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.”
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.
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.
Want to let you know about HCFA’s 2005 Back-to-School Campaign – organized by the Covering Kids and Families Initiative – working to make everyone aware that affordable health coverage is available for every child in Massachusetts. That’s right – no child in Massachusetts need go without affordable insurance coverage. Through this campaign, families see materials posted in schools, libraries, doctors’ offices, and other public areas during September, reminding everyone to make health insurance a priority when sending kids back to school.
In Massachusetts, 532,000 residents lack health insurance, 54,000 of them children. These children suffer educationally because they don’t receive proper care for sore throats, earaches, and asthma – common childhood illnesses that cause school absences. This adds stress to the daily lives of parents and caregivers and hurts kids academically.
Many families don’t realize they are eligible for free or low-cost health coverage through MassHealth or the Children’s Medical Security Plan, even if they are employed or partially covered by their employer’s insurance. The Back-to-School Campaign helps these families find a program and enroll in it. Click here if you would like to connect with the campaign or call the toll-free number: 1(877) KIDS-NOW, where information about affordable health care options is available.
There’s a powerful new book on the realities of being uninsured in America: Uninsured in America, Life & Death in the Land of Opportunity. It puts a human face on the problem in a compelling and careful way. Check out this site on the Commonwealth Fund website for a terrific synopsis of the book as well as descriptions of some key individuals who are profiled.
You (yes, you!) are invited to a reception and conversation with Susan Starr Sered and Rushika Fernandopulle, the authors. The reception will be on September 13th from 5-7 p.m. in the Taubman Conference Room, on the fifth floor of the Taubman Building at the Kennedy School of Government, Harvard University. Please contact HCFA's Marla Stein at 617-275-2926 or email@example.com if you would like to attend.
There will be a panel discussion after the authors’ presentations. This event is sponsored by Health Care for All, Community Catalyst and the Harvard Interfaculty Program for Health Systems Improvement
Earlier this summer, the Bush Administration appointed a commission to develop recommendations to curtail the growth in Medicaid spending. Below is an update on the Commission from the National Health Law Project:
"On August 18th, the Bush Administration's Medicaid Commission made its recommendations to cut $10 billion over five years from Medicaid. The commissioners will send their recommendations to Congress and to the HHS Secretary by September 1. After September 1, 2005 and before December 31, 2006, the commission will hold meetings to consider long-term changes in Medicaid. Dates and places for these meetings have not been set. For information on the commission, visit http://www.cms.hhs.gov/faca/mc/default.asp.
"The commission voted to recommend several short-term options, including implementing tiered copayments for prescription drugs, changing the drug rebate formula, extending the Medicaid drug rebate program to Medicaid managed care, increasing the current "look-back" period for Medicaid eligibility from three years to five, and changing the penalty period start date for individuals transferring assets for Medicaid eligibility purposes.
"In addition, the National Governors Association and National Conference of State Legislatures recently provided short-term recommendations to Congress to cut Medicaid spending. Among its recommendations, the NGA supports increasing cost-sharing for people with incomes over 100 percent of the federal poverty level, and requiring the Department of Health and Human Services to support the states when waivers are legally challenged. For further information, see http://www.nga.org/files/pdf/0508medicaidreform.pdf."
From our perspective, the proposed changes on co-payments will be the most damaging. The eligibility changes mostly affect elderly looking for Medicaid support for their nursing home bills. Affluent families do estate planning that escapes all of these rules changes -- it's the uninformed, less affluent with smaller estates who get caught in these rules.
Not too likely according to a new report from the Congressional Budget Office.
"Uninsured workers are unlikely to purchase individual health insurance, regardless of whether they receive tax credits or other subsidies to help cover the cost of premiums, according to a report released on Friday by the Congressional Budget Office. The report, which surveyed 1,718 individuals, found that only 16% of respondents had individual health insurance and that most of those respondents were women, white and older and had higher income and education levels. Cost did not have a significant effect on whether uninsured workers purchase individual health insurance. A 10% reduction in the cost of premiums would only increase the rate of uninsured workers who purchase individual health insurance by 5.7%, the report said. Although reduced premiums for individual health insurance likely would attract healthy lower-income individuals, a decrease in cost likely would have a smaller effect on less-healthy individuals and those with annual incomes higher than 200% of the federal poverty level."
