"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

November 12, 2005

Our friend, Vicki Pulos from the Mass. Law Reform Institute, did a wonderful chart comparing the House and Senate versions of health care reform. Click here to see it, and make your own judgments.

Here are a couple of comments in response to my last entry:

"Considering the scope of the healthcare problems in the Commonwealth, this bill can only be called a disappointing failure. And I'm afraid that all of the happy talk from Mr. McDonough will not change this. This was a huge disappointment. This is a sad day for proponents of true reform."

Our sense -- don't be disappointed, organize! We have a huge opportunity in front of us. Disappointment leads to despair and despair leads to inaction. And believe us, please, the opponents of reform are anything but inactive. So please save your despair for later when it can be the least harmful. Let's push the rock as far up the hill as we can. Just my opinion, and thanks for yours!

6:15 PM Anonymous said...
"The Senate bill indicates that those who deny insurance coverage when it is offered by their employers will be assessed the costs of their care. If the insurance offered costs more than 50% of your income, is this still the case? I work part time for a company that offers group insurance, but makes no contribution towards the cost."

This comment refers to the so-called "free rider surcharge" included in the Senate health reform bill, which would impose costs on companies with more than 50 workers and which do not offer coverage to their workers when those workers utilize the Free Care Pool; the assessment would also be imposed on workers with incomes between 300-400% of the federal poverty line when they refuse coverage. We have serious concerns about this provision in the Senate bill and will be doing a lot of research and analysis on it. We'll let you know when our analysis is done...

November 9, 2005

Early this evening, the State Senate passed their own version of health care reform, setting the stage for a conference committee likely to report out legislation early in 2006 -- though it could come earlier or later. Thanks to the efforts of Sens. Mark Montigny, Dianne Wilkerson,
Cynthia Creem, Pat Jehlen, Pam Resor, Sue Fargo, Jarrett Barrios, Bob Antonioni, Tom McGee, and Harriette Chandler, we won a substantial amendment to expand MassHealth:

-- increasing eligible for parents from 133% of poverty to 200%;
-- restoring benefits cut in 2002 including adult dental, dentures, and eyeglasses;
-- restoring coverage for about 7,000 low income, legal immigrants.

There are major differences between the Senate and House versions. Looking on the bright side, there are also striking similarities:

-- both now embrace MassHealth as the key vehicle to help lower income uninsured;
-- both recognize the need to restore MassHealth coverage for adult dental and dentures;
-- both include new assistance for moderate income uninsured and small businesses;
-- both recognize the need for fair rates of payment for MassHealth providers;
-- both reform the existing nongroup and small group health insurance markets;
-- both hold employers who don't cover their workers responsible (in different ways)

Some key differences:

-- House assesses employers who don't cover their workers; Senate penalizes employers with uninsured workers (and some workers) who use the Uncompensated Care Pool;
-- House expands MassHealth coverage to about 75,000 low income childless adults with incomes below 100% of poverty; Senate offers no coverage to this group;
-- House raises substantial new revenue to support coverage expansion; Senate raises no new revenues.

Lots and lots of other differences to make for a compelling conference. Too bad it all happens behind closed doors. This one should be a doozy. Click here for the Senate release on their bill.

November 8, 2005

Today, around 1pm, the Senate Ways and Means Committee reported out health reform legislation following dramatic action in the House last Thursday. Senators were given five hours to read, study and reflect, and amendments were due by a 6pm deadline tonight. Most senators were not in the building today because they were participating in municipal elections all over the state. Tomorrow (Wednesday), the Senate will caucus at noon and go into session at 1pm to pass the bill.

Our reaction? It's the word senators hate the most: "Disappointment." The big D. In this case, really big. Proponents claim the plan will cover at least half the uninsured within two years -- or 230,000 based on the now discarded projection of 460,000 uninsured -- the House works on a more realistic number of 580,000 uninsured. We see no evidence to support their optimistic projection, and agree with MIT economist Jonathan Gruber who projects between 12,000 and 52,000 newly covered under the Senate plan.

Ten senators have signed onto an amendment to provide real health expansion in the Senate plan to expanding MassHealth eligibility -- expand parents' eligibility from 133% of poverty to 200%, and childless adults to 100%, and restore dental, denture, and eyeglasses. Sen. Mark Montigny will lead the effort tomorrow. Hey, give a jingle to your senator on Wednesday (617-722-2000) and ask him or her to support the Montigny amendment. Let's try to make this interesting.

November 7, 2005

Sources tell us the Senate will debate its health reform plan this coming Wednesday, and that the package will differ little from the proposal advanced by Senate President Robert Travaglini this past April. While we're pleased to see the Senate move quickly, we're disappointed that the Senate will not embrace more substantive expansion of affordable coverage.

