"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

July 8, 2005

Close to one thousand residents from across Massachusetts attended a hearing and rally today on the Health Access and Affordability Act (S. 738/H. 2777). The Health Care Financing Committee heard their personal stories about the need for health reform. Citizens urged the legislature to take immediate action by passing the bill. Health access and affordability is rapidly deteriorating in Massachusetts. More than 532,000 residents are uninsured, and 70 percent of the uninsured work

In Boston, one out of every seven Latino residents and one in nine Black residents is uninsured," noted Dr. John Rich, Medical Director, the Boston Public Health Commission. "The lack of affordable, comprehensive health insurance contributes to the disturbing racial gap in good health. Equal health coverage is an essential part of the solution to this injustice."

“I've gone without glasses for over two years because I have to choose between glasses or paying for medications. After paying $80 per month for my medicine, I can't afford eye glasses," commented Carlos Rodriguez, a Springfield volunteer with Neighbor to Neighbor. The Health Access and Affordability Act (S. 738/H. 2777), co-sponsored by 18 Senators and 57 Representatives, provides a plan to expand access to affordable coverage, control growth in health costs, and improve quality .

"A consensus is forming. This is the year for health care reform. The commonwealth needs a plan that will reduce the number of uninsured and reinforce our leadership in providing accessible, high-quality care,” said MA Hospital Association Pres. Ron Hollander. “Massachusetts hospitals are eager participants in the reform effort because we serve missions of healing. Insured patients are healthier patients. The ACT! Campaign - a broad coalition of consumers, patients, community organizations, businesses, labor unions, religious organizations, doctors, hospitals, and community health centers – supports the bill.

The Coalition for Social Justice and the Coalition Against Poverty support the Health Access and Affordability Act and the ACT! campaign, because it is a simple and realistic option to provide comprehensive quality health insurance for the uninsured in Massachusetts," said Coalition for Social Justice Organizer Debora Fastino.

“As a businessman, I understand the importance of giving employees access to high quality and affordable health insurance, said Philip J. Edmundson, CEO of William Gallagher Associates and co-chair of Massachusetts Business Leaders for Quality and affordable Health Care. “It is only fair that employers who do the right thing by providing affordable, comprehensive health care benefits are not undercut by companies that shirk this responsibility.”

Affordable Care Today Coalition collaborated with Senator Richard Moore and Representative Deborah Blumer to draft the Act and is proudly advocating for its passage.

The Act is a comprehensive reform plan that improves health care access and
affordability in Massachusetts.

July 8, 2005

The National Health Policy Forum has a good, new report examinging local initiatives around the nation to provide coverage for the uninsured. [Local coverage Initiatives: Solution or Band-Aid for the Uninsured?] It contains some interesting new ideas and models such as the "three share model" -- employers and employees each contribute 30% and the public sponsor contributes 40%. (Muskegon County in Michigan). Relevance for Massachusetts -- who knows? We're a boiling cauldron of new ideas these days, so how about a few more?

July 7, 2005

I know she's not a household name -- but Katherine Swartz, Professor at the Harvard School of Public Health, is one of the smartest thinkers around on the flaws and
weaknesses of the current health cost strategy of "consumer directed health care" (aka -- "faith based health insurance" ... you have to pray you don't get sick.) Here's the conclusion to Katherine's new article in the journal, Inquiry:

"There is no question we need to slow the growth in health care spending to have monies for priorities beyond health. Relying on a strategy of consumer-driven health care implies that a focus on “small ticket” items will achieve that. However, this is only true if people seek medical care less often. The trouble with this strategy is it also increases the likelihood that people will not visit physicians who might catch “unseen” health problems that often lead to high-priced medical care if left unchecked. Hypertension, high cholesterol levels, even creeping weight gains all come to mind."

