"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

October 16, 2005

Today’s Globe includes a page one story with details on the soon-to-be-released House health reform plan. Bottom line: House leaders plan to recommend either cigarette or alcohol taxes or both to increase MassHealth eligibility to 147,000 children and their parents, and to subsidize private coverage for 200,000 more. Kids under 200% of the poverty line ($38,000 for a family of 4) can get MassHealth – House leaders would increase that to 300%; parents get covered now up to 133%fpl and the House wants to raise this to 200%fpl. The House plan is expected to be released later this month.

So what does this mean? Lots. Here are some initial reactions.

1. This is an explicit rejection of the Romney approach which would expand coverage by yet-to-be-seen private, low-cost plans. Since November, Romney has promised that health insurers would develop these plans. The House calls Romney’s bluff.

2. There are now 4 plans – Romney, Sen. Pres. Travaglini, the ACT Coalition’s Health Access and Affordability Act, and the House plan. Two embrace Medicaid expansion as the smartest approach to expand coverage for lower income folks.

3. While expanding coverage for kids and parents is great, there are many lower income adults without children left out of this approach.

4. The DiMasi/Travaglini relationship is a constant topic of insider conversation. With this move, the Speaker has figured out how to disagree with his chief counterpart without being disagreeable.

5. This Globe story was clearly an insider job. There’s a lot more not known than is known about the House plan – ie: the structure of private subsidies, provider rate reimbursement, insurance market reforms, individual mandate, employer responsibility. Stay tuned.

Finally, people who have been dumping on Speaker DiMasi should take a second look. The House – and the Speaker – have worked hard and thoroughly on this issue, and deserves credit for their diligence and openness.

October 15, 2005

The House Ways and Means Committee released their supplemental budget proposal today. The bill includes $25 million in additional funding for the MassHealth Essential program, enough to allow the approximately 9000 people on the waiting list to get coverage.

MassHealth Essential covers unemployed adults below the poverty line. Because of limited funds, the program established a waiting list over the summer. The MassHealth Defense Group has been waging an all-out campaign to get the legislature and governor to lift the cap. Rep. Debby Blumer has been our House champion.

The full $300 million supplemental will be going before the full House on Tuesday. The Senate is expected to take up the bill soon after that. We expect the Senate bill to also include funding for opening up the Essential program.

Once the funding is approved, the state must apply for federal authority to increase the enrollment cap. We urge the administration to start the process with the federal government immediately, in advance of the formal process of appropriating the funds.

We deeply appreciate the House's support for the MassHealth Essential program. Speaker DiMasi, Ways and Means Chairman DeLeo, and the House leadership are to be commended for taking the leadership in providing coverage to these most vulnerable residents of Massachusetts.

October 14, 2005

Something brand new -- and you learned about it here first...

A new three-state (MA-NH-ME) campaign to increase public awareness of the importance of children's oral health and the need for public policy solutions to address this problem -- it's called "Watch Your Mouth", and has a just-launched, brand new website (click here).

In Massachusetts, the campaign is being run by HCFA's wonderful oral health advocacy program. Kate Vaughan is the project manager. Delta Dental of Massachusetts is funding this state's participation. And the Frameworks Institute is behind the creation of the message and the program.

Those of you who have heard about the world of "issue framing" will be especially interested in this effort -- this campaign's foundation is based on the significant body of research related to how real people process information, messages, and other cues.

More to come -- contact Kate Vaughan to learn more at vaughan@hcfama.org

October 12, 2005

Some legislators tell us they need to hear from you! So...

Please take ACT-ion Today! Health reform is on the move in the State House. The House and Senate hope to finalize their proposals this month. Right now legislators are making key decisions about a health reform package – and they need to hear from you.

Today (Wednesday, October 12), please call BOTH your state representative and senator. If we concentrate our State House calls on one day, we can demonstrate broad and solid support for real health reform. Your legislators need to hear that real reform must be comprehensive. Real reform expands coverage, reduces costs, and is fairly funded.
Click here to identify your legislators.
State House Switchboard: (617) 722-2000

Feel free to use the following phone script to call your state senator or representative in support of comprehensive health reform.
State House Switchboard: (617) 722-2000
Hello, I am calling to speak with [the name of your state senator/ representative]. My name is ____________________ and I live in _________. Thank you for making health care reform a priority. I wanted to let you know that health care reform is a priority for me. Please support the Health Access and Affordability Act, H2777, S738, backed by the ACT! Campaign. I believe this bill will improve the lives of those without health insurance in my community because it expands MassHealth eligibility and helps small businesses cover their workers. (Please feel free to add your own personal story here) Thank you.

We hope to generate enough calls to create a buzz about the campaign - a reminder of the over 1,000 people who participated in the June 8 State House for health reform. Please forward this posting to your colleagues, friends and family. Ask them to join you in calling the State House today.