Last April's package included about $168 million in new funding -- about $120 for enhanced rates to Medicaid providers, about $25 million for public health restorations, and the rest for minimal access expansion, mostly involving changes to the small and nongroup insurance markets. The package contained no MassHealth eligibility expansion or restoration of cut benefits such as adult dental and dentures, no significant resources to help moderate income families to afford insurance coverage, and no real employer responsibility.

The Senate claims that their package will reduce the number of uninsured by more than half over two years. We find no evidence to convince us of this claim. This is a significant disappointment to access advocates.

November 7, 2005

Last Friday, Wal-Mart sponsored a conference to respond to criticism of its own economic impact. Wal-Mart paid for a detailed economic analysis that was supposed to repair damage caused by attacks from labor and other critics. But the company was embarrassed by the findings of some of the studies which justified, rather than negated, the criticism.

The conclusion on health care confirmed what we have been saying all along. Economist Michael Hicks found that Wal-Mart increased Medicaid costs an average of $898 per worker. Hicks also found that a 1 percent increase in Wal-Mart's market share in a state is accompanied by a 1.5 percent increase in Medicaid spending.

Click here to read about the meeting. You can see the full study by clicking here.

November 6, 2005

OK, so the House grabbed the high ground last week with a bold and courageous plan to expand access to affordable health coverage – combining employer and individual mandates, boldly going where no state health reform plan (seriously) has gone before. On Thursday, State Senate leaders – who had been urging fast action all year – became, well, languid, suggesting no action was needed until January. Yesterday, a Globe article suggested rethinking was going on, and Senate action could come within three weeks. So, let’s have some perspective on the Senate:

First, Senate President Travaglini deserves credit for being the first major state leader to target health reform as a key priority for 2005 action, back in November 2004 with his pledge to cut the number of uninsured in half over two years. On top of that, the Senate has been the best friend of health access advocates for the last eight years, and just as much since Trav took over in 2003. The Senate President saved 36,000 MassHealth clients from losing coverage in 2003 by establishing MassHealth Essential; Senators took the lead in fully funding the Children’s Medical Security Plan in 2004, ending a waiting list of 15,000 kids; and much more.

The Senate is chock full of terrific and reliable senators with long track records in doing the right thing for health care access – dare I name a few: Mark Montigny, Therese Murray, Dick Moore, Pam Resor, Steve Tolman, Marian Walsh, Fred Berry, Tom McGee, Sue Tucker, Andrea Nucifuro, Jarrett Barrios, Cynthia Creem, Susan Fargo, Jack Hart, Mark Pacheco, Harriette Chandler, Ed Augustus, Pat Jehlen, Dianne Wilkerson – damn, I know I forgot a few! We could do a heck of a lot worse.

So let’s not mourn. Let’s organize and work with senators to get the best possible deal as quickly as possible. Click here to ACT Now, and please don’t wait. And please keep collecting those signatures – click here to download a petition now. We’ve got two weeks left to top 100,000 – all volunteer, no paid signature gatherers. These are your and our sources of power in this debate. Please get involved today.

November 5, 2005

Sorry to not post sooner after late Thursday evening’s dramatic vote in the Mass. House on health care reform. Among many surprises, the most dramatic – by a comfortable, veto proof margin, House members rejected attempts to eliminate a requirement that employers who don’t provide health insurance must pay a 5 or 7% assessment on gross payroll to the state. If asked just one month ago our prediction of the likelihood of this development, we would have dismissed it as wildly improbable. So how to explain this?

There’s a political science model I teach, by Douglas Arnold, called “The Logic of Congressional Voting.” It tries to explain simply how legislators think when facing a controversial vote. It comes down to this: legislators assess any controversial vote in terms of future electoral campaigns and the potential role it might play. Legislators think to themselves: “If I cast this vote, and a future opponent uses it against me, do I have a rationale/explanation that makes sense to me that I can convey with confidence?”

Assessing employers who don’t cover their workers is the third rail of health care politics, and the hysterical reaction of the Massachusetts business community to the DiMasi assessment proposal was no exception. So why did this sell to House members? Two part answer:

First, the DiMasi plan not only created a new assessment on employers who don’t provide coverage, it also eliminated an existing one on employers who do provide coverage -- $160 million worth, payable each year to the State’s Uncompensated Care Pool by employers who cover their workers.

Second, when legislators asked themselves, how can I explain this vote to my constituents, the answer was easy: “I’m creating a new affordable payroll assessment on employers who don’t provide health insurance to their workers, and I’m eliminating an existing assessment on employers who do cover their workers.”

