"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

August 14, 2005

HCFA's crack webmaster, John Lin, pointed me to this frightening story from last week's Guardian. Briefly, an area in western Siberia with size of France and Germany combined, covered with permafrost since the Ice Age (about 11,000 years ago) is undergoing rapid melting. Lodged under this permafrost is an awesome peat bog loaded with the powerful greenhouse gas methane. No models or calculations on the threat and pace of global climate change have factored in the addition of this new vast reservoir of greenhouse gases, though the implications are profound and startling.

This is not our beat at HCFA, for sure. Since seeing the story, I've spoken with friends in the environmental movement, all of whom are familiar with this alarming development. Many of us are familiar with the icon of chaos theory -- a butterfly flapping its wings in Japan can trigger a tornado across the globe. This is more than a butterfly as the Siberian permafrost has been estimated to contain 1/4 of all the ground-based methane gas on our planet.

Maybe this has nothing to do with health care policy, and maybe it does. The kind of changes global climate change could trigger could sure be a distraction from universal coverage. Every other advanced society on our planet figured out how to provide health security to all their residents back in the 20th century. Here we are still struggling to figure it out in the 21st, alone among nations. Meanwhile we're the leading nation contributing to global climate change and sticking our heads in the sand in addressing it.

I remember back in the 1980s, we had this awful threat from the growing hole in the ozone layer over Antartica. Somehow, the world community got its act together and fixed that problem. What a remarkable achievement. What will it take to trigger a repeat?

August 14, 2005

More than one-third of the U.S. Latino population in 2004 lacked health insurance, and one-fourth received coverage only through public health insurance programs, according to a new study by the Agency for Healthcare Research and Quality. Latinos make up 15% of the US population and account for 29% of uninsured residents and 36% of uninsured children younger than age 18. The study also found:

-- About one in seven whites lacked health insurance in 2004, and 10% received coverage only through public health insurance programs;

-- Whites comprised 65% of the population but accounted for less than half of uninsured residents in 2004;

-- One in five blacks lacked health insurance in 2004, and 28% received coverage only through public health insurance programs;

-- About 64% of workers in private companies with 50 or more employees participated in employer-sponsored health insurance plans in 2003;

-- 82% of workers in the mining and manufacturing industry participated in employer-sponsored health plans in 2003, compared with 41% of those in "other service industries"; and

-- Workers, on average, contributed $627 annually toward health insurance premiums for single coverage and $2,242 for coverage for a family of four in 2003.

The study found that 19% of adults under 65, or about 48 million, lacked health insurance in the first part of 2004. Almost 12% of children younger than age 18, or 8.5 million, lacked health insurance in the first part of 2004 -- a "figure significantly lower than estimates from the previous decade," because of expansions of public programs such as Medicaid and SCHIP.

About 35% of young adults between ages 19 and 24 lacked health insurance in the first part of 2004, according to the study.

August 13, 2005

A new issue brief from the Commonwealth Fund includes valuable new insights into the extent to which medical debt is becoming a pervasive national problem.

CF reports that "77 million Americans age 19 and older—nearly two of five (37%) adults—have difficulty paying medical bills, have accrued medical debt, or both. Working-age adults incur significantly higher rates of medical bill and debt problems than adults 65 and older, with rates highest among the uninsured. Even working-age adults who are continually insured have problems paying their medical bills and have medical debt. Unpaid medical bills and medical debt can limit access to health care: two-thirds of people with a medical bill or debt problem went without needed care because of cost—nearly three times the rate of those without these financial problems."

Health Care For All has been working on the issue from the perspective of hospital billing and collection practices. Briefly, how well or how poorly you get treated when you have unpaid hospitals bills and no way to pay depends on what hospital you use. HCFA's Melissa Shannon has been working on this issue and we are hoping to issue our own Massachusetts report in the fall. For more info, contact Melissa at shannon@hcfama.org

August 11, 2005

Special elections can be handy. Because candidates need to appeal directly to voters, their opinions present a window on current public attitudes. The special Second Middlesex State Senate race (primary August 30th) is such a window. Two leading candidates, former Rep. Joe Mackey and current Rep. Pat Jehlen responded to a questionnaire issued by the first-rate political blog, Blue Mass Group (required daily reading!). Their answers on health reform are revealing.

Health care: do you support the Health Access and Affordability Act, which would move toward universal health insurance through a combination of employer mandates and expanding MassHealth, and would be funded by an increase in the tobacco tax along with other sources? Other options on the table include Governor Romney’s individual mandate – would you support that approach? Would you go even further than any of these proposals, and if so, how?