"Since the vast majority of health care spending goes for a tenth of us, a much greater gain may be found in refocusing on health problems that cause high expenditures. Being overweight or obese, for example, greatly increases a person's chances of developing diabetes, which raises the odds for stroke, kidney problems, vision loss, and circulatory problems. All these contribute to high spending. Community or statewide efforts to publicize the dangers and costs of such problems—akin to what has been done over the past 40 years to reduce smoking, and has been supported by insurers, employers, and governments—might do more, at less cost, to reduce avoidable medical spending."

"Ultimately, we have to confront the fact that much of what drives health care spending is out of consumers' hands. When people become ill, the costs of their care quickly climb beyond today's high-deductible levels. Consumer-driven health care is not going to curb spending for these people. We're kidding ourselves if we think otherwise."

Check out the full article by clicking here.

July 7, 2005

Gov. Romney today named Tim Murphy to replace Ron Preston as his H&HS Secretary. Here's an except from the official press release:

"Murphy is the Director of Policy in the Governor’s Office, working on education, job stimulus and transportation agendas, and has been more recently focused on the Governor’s health care reform efforts. As the Governor’s point person for health care policy, Murphy is working closely with hospital, business and government leaders in reforming the health care market to make insurance more affordable and widely available to all citizens. Prior to this position, Murphy was the Director of Capital in the Executive Office for Administration and Finance, where he advised on capital investment, managed the state’s annual $1.3 billion capital budget and worked with the Office of Treasurer to oversee the Commonwealth’s debt program. Before joining the Romney Administration, Murphy was a Vice President in the Investment Banking Division of J.P. Morgan in New York City. He advised and raised capital for both for-profit and not-for-profit clients, including hospitals. He also served as a legislative aide and budget analyst for the Massachusetts Senate Committee on Ways and Means from 1989 to 1992. "Tim Murphy is one of the brightest, most capable people I know," said former Senate Ways and Means Chairwoman Patricia McGovern. "Tim's selection as Secretary is a testament to his keen intellect, hard work and ability to get things done. Tim is a problem solver. His blend of private and public sector experience will bring a fresh perspective to the Secretariat. In addition, his ability to listen and work with Republicans, Democrats, providers, advocates and insurers is a positive step to achieve healthcare reform this year."

Murphy's most public exposure came recently when he publicly criticized hospitals in May for not pursuing payments from uninsured patients more aggressively. He has been a key architect of Gov. Romney's personal responsibility and individual mandate health insurance proposal. This is a key position with huge consequences for the health and human services systems in Massachusetts. We wish Tim well, and we'll be watching closely.

July 6, 2005

Powerful testimony today before the Legislature's Health Care Financing Committee on bills to repair damage to MassHealth inflicted during the fiscal crisis. Our dynamic oral health advocacy coordinator, Stacey Auger, kept notes from some testimony:

SC from Cambridge: Without a full set of teeth, it becomes difficult to chew and et nutritious food. One of my favorite things to eat is salad, but I can't eat it. Everything I eat I have to chop or mash like it's baby food.

LN from Worcester: I have always had gum disease. I worked all my life and have had good jobs and good insurance. I was a productive member of society. Once I became disabled and went on MassHealth, though, it's like the world said "go over in that corner; we don't need you any more." Just because I can no longer afford these services doesn't mean I don't need them. If I had them I could be a productive member of society again. ... My gum disease is so bad I only have four teeth left. When you don't have teeth, you don't eat well. You don't digest, you choke easily. I'm tired of eating baby food. When your oral health suffers, you lose teeth. People perceive you as poor. Your self esteem goes down. You don't smile. Kids walk us to me and say 'ma'am' because I look like a great grandmother. You can't keep or get jobs.