Even though the business community can’t/won’t accept the logic, the legislators did. It was amazing sitting in the House gallery on Thursday evening and hearing legislators who know little about health care financing grasp this essential logic – assess businesses that don’t, and help businesses that do. It’s a powerful and logical argument that can be explained and defended with ease.

That’s why DiMasi – and we – won.

November 2, 2005

OK – business is going berserk because health reformers and House leaders think most employers should contribute at least a minimal level to help workers get health insurance. Let’s look at the larger picture here.

Nationally, employer sponsored covered is undergoing a shocking meltdown. Kaiser Family Foundation finds employers who offer worker health coverage dropped from 69% in 2000 to 60% in 2005. Yikes!

Here’s new research from Health Affairs: “Between 2000 and 2004, the number of uninsured Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage.” Ouch!

OK – but that’s the rest of the nation, not Massachusetts . . . right? Wrong. A new study by the Economic Policy Institute, using census data, shows an alarming drop over the past five years in the proportion of workers able to obtain health insurance on the job. Here’s the surprise: “Among the working population, the average loss in employer-provided coverage was 2.7 percentage points between the 1999-2000 and 2003- 04 periods. ... some states fared better than others. ... The sharpest rate decline was in Virginia, with a 6.7 percentage-point decline in coverage. The next largest declines were in Indiana, Massachusetts, and New Jersey, all with 5.6 percentage-point declines.”

Alright already! But it’s just poor employers who don’t offer decent benefits because they can’t afford it, right? Nope. Take a look at a candid, confidential Walmart memo written by a senior exec recommending ways to cut health benefits further: “In 2004, 38 percent of enrolled Associates spent more than 16% of the average Wal-Mart income on healthcare. ... In total, 46 percent of Associate’s children are either on Medicaid or are uninsured.” (Walmart workers are called “associates.”)

Yeah, yeah. We know about Walmart, but they’re rogues. Well ... take a look at the state sponsored study from last February showing employers in Massachusetts with more than 50 workers using the Free Care Pool, MassHealth or both. It’s a who’s who of Massachusetts employers.

Bottom line: It’s time to talk about the future of employer health insurance like grown-ups. No more sticking heads in the sand – at least if we can help it.

November 1, 2005

To get all of the key documents relating to the House health care plan -- as well as updates -- be sure to visit the Affordable Care Today website (click here). The House reform proposal does what it purports to do -- covers more than 90% of the state's 500,000+ uninsured residents, lowers premiums for everyone with private coverage by $160 million, creates a durable framework to enable everyone to get and keep more affordable coverage, and addresses important quality of care issues. A great job.

Despite $160 million in premiums reductions for private health insurance, business associations are ramping up opposition to the new 5-7% payroll assessment on employers who don't cover their workers (exempting firms with 10 or fewer workers). This is the heart of the plan's financing -- so elimination or watering down will result in the loss of resources needed to pay for expansion. This will be the heart of the battle on the floor of the House later this week.

Today at noon, outside the House Chamber in the State House, business owners and leaders will hold a press conference to support the House proposal and to offer an alternative view of why the plan is good for business. Lots more to come...

October 30, 2005

On Monday, the House rolls out its long-awaited version of health care reform. In brief, the Health Care Financing Committee and House Leadership have done a first-rate job drawing from all three major proposals (ACT Coalition/MassACT, Gov. Romney, Sen. Pres. Travaglini) and adding their own innovations. There are lots of ways we would do it differently -- yet the overall impression is one of a serious and thoughtful effort that demands respect. It also takes courage -- the employer responsibility issue is the third rail of health care politics. Speaker Sal DiMasi and Health Financing Chair Patricia Walrath have led an admirable effort and produced legislation that is nationally significant.

Just one example: progressives like employer responsibility and the conservatives like individual responsibility -- and neither likes the other. The result is stalemate as each side's second choice is status quo. By combining employer and individual responsibility, the House bill challenges both sides to put up or shut up. We'll see who's up to it...

We confess -- we're not wild about an individual mandate. After lots of discussion with many of our partners, we concluded not to reject an individual mandate out of hand IF: a. it were crafted so that noone gets caught if insurance purchase is not absolutely affordable; and b. if other key components are included such as -- employer responsibility, MassHealth expansion and restoration, fair financing, and support for moderate income families. Though we have not yet seen the legislative language, it's pretty clear that all our concerns are being addressed.

And yes, we absolutely agree with Len Stewart that more time for public consideration should be required. We're stuck with the legislative process we have, not the one we might desire.

Despite this, we're facing an historic opportunity this week to enact huge health reform that could result in coverage for 90%+ of Massachusetts' uninsured. Debate will start on Thursday at noon. Please stay in touch with the HCFA website for regular updates and summaries as well as this blog. If you have not contacted your state rep to indicate your support, p l e a s e do so before Thursday. And thanks!