"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

September 21, 2005

While it gets no play in the general media, Massachusetts has a fast developing and engaging community of progressive bloggers chatting every day about local, state and national politics. They take on the Globe, the Herald, and each other. And as the general media becomes increasingly vapid and out to lunch, it’s worth recognizing and celebrating this new part of the MA political landscape. The easiest way to keep in touch with MA blogs is by checking the Massachusetts page of the website, leftyblogs. Yes, I know, many of you readers don’t consider yourselves “lefties” – don’t let that keep you from missing this great site.

There’s this false image of bloggers as antisocial nerds – it’s wrong; the bloggers we know are connected, smart, perceptive, and full of unique takes on MA political developments you won’t find anywhere else. This week, a series of blog entries at leftyblogs comments from many perspectives on the MassACT ballot initiative signature drive. One of the our favorites is Blue Mass Group run by a trio which includes opera singer Charley Blandy (whose wife just had a baby – congrats!). Other worthy sites: Cape Cod Works, Frederick Clarkson, Marry in Massachusetts, the Eisenthal Report, wonk Not!, and Left In Lowell, among others. These folks are helping to keep real democracy alive in Massachusetts – they deserve our attention and respect.

Elsewhere on the trail, today my signature total in week one is up to 88. Got several signatures of note: Boston Mayor Tom Menino, State Reps. Mary Grant and Ellen Story, and Dr. Don Berwick, President and CEO of the Institute for Healthcare Improvement. Don’t be square – get on the signature bandwagon today – massact.org

September 20, 2005

The official signature drive kickoff isn't until Thursday -- so these few days are like our pre-Broadway tryouts. Already, the excitement is infectious. People are diving into this drive with enthusiasm and energy. I got 70 signatures over two days -- Rep. Jim Marzilli, Rep. Peter Koutoujian, former Sen. Warren Tolman, Worcester Mayor Tim Murray, former Cong. Chet Atkins, among others. Cong. Jim McGovern, one of our top 10 signers, gave us a nice boost at two events this week.

This Saturday, Sen. Jarrett Barrios and the Greater Boston Interfaith Organization will meet at the Danehy Park Family Day in Cambridge to gather signatures. Come for an hour or more and help make sure we get the number of signatures we need to get on the ballot. MEETING LOCATION: Parking lot off of Sherman Street between Walden and Rindge Street in Cambridge. WHEN: This Saturday, September 24 from 1:00 pm to 4:00 pm. To RSVP, please e-mail stuart@barrios.org.

We're rockin', so feel welcome to be a part of this movement. Commit to collect 100 signatures between now and October 5, or whatever number you can. For materials, contact Lisa Vinikoor at vinikoor@massact.org or call 617-275-2807. OR, just go the MassACT website (click here) where you can download the petition yourself, sign it, and mail it in. What could be easier? God bless the WEB!

September 20, 2005

From our friends at Community Catalyst:

The gulf coast tragedy has affected thousands of African American and low-income residents who depend on Medicaid and other programs, such as food stamps and subsidized housing. They need emergency assistance to meet immediate needs and to rebuild their lives. Emergency Medicaid is the best way to make sure survivors have access to physical, mental health and long term care supports and services they need, and that Medicaid can easily and efficiently provide, no matter where survivors are temporarily living. 'Ensuring that these individuals get access to health care, wherever they are, is our biggest issue,' said Dr. Fred Cerise, who heads Louisiana's Department of Health and Hospitals. Tribune,September 14, 2005.

A new bipartisan proposal, supported by Sens. Grassley and Baucus and members of Congress from the states hit by the hurricane, would immediately provide Medicaid coverage to low-income Katrina survivors. States could immediately enroll low-income Katrina survivors in Medicaid and would be offered to adults with income below 100 percent of the poverty line or children, pregnant women, or people with disabilities with income below 200 percent of the poverty line. The Federal government would pay 100 percent of the cost of coverage and administration, ensuring that states get the assistance they need.