Health Care For All and the Commonwealth have agreed to a “joint remedial program” in the case of HCFA v. Romney which alleged that the Commonwealth’s administration of the MassHealth dental program for children violated federal law. On July 14, federal district judge Rya Zobel ruled in favor of HCFA and ordered the Commonwealth and HCFA to develop a joint remediation plan to address the deficiencies in the state’s management of dental services for more than 450,000 low-income Massachusetts children.
You can read the “First Joint Report on Proposed Remedial Program” filed yesterday with the federal court by clicking here. You will read areas where we are in agreement, and the areas in which we still have work to do. We agreed to ask the Court to file an updated report on the areas of disagreement no later than December 31, 2005. For a history of HCFA’s dental lawsuit, filed in 2000, click here.
HCFA is represented in this action by an outstanding legal led by our crack law firm Health Law Advocates, (Laurie Martinelli and Steve Rosenfeld), Clare McGorrian, and Greater Boston Legal Services Attorney Sara Anderson. Our expert remediation team includes Zoila Torres Feldman of the Great Brook Valley Community Health Center, Dr. Mark Doherty of the Dorchester House Neighborhood Health Center, HCFA’s Stacey Auger, and Dr. Rick Niederman of the Forsythe Dental Clinic.
And thanks to the Executive Office of Health & Human Services and Attorney General Tom Reilly for approaching this court-ordered task in good faith and cooperation.
HCFA, other advocates, hospital groups and physicians sent a letter to Governor Romney yesterday asking him to freeze plans to make changes to the state’s Uncompensated Care Trust Fund (“free care pool”), the state administered fund that makes payments to hospitals and community health centers for care they provide to low-income, uninsured patients (read the letter here).
Earlier this month, the Romney administration proposed new regs that would impose new co-payments on pool users, restrict eligibility and eliminate payment to hospitals for services now covered by the fund. The proposal requires all free care patients, whose income varies between zero and 200% of the federal poverty level ($33,000 a year for a family of 3), to make a co-payment for every health care visit and every prescription, and will leave hospitals with no payment source for many of the services they provide.
The letter authors, which include leaders of Health Care For All, the Massachusetts Hospital Association, the Massachusetts League of Community Health Centers and the Massachusetts Medical Society, say these changes will shift at least $100 million in costs on to providers and patients.
The proposed changes are scheduled to take effect on October 1st, but the 14 signers of the letter asked the Governor to delay any significant changes to the pool until after the legislature has acted on the major health reform proposals pending before it. “Now is not the time for the administration to unilaterally initiate major changes to the state’s safety net program,” the letter reads. “Rather, all the stakeholders should now be working together through the legislative process to expand health care coverage and devise a stable and sustainable safety net for the uninsured.”
The proposed changes are scheduled to be heard in a public hearing held by the Division of Health Care Finance and Policy on September 8th at the University of Massachusetts Boston campus.
Brian Rosman is HCFA's point person on this. If you would like more info, contact Brian at firstname.lastname@example.org
Here are excerpts from our press relase today on the 2005 Census Bureau report on the uninsured:
"Health care advocates are disappointed by new figures showing substantial growth in the number of uninsured people in Massachusetts.
“'The numbers continue to increase. We need aggressive leadership at all levels of government to get people the basic coverage they need to be secure and healthy,' said John McDonough, Executive Director of Health Care For All.
"The federal census bureau released the results of its 2004 Current Population survey today. The census found the uninsurance rate in Massachusetts grew from 10.3% in 2002-2003 to 11.2% in 2003-2004. The rate was 9.1% in 2001-2002. This growth rate corresponds to a 23% increase in the uninsurance rate since the 2003 report, the fourth highest of any state over this period. The Commonwealth is one of only 5 states that marked a significant increase in the past 2 reports.
“'We know from multiple studies that the uninsured receive less care and are therefore more ill. Besides the impact of disease and poor health, uninsurance results in reduced earnings and lower levels of educational achievement,' McDonough said."
It's widely recognized among health policy researchers that the state by state census numbers overestimate the number of uninsured. What is important and valid is the overall trend rate, which -- for Massachusetts -- is up and up and, now once again, up.