Dr. Mike Monopoli, Delta Dental: In 2002, at the height of the fiscal crisis, the administration eliminated dental benefits for 560,000 adults in MassHealth as a cost-savings measure. Cost-savings is not cost-effective. Lack of access to dental care increases MassHealth costs in the long run. Lack of preventive dental care leads to increased risk for periodontal (gum) disease. Periodontal disease is associated with increased risk of premature and low birth weight babies in mothers. Complications associated with low birth weight result in high cost to care for infants in their first months of life and increased medical costs for years thereafter. Untreated periodontal disease increases medical costs for adults with cardiac disease and diabetes. Untreated cavities leads to infections and the need for root canal treatment, extractions and dentures. MassHealth adults without access to dental care burden hospital emergency departments when they are in pain and have nowhere to go. Dental care in a hospital ER is the most costly and least effective way to provide dental care.

July 5, 2005

Today's USA Today covers Gov. Romney's health insurance proposal that includes an "individual mandate" for individuals to purchase coverage or face state penalties: Mass. Gov. Romney's health care plan says everyone pays. Here are two key selections:

"Romney's plan comes as politicians, employers and benefit consulting firms are focused on the latest trend in health care cost control: 'personal responsibility.' ... It's a conservative idea," says Romney, "insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase."

Those who have followed this issue know we have real/practical reservations about Romney's plan: insufficient money to subsidize insurance for low/moderate income families, lack of financing/coverage details, faulty assumptions, incentives for employers to drop coverage, inappropriate cost sharing, and more. Yet let's consider the big picture:

"Personal Responsibility" is the conservative tonic for what ails the US health care system. While RomneyCare takes it a big step further, it's part of a larger pattern that assumes individual consumers are the problem, and cost sharing plus other financial burdens are the solution. Since each year, 80% of consumers are responsible for only 20% of medical spending, we reject this. We note that "employer responsibility" is not part of this vision at all as employers are left off the hook -- a happy convenience for conservatives.

Perhaps this is the start of a Nixon Goes To China moment in health policy -- a path to universal coverage that requires the embrace of an explicitly conservative agenda. Yet before the rest of the nation embraces this vision, they should remember it's only possible because Massachusetts already spends massive amounts on our safety net, resources that don't exist in most other states. And before we place our hard won safety net resources at risk for a plan with no details, we've got a lot more looking to do before we take this leap.

We've seen prior MA governors offer ambitious plans with great predictions: eg, in 1995 Gov. Bill Weld promised that his innovation, the Insurance Partnership, would cover 100,000 uninsured in year 1 and more than 250,000 in year 3 (today, in year 6, it covers about 14,000). Bill Weld, of course, never had to explain why he got it wrong -- his national ambitions took him far away from MA before any results could be tallied. Sound familiar?

July 4, 2005

Happy 4th everyone! Here's a surprise. Today's New York Times describes a fast brewing revolt by Republican governors and other state officials against a key part of the Medicare Prescription Drug Law, passed in 2003, scheduled to start in Jan. 2006. A number of states are revolting against a requirement that they must reimburse the federal government a large portion of drug costs for "dually eligible" seniors -- those who qualify for Medicare and Medicaid, and have had Medicaid cover their drug costs for many years.

The inelegant term in the law is the "clawback." (Fed officials have been ordered not to use that word.) Since states would get windfall savings when the feds begin covering drug costs next year, the law requires them to pay back 80% of expected savings from the new law each year. This appears to be the first time the feds have required states to write checks to them. The "clawback" formula is complex, and many states may owe more than 80%, (even more than 100%) especially states that have done a good job on prescription drug cost containment, such as Massachusetts.

Who's leading the charge? Remember the Alamo! "Texas is leading the charge against the requirement, which states see as more onerous than the mandates imposed on them by the 2002 education law, the No Child Left Behind Act. Gov. Rick Perry, a Republican, has vetoed a $444 million appropriation covering the Texas contribution for the next two years. In his veto message and in a letter to other governors, Mr. Perry said he objected to the federal requirement in principle and to the way it was being interpreted by the federal Medicare agency. 'For the first time," Mr. Perry said, "state governments would be expected to directly finance federal Medicare benefits with state tax dollars. In effect, states will be billed on a monthly basis for the cost of federal services.' ... In New Hampshire, the state budget enacted last week stipulates that 'no payments shall be made to the federal Medicare program, unless a court has determined that the provisions' of the federal law, 'popularly known as the clawback, are constitutional.'"