Congress should pass Grassley-Baucus now. Each day that passes, more lives are at risk. This legislation should be enacted on an emergency basis now. People from the disaster areas have been forced to wait too many times. This proposal has broad bipartisan support including Majority Leader Frist and Minority Leader Reid.

YOU USE THE FAMILIES USA toll free number to contact Congress. Call 1-800-828-0498 and you will reach the direct line to the US capitol. Ask for your Senator by name.

At this time the enactment of federal Medicaid cuts, which will harm the most vulnerable populations, especially those affected by hurricane Katrina, has been temporarily postponed. We want to make sure these proposals are dropped, so continue to communicate this message to your members of Congress and in letters to the editor, along with your support for the relief bill.

September 18, 2005

The journal Health Affairs has a new survey on the new high deductible health insurance products becoming so prominent ("faith based health insurance" I call it -- pray you don't get sick). The article requires a subscription but here are juicy details from the abstract:

"Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging $1,870 for single coverage and $3,686 for family coverage in high-deductible health plans with an HRA and $1,901 for single coverage and $4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers."

What's surprising? The size of deductibles averaging $1901 for individuals and $4070 for families. Ouch! The federal HSA enabling legislation calls for minimum deductibles at $1000/$2000 -- the real levels being used are much higher. And, we suspect, it's lower income workers who are more likely to get high with higher cost sharing. There's a backlash coming on this -- it may take a little time, but it will be fierce and well deserved.

* * *
Here's the first of regular updates on the drive to collect 100,000 signatures for the MassACT ballot initiative. Kudos to Cambridge City Councilor Brian Murphy for his endorsement and particiapition:

"City Councillor Brian Murphy encourages all Cambridge residents to sign the petition by MassACT aimed at placing a health care reform bill,Massachusetts Quality Affordable Health Care Act, on the statewideballot inNovember of 2006. The initiative has been organized by a coalition of laborunions, small businesses, and advocacy groups. One hundred thousand signatures will be needed to move the initiative towards the 2006 ballot. Signatures will be collected between September 23rd and October 4th."Health care costs are crippling city budgets and the number of uninsured residents increases dramatically each year", stated Murphy. "I want to encourage all Cambridge residents to sign the MassACT petition. This initiative would reduce premiums, help small businesses, and increase access to health care for all Massachusetts residents". Brian Murphy is a member of the National League of Cities' Working Group on Health Care. For more information on the MassACT initiative or to get involved, please visit www.massACT.org, and for more information on BrianMurphy please visit www.BrianMurphy.org."

Have you gotten your signatrure sheet yet? Click here now to download and petition and help.

September 17, 2005

OK folks, you say you want health reform? How much? Enough to collect 100 signatures of registered voters between now and October 4th? Really? Well that's just great!

As of 5pm on Friday, signature sheets for the MassACT (Affordable Care Today) ballot campaign became available. Click here for the website. You can call, write, or email to get signature sheets and instructions. Here's the incredible thing:

You can download and print the ballot petition as a PDF file no problem -- along with instructions, and dos & donts. (Don't you love this internet!) Here's a prediction -- if you don't help out, you will regret it, and if you help out, you will feel great about being a part of this incredible effort. By the way, if you can't collect 100, please help anyway -- even if it's just signing it yourself and mailing it in.

Here are a few important things:

1. When you print the petition, make sure you print on both sides (doesn't matter if it's the right way up on both sides -- really).

2. People only sign the same sheet from the same city or town. A different sheet for each locale.

3. NO extraneous marks or notes on the peitition -- invalidates the whole bloody sheet!

Join this great campaign. This is going to be fabulous!

September 16, 2005

Here's a great post from our friends at the Medicare Rights Center:

A Houston pharmacist opens up this morning to find Mary Bracken, a new patient, waiting. Displaced by Hurricane Katrina, she doesn't know the name of her HMO from Louisiana, she has no way to contact her doctor’s office, and she has never enrolled in Medicaid and has no idea if she is eligible. She knows she is supposed to take four different pills every day, but she doesn’t even know their names. The pharmacist shrugs, sympathetically but helplessly.