Let us know when you make your calls. Email Fawn Phelps, ACT! Campaign Manager, at phelps@hcfama.org when you make the calls and any comments from your legislators.

Please visit the ACT! Coalition website ww w.hcfama.org/act for updates on the campaign and ways that you can continue to be involved. The Coalition appreciates any donation you can give to help us make this the most comprehensive, successful campaign for health reform as possible. Visit the Coalition's donation page if you would like to contribute. Please contact us with your questions and suggestions by emailing Fawn Phelps (phelps@hcfama.org).
Together we are building a movement for better quality, more affordable health care. Thank you for being with us!

October 11, 2005

Here's a great editorial from today's Berkshire Eagle on the state of Mass. health reform -- someone there really gets it:

"Speaker Salvatore DiMasi has promised action on health care reform in the state by the end of the session, November 16. He even threatened to call lawmakers back to Boston to hammer out a deal should they miss the deadline. The urgency in the speaker's remarks was welcomed by state Senate President Robert Travaglini, who has overseen a dialogue between the Senate and governor that has excluded the House. There is a convergence of pressure to finally reform a health care system that is broken, though the effort lacks the necessary imagination.

"While Speaker DiMasi has not released details of the House version of health care reform, compromise is necessary because the plan presented by Governor Romney is unrealistic and the Senate plan is too cautious. The governor proposes a mandate that everyone in the state have insurance, but no private insurer has embraced the governor's challenge to present a health care package valued at $200 a month, as he has proposed. Also, the governor doesn't anticipate the need for tax hikes, which is impossible if the state is going to mandate universal coverage.

"The Senate's plan calls for a reduction by half of the number of uninsured people in the state within two years, an admirable goal but short of what is needed.

"Both sides are shortsighted in dismissing the idea of tax hikes to fund expanding health coverage. What the state pays in getting more residents on the insurance rolls it will save in making the state a more friendly place to do business. A single-payer plan, would be the ideal solution, covering everyone in the state and relieving businesses of the burden of ever-increasing health care costs. But short of that proposal, given Boston's political timidity, reform must be enacted that would ensure coverage of everyone in the state while lessening the cost to businesses and individuals.

"Health Care for All, a coalition of reform advocates in the state, have endorsed a few sensible funding mechanisms to increase the amount of residents eligible for MassHealth, the state's version of Medicaid. The group calls for a 60 cents hike in cigarette taxes, which it says would generate $160 million a year - the same amount insured people pay in higher premiums to finance uninsured people's health care costs. Health Care for All would also charge businesses that don't offer health insurance to their employees, which would encourage more to do so or at least generate revenue to help offset the costs of companies that do offer employees' health care.

"There are reform measures within the realm of possibility that could greatly diminish the number of uninsured, if not bring their ranks to zero. The system in effect now is too heavy a load for families, businesses and municipalities, and community hospitals such as North Adams Regional Hospital are struggling to stay afloat. A realistic approach that shares the responsibility among individuals, employers and the state is required. The desire is there on Beacon Hill but we will see if it is matched by will and determination."

Thanks to HCFA's Board Chairman Chip Joffe Halpern for this lead.

October 10, 2005

Lots of rhetoric in MA and across the nation about "association health plans" -- allowing small businesses to band together to get lower rates from health insurers. President Bush regularly extols them as the answer for small business health insurance affordability. Sounds like a great idea. What's the problem?

First, it's a different issue in Washington DC and in Massachusetts.

Nationally, in most states, employers already have the right to band together in associations, as long as the associations comply with state consumer protection laws. There's the rub. The national effort would allow employers to band together and evade all such regulations. Experience shows that when they do that, consumers get screwed by sleazy operators, with no government protection.

Another seemingly attractive "reform" promoted by national Republicans is to allow consumers to purchase health insurance in any state. Here's a real life story -- a Florida consumer (where such purchases are allowed) bought a cheapo plan in Mississippi. When the plan refused to pay promised benefits, the Florida insurance regulators said, "Sorry, we don't regulate those guys." When the consumer called the Mississippi insurance regulators, she was told, "Sorry, we only serve Mississippi consumers." "What can I do?" asked the poor lady..."Move to Mississippi."

In Massachusetts, it's a different story. And a terrific new report by Nancy Turnbull and Bob Siefert, paid for by the MA Assn. of Health Plans, puts the MA AHP story in context. Prior to 1991, MA had a poorly regulated small group health insurance market that left consumers in the lurch whenever something bad happened to them, healthwise. In 1991, the state reformed that market offering good protections, and establishing a pretty big group of about 750,000 MA consumers and their employers. Initially, the law allowed employers to form their own associations. The association allowance led to real problems in the market, well outlined in the Turnbull/Siefert report.

In 1996, the state passed another law ending the association exclusion. For the past five years, small business associations that hope to market these new plans have been pushing to pass a new law re-allowing association health plans in MA. An odd coalition -- including HCFA, the state AFL-CIO, Associated Industries, and the MA Association of Health Plans -- opposes the proposal.

