair: Rep. Patricia Walrath (D-Bolton, Hudson, Maynard, Stow) 617-722-2430
Rep. Ronald Mariano (D-Holbrook, Quincy, Weymouth) 617-722-2220
Rep. Robert Hargraves (R-Ayer, Dunstable, Groton, Pepperell, Townsend) 617-722-2430

A few observations: House conferees do not include the Ways and Means Chair Bob DeLeo, opting for Financial Services Chair Ron Mariano, while the Senate Conferees do include W&M Chair Therese Murray as vice chair. This indicates Murray's keener interest and history in the topic. Here's a switch -- Sen. Moore is lead defender of the Senate bill which does not include the employer assessment on businesses; and Sen. Moore is also the lead Senate sponsor of the Health Access and Affordability Act (HAAA) which included an employer assessment; Rep. Walrath will be lead defender of the House employer assessment and was not an original sponsor of the HAAA.

Timing -- they could reach a deal anytime, though most observers think this will go at least until mid-December, quite possibly into January, maybe into February or later, though that's considered unlikely. The key federal official -- Dennis Smith of the Centers for Medicare and Medicaid Services (CMS) -- asked the state to have a plan connected with the renewal of $700 million in federal dollars to them by January 15th. That's considered a soft, not a hard, deadline, though the Commonwealth is taking chances if they let this deadline slide too much. Check out my September 30 blog if you want to read the actual Smith letter.

Today's Boston Globe has an article about a Cape Cod restaurant owner who fears the employer assessment in the House reform bill. What's missing from the story is any attempt to nail down what the assessment would actually cost the owner beyond the phrase "hundreds of dollars a month".

Coming Attraction -- tomorrow morning at 10am the WBUR (90.9) program, On Point, will host a discussion on the Massachusetts health reform controversy. I may or may not be on it -- but please listen and call in if you are so motivated.

November 16, 2005

Is there a better interviewer on Boston television than Jim Braude on NECN's Newsnight at 8:30pm?

Last night, Braude grilled Gov. Mitt Romney on many topics, first among them health reform. Three times Braude asked the Guv if it was fair that employers who provide health insurance to their workers have to subsidize other workers and their employers who don't offer coverage. Three times the Guv dodged the question and tried to change the subject.

The night before, Braude interviewed Speaker Sal DiMasi and gave him a fair working over on the soft spots in the House plan. DiMasi gave as good as he got, and the exchange was provocative, fast-paced, smart, and interesting.

Click here if you want to see either or both interviews. Cheers to Jim Braude for lifting the intelligence level of Boston television.

November 15, 2005

From Melissa Shannon -- HCFA's Consumer Health Policy Coordinator:
Today is the first day Medicare recipients can enroll in a Medicare Prescription Drug benefit plan. The complicated structure of this benefit and the poor roll out are leading to avoidable mass confusion. At HCFA, we are most concerned about those already on a subsidized drug plan who will lose that coverage on 1/1/06. These are the Medicare enrollees who also are enrolled in Medicaid (197,000 “dual eligibles”) and 80,000 enrolled in our senior pharmacy program, Prescription Advantage.

Advocates across the nation are so concerned about what will happen to dual eligibles on 1/1/06, they have filed a lawsuit against the feds to protect Medicaid access to drugs for dual eligibles until they are enrolled in Medicare drug plans that meet their needs. Click here for info.

HCFA works in in coalition with other Massachusetts elder and disabled advocates, and we are taking a different approach. We're asking the legislature to require the state to provide one-time 30-day supplies of medications to duals and Rx Advantage enrollees whose new Medicare drug plans won’t cover a medication they need. The State Senate has adopted this language in a supplemental budget. Now we’re waiting for the House to agree in conference. Please call your rep now to urge support for this important protection.

November 15, 2005

HCFA and children's health advocates and got good news yesterday that the Massachusetts Medcaid Office has implemented new, affordable premiums for the Children's Medical Security Plan effective 11/1 instead of 12/1.

In June, the legislature approved an FY06 budget that included affordable premiums for the CMSP, and rolling back premiums advocates thought were way too high. CMSP premiums were increased during the 2003 fiscal crisis and have been as an eligibility and retention barrier to CMSP which only provides kids with preventive and primary health coverage.

The Legislature intended this change to be effective July 1st. Yet Office of Medicaid officials, who administer CMSP, told us the change would not be implemented until December 1st -- five months too late for many families who should pay nothing under the new structure.

During this period of implementation, families were still asked to pay premiums under the outdated structure and were even cut off from eligibility for failure to pay these premiums that they should no longer be paying. Over 20% of CMSP cases that close do so because of a missed premium payment. Also, some families have been overcharged as much as $150 during this period of implementation. This was of great concern to HCFA, along with other advocates (specifically MLRI) and the Legislative Children’s Caucus (Thanks to Sen. McGee and Rep. LeDuc) that championed this issue through the budget process.

According to HCFA's Children's Health Coordinator, Mandi Janis: "Our combined advocacy paid off – we got great news today that the premiums were implemented effective November 1st. It's four months past the effective date but one month earlier than planned. Better late than never for the Massachusetts families who have had to make difficult decisions between paying for household necessities and premiums for CMSP."

November 14, 2005

Here’s a cab driver story from Melissa Shannon, our consumer health coordinator.

"I jumped in a cab at 10:30 on Friday night and the cab driver was listening to Phil Edmundson talking about the House health reform bill on WBZ Radio's Paul Sullivan Show. The cab driver is intently listening to the whole thing, and is happy to turn it up for my benefit. When it’s over, I ask his take. He agrees everyone ought to pay something, including businesses and including him. He needed heart surgery a few years ago and worries that it may have come later than it should have because he wasn’t insured. (His local hospital kept sending him home until his symptoms were irrefutable and then they transferred him to Boston Medical Center.) In the end, he got the surgery and the Free Care Pool picked up the whole tab, but he’d prefer to be insured to assure himself of better care. He’s also willing to pay, as long as they make it affordable. His view is that even people who make $5000 a year ought to pay 50 cents. It was interesting to see how engaged this random cab driver is in the issues we are struggling with and to hear his opinion that everyone, even employers, ought to pay something."

November 13, 2005

The 11/14 issue of the New Yorker has a first rate piece by Dr. Atul Gawande on medical malpractice. (Unfortunately, you can't get it online -- click here for contents.) Who said for every problem there's a simple elegant solution that's wrong? That seems to characterize this endless, dense controversy. Gawande elegantly captures the true complexity of the problem -- profiling a former orthopedic surgeon who went to law school and is now a successful plaintiff's attorney, and an MGH physician who found himself participating in a lawsuit against another doc in his own hospital.

What's most clear is that the system we have now is broken, badly, and that the easy fixit of an arbitrary cap on pain and suffering does nothing to alter the real problems in the system -- namely that about 98 percent of folks injured by medicine get no compensation or relief at all. We have a system that brings out the worst in all of us.