First, Joe Mackey:

I strongly support the Health Access and Affordability Act (H. 2777, S. 738) as it strives towards universal health insurance, expanding affordable coverage and MassHealth and working with employers to meet the crucial health care needs of their employees. We can no longer tolerate the number of uninsured citizens growing, while health care access and affordability continue to deteriorate.

The impressive and effective Coalition of 32 Steering Committee members that has formed to promote the Health Access and Affordability Act gives us hope that this bill will be successfully passed. The American Cancer Society, Health Care for All, the Massachusetts AFL-CIO and the Massachusetts Hospital Association are a few of the organizations that are working together to see that this effort becomes reality.

I am ready, willing and able to work with this Coalition and use my legislative skills as your next State Senator to help make sure that we improve and invigorate our affordable health care efforts.

I have been going around the Second Middlesex Senatorial District and speaking out against a number of Governor Romney’s proposals. I definitely do not agree with the Governor’s individual mandate that would punish those who can least afford the extremely high health insurance costs. It is ludicrous in its approach and mechanism.

I plan on spending a lot of my efforts in supporting high-quality health care coverage for all our residents, through the Health Care Trust bill and other proposals that will be before the Legislature. I will work to ensure that prescription drugs are affordable for our citizens, especially the elderly, who often have to choose between their needed prescriptions and food and shelter. I strongly support advancing medical research, including stem cell research.

As a Legislator, I spearheaded the Healthy Start program, which provides access to early, comprehensive and continuous prenatal care for low-income, uninsured women to improve the health of newborns and their mothers. This next legislative session is the time to finally come to grips with one of society’s greatest needs - health care for all.

And now Rep. Pat Jehlen:

Just this week I talked to a woman who works in an insurance company. She said individuals and small businesses are dropping their policies rapidly. It’s just not affordable. But the increase in uninsured people leads to poorer health as people defer treatment, and to higher costs as they use uncompensated care.

The Health Access and Affordability Act is the best of the incremental solutions, and I strongly support it. It has the kind of organizational support that gives it a chance to pass and expand coverage.

I support expanding MassHealth and restoring benefits such as dental care. I am the lead sponsor of a bill to extend benefits to the elderly and disabled. I certainly oppose the Governor's proposal to penalize those who cannot afford the exorbitant price of health insurance; his plan creates a lot more bureaucracy without addressing the real problems.

I have been a long time supporter of single payer universal healthcare, as proposed in the Mass. Health Care Trust bill. Until care is truly universal, and paid for by broadly based, progressive taxes, we will continue to have people denied basic care that they need and deserve and our system will be unfair and inefficient.

Finally, I support the constitutional amendment which would make access to affordable health care a constitutional, enforceable right. If passed, this amendment would increase pressure on the legislature to adopt a comprehensive solution.

August 10, 2005

Yesterday, about 40 people gathered at HCFA to discuss the new regulations proposed for the Uncompensated Care Pool (for a basic summary, scroll down to the August 2 entry; for more info, check out our pool page here). For a meeting in August, that's a lot.

The participants included people affiliated with hospitals, community health centers, physicians, consumer legal assistance, programs for the homeless, and the mentally ill. There was considerable anger among the group. The consensus among the group was that the new regulations will hurt low income people seeking critical care and shift substantial costs onto providers. The new regulations appear to try to implement parts of the Governor’s health care reform bill, before the bill has even had its hearings. “It’s like putting the cart before the horse,” said one person.

The group committed to an aggressive advocacy campaign with both the legislature and the administration to try to alter or delay the regulations. People interested in participating in the campaign should contact Gretchen Weiss, at weiss@hcfama.org, or 617-275-2916. We are planning a major presence at the September 8 hearing on the proposal.

Also yesterday, we were amused (sort-of) by an information sheet put out by the administration explaining their reasoning behind some of the Pool changes. The administration’s explanation for imposing co-pays on all Pool patients (remember, over 40% of Pool users report having no income) was as follows:

All UCP [Uncompensated Care Pool] co-pays will be higher than
MassHealth co-pays to encourage enrollment into MassHealth.

Hello? You can’t encourage Pool patients to enroll into MassHealth, because by definition Pool patients are ineligible for full MassHealth. That’s why they’re eligible for the Pool in the first place!

We await the administration’s clarification of their thinking.

August 9, 2005

Today's Wall Street Journal contains a rosy-toned article on how the rate of growth in health insurance costs are moderating. Here are some tidbits from "Insurers Expect Slowing Growth in Medical Costs":

"Major health insurers continue to see stable or slowing growth of medical costs, recent corporate earnings reports and forecasts show, and the slowing medical-cost trends are reaching employers. WellPoint Inc., Aetna Inc., UnitedHealth Group Inc., Humana Inc. and PacifiCare Health Systems Inc. have reported steady or moderating medical-cost trends in their commercial health plans.