Nancy's report is a great introduction to and overview of this issue you have heard about.

October 9, 2005

The Health Report to the American People was released October 6, 2005, by the Citizens' Health Care Working Group (CHCWG). This report is a part of a two-year federal effort to learn what kind of health care system Americans want. With a focus on costs, access and quality, it is designed to be a resource for nationwide dialogue to lead to proposals for reform in late 2006.

The CHCWG is a 14-member group mandated as part of the 2003 Medicare legislation. The initial phase of the work included a series of hearings to gather input for this report. The next phase will focus on soliciting public responses to a very specific set of questions.

-- What concerns you most about the health care system in America today?
-- What health care benefits and services should be provided?
-- How should health care be delivered?
-- How should it be paid for?
-- What have you seen in America's health care system that works well?
-- What trade-offs should the American public be willing to make in either benefits or financing to ensure access to affordable, high-quality health care coverage and services?
-- What is your single most important recommendation to make to improve health care for all Americans?
-- Public responses to these questions will be collected in three ways:

1. Community meetings sponsored by the CHCWG around the country
2. Community meetings organized by concerned citizens
3. Online public comment questionnaire

October 8, 2005

House Speaker Sal DiMasi yesterday gave his much-anticipated speech on Massachusetts health reform at the Blue Cross Blue Shield Foundation meeting at the JFK Library in Dorchester. He did not reveal details of the forthcoming House plan, expected by the end of this month. See today’s Globe for details. He did give indications of House thinking on the issue. Some items that caught our attention:

First, he recognized that three plans are contributing to this process, Gov. Romney’s, Sen. Pres. Travaglini’s, and the Affordable Care Today Coalition's – more than a few commentators leave off the third plan, and it’s significant that DiMasi recognizes this proposal in this plan – including the important role of employers.

Second, he validated one of the core concerns with RomneyCare: “The time has passed for fuzzy math or for mysterious insurance products with a price tag but unknown benefits.” Though the Governor has been bragging about his $200 per month premium plans since last November, not one of the state’s insurers has yet to produce a detailed plan.

Third, while recognizing the role of individuals in needing to buy insurance, he also recognizes business responsibility: “We want to encourage employers to maintain their commitment to their employees. … Businesses that currently do not offer insurance will be encouraged to do so.” Yep, leaves a lot to the imagination. Still, his words advance the conversation.

Fourth, he committed to House to action on health reform this year, even pledging to bring the House into session during its six week recess from mid-November to early January if a plan is not yet completed by 11/16.

Fifth, he recognized the racial and ethnic health disparities, beyond insurance coverage, is a health system problem that must be addressed and fixed.

Also significant, Sen. Pres. Travaglini showed up to hear DiMasi’s remarks, with no speaking role for himself. A good gesture on his part, showing his sustained commitment to get something done, and a good spirit of cooperation between the two branches.

On the 20-person panel before DiMasi’s speech, ACT leaders Jonah Pesner and Celia Wcislo provided great commentary. By the way, the MassACT ballot initiative total now exceeds 45,000. Sign up to help out today – www.massact.org

October 5, 2005

Please don't miss Eileen McNamara's superb column in today Boston Globe recognizing the other ballot initiative around which churches, synagogues and temples across Massachusetts are rallying to support. It's not anti-gay marriage, it's pro-real health care reform. Eileen did a great service recognizing the incredible work of the Greater Boston Interfaith Organization, one of the best grassroots groups with whom I've ever had the pleasure to work.

''For us, this is a no-brainer; 30 or 40 percent of the people we serve are without health insurance," said Brother Jack Rathschmidt of Our Lady of Lourdes. ''They might go to an emergency room in a crisis, but they go without preventive care. For reasons that I don't fully understand, the church has not jumped in as aggressively on this issue as on some others."

And, yes, I did say "blitheringly." Don't know from where the heck these words come...

October 3, 2005

In just ten days the Massachusetts Affordable Care Today! (MassACT!) Campaign has collected over 38,000 signatures to qualify our health reform proposal, the Massachusetts Quality Affordable Health Care Act, for the November 2006 ballot. Driven by over 2000 health care advocates throughout the state the campaign collected over half of the 65,825 signatures required to qualify for their proposal for the ballot.

“Residents from throughout the state have truly rallied around the need to make health care more affordable and accessible for everyone in Massachusetts,” said David Jordan, spokesperson for the MassACT! Campaign. “In ten days our activists have built momentum for our health reform movement by collecting signatures from their family, friends, colleagues and community.”

By the way, the Boston Globe, which is obsessed with the anti-gay marriage petition -- reporting every time their leaders sneeze -- reported with amazement today that the anti gay marriage foes have collected 25,000 signatures. Eat our dust! Let's make health reform the number one ballot initiative of the season -- join the initiative campaign today!