Here's a prediction. Implementation of this convoluted atrocity of a law -- beginning in October -- will be the domestic equivalent of the Bush Administration's Iraq reconstruction fiasco. The biggest fireworks this year will not be on the 4th.

July 2, 2005

Legislation to expand family planning services to more low-income residents is before the Health Care Financing Committee next Wednesday. The proposal (H4178) would direct state health officials to seek a federal Medicaid waiver to pay for services like medical and gynecological exams, screening for breast and cervical cancer and sexually transmitted diseases, and education and counseling about contraception. The waiver, in place in 21 other states, would reimburse the state 90 percent. The proposal was included in the Legislature's fiscal 2005 budget and vetoed by Romney.

Members will hear other Medicaid-related bills including proposals to restore adult dental coverage, require MassHealth to pay for smoking cessation programs, remove enrollment caps. In 2002, the state eliminated dental coverage for 560,000 adults in MassHealth . The committee will be asked to support legislation restoring that benefit at a cost of $29 million. Romney vetoed a provision in the fiscal 2006 budget to restore dental coverage for women with children under 3 who are enrolled in MassHealth. The bill is sponsored by Sen. Harriette Chandler and Rep. Kathleen Teahan. (Wednesday, 10 am, Room A-2)

July 1, 2005

We missed the celebration -- the balloons, banners, band, confetti and the rest celebrating the first day of Massachusetts' new Medicaid waiver. It begins today, July 1, ready or not, and one of the only clear things is that we're NOT ready.

What the heck is the 1115 waiver? Massachusetts, like many states, runs our Medicaid program under special terms negotiated with the US Department of Health and Human Services, giving the state much more flexibility than permitted under standard Medicaid -- and much more money, about $1.3 billion in our case. Massachusetts' first waiver, which ran from 1997 to 2001, allowed the state to expand MassHealth (the name of our Medicaid program) to more than 300,000 lower income persons, driving down our rate of uninsurance to one of the lowest in the nation. The second waiver ran from 2001 until last night at 11:59pm. The new waiver starts today.

Senator Kennedy and Gov. Romney negotiated the broad outlines of an agreement released in February of this year. That deal left many, many vital details unanswered with the expectation those details would be ironed out before 7/1/05. These details have not yet been worked out, leaving the state driving on this expensive highway with blinders. The waiver is also a key component of the RomneyCare health reform proposals.

If you want to know gory details about the Massachusetts waiver, check out this excellent policy report produced in April by the Mass. Medicaid Policy Institute. In the meantime, happy new waiver day to you and yours!</sp

June 30, 2005

Not that we're picky, yet we could not help noticing in Gov. Romney's "Report to the Commonwealth" circulated as a glossy supplement in yesterday Boston Globe, the Governor claiming the following task as "Done" ... "Reduce by 20 percent by 2005 the number of uninsured."

Excuse us? In 2000, the State's uninsured survey showed 365,000 uninsured in MA; in 2002 the figure was 418,000; in 2004, the state-documented figure was 460,000; last week the Urban Institute estimated the current number at 532,000. By the state's own data, the number of uninsured grew from '02 to '04 by 10%, and according to the Blue Cross estimate by 26%. Could anyone tell us how this task gets marked as "Done"?

And speaking of picky, here are some health access items the Governor picked apart with his veto pen, just announced:

  • Restoration of dental benefits for poor mothers with children up to age 3 -- vetoed;
  • Restoration of smoking cessation benefits for poor new mothers -- vetoed; (What's the Governor got against poor new mothers?)
  • Restoration of affordable premiums for poor children enrolled in the Children's Medical Security Plan;
  • Prohibition of "sponsor deeming" for poor elderly and disabled legal immigrants in MassHeatlh -- vetoed.