"Generally, the companies are reporting slowing growth in pharmaceutical expenses, stable increases in physician costs, slightly moderating outpatient pricing expansion and flat hospital inpatient demand, according to J.P. Morgan analyst Scott Fidel. ... Employers, which have been passing on more expenses to workers, are seeing some health-cost pressure ease. In June human-resources consulting firm Hewitt Associates said U.S. health maintenance organization rates for 2006 are expected to rise at their most moderate pace nationally in more than five years.

"WellPoint, the largest U.S. managed-care company by membership, said medical-cost growth continued to slow in the second quarter. The company expects such costs to rise by less than 9% this year, about one percentage point better than in 2004.

"In reporting its second-quarter results, Aetna noted that it started the year forecasting commercial medical-cost growth of 8.5%. By the end of the first quarter, Aetna had lowered that view to a range of 8% to 8.5%. UnitedHealth Group expects its growth in medical costs to remain at 8% or lower with no meaningful increase for the rest of the year, and for 2006 to remain roughly in line with the 2005 range."

With inflation growing at about 2.5 percent and overall US economic growth rising at about 3.5 percent, that means health insurance costs are still rising two to three times faster than everything else. Last week, the Boston Globe reported that premium increases for Massachusetts based health plans will rise between 8 and 12 percent in the coming year, the sixth year in a row of double digit increases.

Generally, in decent economic times like these, we see premium increases tend to moderate much more than we're seeing now. Something's amiss -- who's paying attention, and who has any constructive ideas?

August 5, 2005

Today's Herald has a column by Wayne Woodlief debunking the assertion in last Saturday's Boston Globe that Democrats in the Legislature will kill health reform to avoid giving Gov. Romney a political win he can use in his upcoming presidential run. Wayne, one of the town's smartest and most decent reporters, gets it just right. The Legislature is in no mood to do Gov. Romney any favors. And they will not allow that to stand in the way of doing the best job they can on health care reform. Here are some quotes from today's column:

Whew! I didn't think Democrats could be that dumb. Just file under N for nonsense those reports in that other newspaper that some unnamed malcontents in the majority party on Beacon Hill want to put the brakes on vital health care legislation – just to deny Gov. Mitt Romney a bragging point for his likely presidential campaign.

It's not gonna happen. Take it from Senate President Robert Travaglini, House Speaker Sal DiMasi, Democratic state chairman Philip W. Johnston and Sen. Richard Moore (D-Uxbridge), Senate chairman of the Health Care Finance Committee. And they said it on the record.

The truth is the governor is increasingly deemed irrelevant on Beacon Hill. The Legislature just finished overriding a slew of his vetoes. And though the Democratic leadership can't say it outright (they have to work some with the guy), whether and precisely when he announces for president, not re-election, does not matter a whit. ...

Travaglini said, ``Access to affordable health care remains one of our most pressing issues, probably even more so today, since we continue to see double-digit increases in insurance premiums.'' Stall? Not on Trav's watch. He vowed to pursue his goals of covering half of the 532,000 uninsured Bay Staters and cutting costs for consumers, employers and taxpapers by 2006.

And DiMasi has termed health care ``the premier issue of our time.'' His spokeswoman Kim Haberlin said: ``He wants this addressed in an honest, timely way, and we have a historic opportunity,'' since Romney, Travaglini and DiMasi are all moving toward the same goal – albeit with differences in means.

Moore promised all deliberate speed on a reform bill being steered through the Health Care Finance Committee he co-chairs. ``We've done all our hearings and we hope to get a bill released from our committee early in September, maybe sometime around Labor Day,'' Moore said. It would take some from the Senate bill, some from the House's ideas and those of health reform advocates and, yes, even some of the governor's proposals. But not so much that he could take it on the presidential trail, Moore forecast.

And here's a news flash for the governor: His proposal that individuals must buy health insurance ``probably won't fly,'' said Moore, adding that Romney's plan for a new state agency to create a purchasing pool intended to help employers and employees lower their insurance costs is likely to be jettisoned, too. ``I think we can do it without creating a new state agency and adding more bureaucrats,'' said Moore. Hey, who's the conservative here? ...

Most of the other Democrats can chew and walk at the same time. They know how to claim credit, especially when they control the legislative process. They're smart enough to put people in need first and not shoot themselves by sitting on a vital reform bill. And their leadership is wise to be statesmen now and save the credit games for later.

August 4, 2005

Sixteen initiative petitions -- some for laws and some for constitutional amendments -- were filed by yesterday's 5pm deadline. You can see the fill list and view the actual language of each submission by clicking here for the Attorney General's website. Isn't this web stuff just amazing or what.