The health crisis brought about by Hurricane Katrina is visible to anyone who looks. It has exposed a fragmented health care system that erects financial and bureaucratic obstacles to care, leaving the most vulnerable unprotected. For health care consumers in America, the fragmentation is getting worse, not better. Hidden catastrophes face ill Americans each day, catastrophes that are only noticed in the wake of a natural disaster. The poorer you are, the greater the risk for catastrophe.

But some Americans have been protected from the harsh reality of the health care market bazaar: they have been among the 43 million Americans who have Medicare health coverage. Elderly and disabled Americans have for decades been protected by Medicare, a health insurance program governed by rules that allow near universal enrollment, provide access to a standard benefit, and protect people from financial ruin when they need costly health care. It is a model that has worked for 40 years, yet it is a model consistently rejected by this generation’s political leaders.

This fall, two of those rejections will be felt hard by Americans in need: those displaced by Hurricane Katrina and those striving to find benefit in the 2006 Medicare prescription drug plans. No serious consideration is being given by the White House or Congress to a Disaster Relief Medicare, the most practical way to bring immediate health care to people displaced by
Hurricane Katrina. Congress could offer Medicare eligibility to displaced persons, opening up virtually every health care provider to the men, women and children far from home scattered across the nation. In all states nearly every doctor, hospitals and clinic accepts Medicare. The American health care infrastructure could be opened up tomorrow to care for middle class families far from their insurance networks and poor families quartered in shelters in states from New England to Texas. The political will to make this happen is absent.

And come January not just hurricane victims will be offered sympathetic but helpless shrugs at pharmacies across the nation. That is because Congress and the White House, in enacting the 2006 Medicare prescription drug benefit, threw overboard the simplicity and fairness inherent in Medicare’s structure. The 2006 Medicare drug benefit requires an individual to select among scores of private plans a single plan that may not allow purchases in certain pharmacies, that may not cover needed drugs, that may charge hundreds of dollars in co-payments for needed prescriptions and that may not work out-of-state. Some people are eligible for special financial help, but only if they meet stiff income and asset tests and navigate the application maze. People in great need will be systematically excluded from the drug help they need because the structure of the benefit will be too much to master.

The White House and the Congressional leadership insist that there will be no fix to the drug benefit this year. Next year will be too late to save some people who will be lost. But, here’s a recap, bullet by bullet, of 11 ways to fix the Medicare drug benefit:

September 15, 2005

Each September, the Kaiser Family Foundation releases a first-rate report on national trends in in health insurance coverage. Click here. This year's report is no exception. Some highlights:

The percentage of businesses offering health insurance to workers has declined steadily over the last five years. The survey found that three in five firms (60%) offered coverage to workers in 2005, down from 69% in 2000 and 66% in 2003. The drop stems from fewer small businesses offering health benefits, most businesses (98%) with 200 or more workers offer such benefits.

Premiums increased an average of 9.2% in 2005, down from the 11.2% average found in 2004. The 2005 increase ended four consecutive years of double-digit increases, but the rate of growth is still more than three times the growth in workers’ earnings (2.7%) and two-and-a-half times the rate of inflation (3.5%). Since 2000, premiums have gone up 73%.

Annual premiums for family coverage reached $10,880 in 2005, eclipsing gross earnings for a full-time minimum-wage worker ($10,712). The average worker paid $2,713 toward premiums for family coverage in 2005 or 26% of the total health premium. While workers’ share of premiums has been stable over the past few years, they are now paying $1,094 more in premiums for family coverage than they did in 2000.

20% of employers who offer insurance provide a high-deductible health plan option. Jumbo firms – those with 5,000 or more workers – are more likely than smaller firms to offer a high-deductible plan option, with 33% offering one in 2005. High-deductible health plans are those with at least a $1,000 deductible for single coverage or $2,000 for family coverage.