Lots of issues -- gay marriage, the war in Iraq, dogs (a perennial favorite), selling wine in convenience stories, personal care attendants, and more. MassACT, the health care initiative committee, filed four versions of a health access ballot question -- each with minor differences. Version A is the comprehensive version if you want to look at just one of them.

Next steps -- the Attorney General decides by late August/early September which questions are permissable under the requirements of the Massachusetts Constitution. The Secretary of State makes petitions available in mid-September. Groups then have until mid-November to collect at least 65,000+ signatures of registered voters.

Back in 2002, I wrote a lengthy piece for Commonwealth Magazine on the history of initiative and referendum in Massachusetts. Found out a lot of fascinating history. If you would like to read that piece, click here.

Vox populi!

August 3, 2005

Today, a coalition organized as MassACT (Affordable Care Today) will file an initiative petition for a law to achieve health reform in November 2006 if legislative reform efforts fail or fall short. The initial Coalition includes Health Care For All, FamiliesUSA, the Greater Boston Interfaith Organization, the Mass. AFL-CIO, the Service Employees International Union, Neighbor to Neighbor, and the Coalition for Social Justice. MassACT is the ballot initiative committee. The ACT! Coalition is the legislative group promoting the Health Access and Affordability Act, filed by Sens. Moore and Montigny and Rep. Blumer. The proposed initiative would: 1. Help uninsured workers and small businesses buy affordable health insurance on a sliding scale 2. Expand MassHealth for lower income uninsured working adults 3. Lower health premiums for all currently insured -- with an immediate cut of $160 million annually to every health insurance policy holder in Massachusetts 4. Require fair payments for hospitals, physicians and health centers to end the cost shift to private insurance premiums 5. Level the playing field between businesses that provide insurance and those that don't by establishing a Fair Share assessment on employers who don't provide health insurance to their workers 6. Raise cigarette taxes 60 cents 14 persons signed the petition filed today with the Office of the Attorney General: Sen. Mark Montigny, Cong. Jim McGovern, Kathy Casavant, Philip Edmundson, Rev. Ray Hammond, Elmer Freeman, Chip Joffe Halpern, Rabbi Jonah Pesner, Rocio Saenz, Zoila Torres Feldman, Phil Villers, Celia Wcislo, Dr. Barry Zuckerman, and John E. McDonough. The Coalition must collect 65,000+ voter signatures this coming fall. More to come on that in September. For more information, contact MassACT's Lisa Vinikoor at vinikoor@massact .org The plot is thickening...

August 2, 2005

Yesterday the Romney administration released proposed new regs for the Free Care Pool. The regs would impose new copayments on free care patients, and impose many new restrictions on hospitals and health centers treating free care patients. The new regs are due to take effect on October 1, 2005. A public hearing on them will be held on September 8 at UMass Boston.

Among the proposed changes:

1. New co-pays for services provided to Pool patients
$3 per community health center visit.
$5 per hospital visit or inpatient admission.
$5 for brand name drugs;
$3 for generic drugs.

Studies have found that even very modest co-payments imposed on low-income families can impact health. A Minnesota study found that more than half were unable to get prescriptions at least once in the last six months because of copayments of $3 for brand name drugs or $1 for generic drugs. A third of the patients who failed to get medications had subsequent emergency room visits and hospital admissions for related disorders. The inability to afford copayments had serious health consequences and led to use of more expensive medical care. A good summary of research on this issue is available here.

2. A patient will no longer be eligible for the Pool if the patient is terminated from MassHealth for failure to pay premiums or deductibles. In 2003, MassHealth began imposing premiums on many families with incomes as low as 114% of the poverty level ($10,900 for an individual). These premiums have resulted in many people losing coverage for failure to make a monthly payment on time.

3. A patient will no longer be eligible for the Pool if the patient is eligible for MassHealth’s premium assistance program for employer sponsored insurance but fails to enroll or apply for employer sponsored insurance.

4. The Pool will reimburse for costs going back 60 days before the date of application. Currently, the pool pays retroactive claims for up to 6 months. This will snag many patients who believe they have health coverage, but turn out to be uninsured. The new regs allow hospitals to bill a Pool-eligible patient if the patient applies more than 60 days after a service is provided.

5. Pool patients using hospital pharmacies will have coverage only for drugs that are on the MassHealth list. The exceptions policy available to MassHealth patients, which allows a doctor to prescribe a drug not on the approved list, will not be available to patients using hospital pharmacies.

Complete analysis and links to information on the hearing and the text of new regulations can be found on our website.