Despite the availability of high-deductible plans, few workers are enrolled in consumer-driven arrangements. About 2.3% of non-federal covered workers, or 1.6 million people, are enrolled in high-deductible health plans with an HRA, and about 1.2%, or 810,000 people, are enrolled in plans that are eligible for use with an HSA.

Firms that do not offer health benefits – the overwhelming majority are small firms – cite cost as a key factor.

MassHealth Adults Dental -- Today, Kaiser also released a new report on the fiscal and human impact of cutting MassHealth adult dental benefits in 2002. Good report prepared by our friends at the Access Project. Definitely worth a read. State officials could not have understand the human impact of what they did -- incredible and startling human suffering from this. We've got to change this!

September 14, 2005

Catching up on reports that appeared in late summer, one stands out. The Center for Studying Health System Change regularly monitors trends in 12 health care markets – including Greater Boston. Their reports are always illuminating. One new report released in August – Initial Findings from HSC’s 2005 Site Visits: Stage Set for Growing Health Care Cost and Access Problems” – is worth a read.

Conclusion – what’s driving health care inflation is all about intensifying market competition among providers. It’s not lowly consumers making costs skyrocket; it’s the insane way we keep pursuing the myth that market competition among providers will bring costs down.

Here are some excerpts:

“Many developments in location care markets appear to be setting the stage for additional health care costs increases and access-to-care problems, according to initial findings … Hospitals and physicians are competing more broadly and intensely for profitable specialty services, making costly investments to expand capacity and offer the latest medical technologies, especially in more affluent areas with well insured populations. Employers and health plans have launched few initiatives to control rising costs beyond increasing patient cost sharing. As rapidly rising costs continue to push private health insurance out of reach for more people, state and local governments are struggling to meet the needs of low-income people and an increasing number of uninsured people.”

Here’s the conclusion:

“Overall, the promise of quality improvement initiatives and IT investments pales in comparison to the scope of the cost and access problems confronting the health care system today. If current trends continue unabated, communities are likely to face growing numbers of uninsured people and increasing disparities in access to care by income and geographic location. Looking forward, all health care stakeholders, policy makers and the public will have to more explicitly address the problems underlying these trends and either revisit solutions that have been discarded, get serious about developing new ones, or accept the implications of continuing the status quo.”


September 13, 2005

Thursday, September15, at the Grand Staircase in the State House, the Access Project will release a new report on the human and fiscal impact of the 2003 elimination of coverage for adult dental services in the MassHealth Program.

The report was sponsored by the Kaiser Commission on Medicaid and the Uninsured. More than 500,000 adults lost all coverage -- except for extractions -- and have suffered enormously since the loss of this coverage.

This past spring, the Oral Health Advocacy Task Forces succeeded in convincing the Legislature to restore coverage for pregnant women and mothers with children up to three years old. We're continuing the effort to achieve full restoration.

The report is embargoed until Thursday. We'll make it available through our website asap.

September 8, 2005

Today, the state's Division of Health Care Finance and Policy held a public hearing to gather public input on proposed new rules governing the Uncompensated Care Pool (see blogs of August 2 and 31). More than 100 persons attended. Except for the administration's representative, no one testified in support and everyone else testified in strong opposition. These new rules will make it harder for uninsured and very low income persons to obtain medically necessary care at hospitals and health centers. It will also create financial hardship for hospitals and health centers that care for large numbers of these individuals. A detailed and thoughtful critique of the proposal, prepared by Vicky Pulos of the Mass Law Reform Institute, can be found here.

Romney Administration Health and Human Services Secretary Tim Murphy testified in support, and recommended postponing implementation from this October 1 until January 1, 2006. Sen. Dick Moore recommended that any implementation be postponed until October 1, 2006. We testified that any such changes should be shelved until the Legislature and Governor agree on a health reform plan -- and then revisit Pool regulatory changes.

For information on the Pool, the proposed changes, and our testimony today, click here.