"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

June 19, 2005

University of Mass. poll (6/6 to 6/12/05) for MassInsight: (a little squirrel gave them to us.)

How much responsibility do you think state government has for keeping the state's health care system financially stable?
A lot: 47%; Some: 37%; Not Much: 9%; None: 4%

One proposal to increase access to healthcare coverage for the uninsured required increasing the cigarette tax by 50 cents a pack. How strongly would you support such a proposal?
Very Strongly: 63%; Somewhat Strongly: 13%; Not Very Strongly: 5%; Not at All: 17%

Today, many companies like Stop & Shop, CVS, and Home Depot do not offer health insurance to their part time workers. When these employees become ill, they use hospital emergency rooms and the state pays the bill. How strongly would you support the state assessing a tax on companies which do not offer health insurance for those employees who use the state's Free Care Pool?
Very Strongly: 55%; Somewhat Strongly: 26%; Not Very Strongly: 7%; Not at All: 10%.

June 17, 2005

"Rep. Anthony Weiner (D-N.Y.) and Sen. Edward Kennedy (D-Mass.) later this month are expected to introduce legislation intended to encourage large employers such as Wal-Mart to provide health insurance to more workers, CQHealthBeat reports. The bill -- which has the support of several other Democratic legislators -- would require states to disclose annually the number of employees of companies with a workforce of 50 or more who receive health coverage through publicly funded programs rather than employer-based plans. States would be required to report the cost of health coverage for those employees, as well as the ratio of employees in the company who receive such assistance. About a dozen states have proposed bills that would require large companies to offer health care insurance or face penalties such as paying higher taxes, contributing to funds for the uninsured or reimbursing the state for workers on Medicaid. Wal-Mart executives defend the company's health care coverage, saying that its health care benefits are equivalent to those of other large retailers (CQ HealthBeat, 6/14)."

Masssachusetts was the first state to produce a legislatively mandated report along these lines. You can obtain that report by clicking here.

June 16, 2005

New polling data by 7News and Suffolk University: 3 questions for 400 registered voters:

1. Should the Commonwealth provide health care for every resident?
Yes 67% No 28% Undecided 6%

2. Can the Commonwealth afford to provide health care for every resident?
Yes 34% No 52% Undecided 14%

3. Should people who can afford health care be compelled to pay for it?
Yes 69% No 20% Undecided 12%

Same old story. A strong majority of the public wants everyone to have health care, health insurance, or whatever. And the strong majority evaporates when the cost issue is brought forward. These days, we talk in high falutin' ways about values. I find it helpful to think about the word "values" in a more practical sense. We may "value" health care or education or environmental protection in abstract ways. The real test comes when we have to choose between one thing we value and something else. Do we value expanding health care more or less than we value keeping taxes where they are? When that question produces a good majority of "yes" answers, that's something we can take to the bank.

And what about question 3? I guess the operative words are "can afford" -- and affordability is very much in the eye of the beholder. Still, "compelled" is a tough term to gather 69% approval. Give us your own reactions to these questions and we'll include your responses in a future entry.

June 15, 2005

OK, it's got nothing to do with health care. Just click here and connect to the 51 official emblems of the Commonwealth of Massachusetts, including such gems as the state's: official donut, cookie, glee club song, polka, folk hero, muffin, cat ... you get the idea. (Thanks to HCFA's web-star John Lin for finding this.) How does it happen that these designations occur? Good question.

Usually, an energetic high school social studies teacher decides to teach a class about the legislative process and tries to find the most noncontroversial matter imaginable ("let's designate blah the officlal state blah!"). The local state senator and reps are usually happy to comply.

Sometimes it goes like clockwork, and other times, the unexpected happens. For example, the plucky students trying to declare the corn muffin as the official state muffin (chapter 2, section 28) ran into an unexpected roadblock in the form of the cranberry muffin. After a fierce battle, corn prevailed -- there's value in getting there first. Similarly, the chocolate chip cookie (invented in Plymouth) lobby thought they had an easy win (chapter 2, section 42) until they ran into the fig newton (guess where that was invented?).

My favorite meaningless designation moment: in June 1996, the House passed landmark health reform legislation that would result in the expansion of Medicaid by more than 300,000 low income persons, and we did it by a more-than-two thirds margin, meaning we had the votes to override a certain veto from Gov. Bill Weld. Not too shabby, I thought, and looked forward to seeing how the evening TV news would report the story. All three major stations were at the State House that day to report the big news -- but it had nothing to do with health reform. All stations reported on the same legislative hearing that day -- a bill to declare the Boston Cream Pie as the official state dessert (chapter 2, section 41).

God save the Commonwealth.

June 14, 2005

Important new data from the respected Employee Benefits Research Institute:
"WASHINGTON -- Immigrants make up an increasing share of the nation's uninsured population, a new study shows, ... In 2003, immigrants accounted for about 26% of the uninsured, according to research released by the Employee Benefit Research Institute. The nonpartisan Washington think tank, which analyzes economic security and employee benefits, said that of the 44.7 million people under 65 without health insurance living in the U.S., 11.6 million were immigrants, a 70% increase since 1994. In that year, 36.5 million were uninsured, meaning they weren't enrolled in public or private health care.

"Immigrants, both legal and illegal, are disproportionately uninsured," says Kenneth Thorpe, chairman of the health policy and management department at the Rollins School of Public Health at Emory University. "As those numbers rise, they're going to put an added burden" on local and national health services...

"While the institute's study didn't distinguish between legal and illegal immigrants, Paul Fronstin, the study's author and the director of the health-research programs at the institute, said what was most significant was how quickly immigrants are becoming a larger segment of the uninsured. "The immigrant population accounted for 86% of the growth in the uninsured between 1998 and 2003," he says. "That's up significantly from how much it accounted for from 1994 to 1998, when immigration accounted for about a third."

"The study paints a dark picture of health coverage for immigrant noncitizens. About half of them lack health insurance. But immigrants who have become citizens fare much better, with only about 1-in-5 lacking health insurance. The problem is most acute in states with large numbers of immigrants, such as California, Texas, New York and Florida. Mr. Fronstin says one reason for the acceleration might have been the 1996 welfare-reform law, which set a five-year residency minimum for most new immigrants before they could take part in public programs such as Medicaid."

June 12, 2005

Back in early April, it looked like Vermont was moving toward a single payer/tax financed health scheme as the House passed legislation mandating such a system (though leaving tax levels and benefit design to be determined later). The Senate balked and passed a bill creating a new payroll tax on employers who don't cover their workers.

Both branches have now agreed on a plan, and the Senate prevailed -- a payroll tax (1% on the first $50K of payroll, and 3% over that) and a new 1% income tax on individuals without health insurance would be used to create a primary/preventive care program for individuals without health insurance. I use the word "would" because Republican Governor Douglas is planning to veto the bill this week leaving its fate up in the air. Gov. Douglas proposes instead a 3% tax on insurance premiums to fund a similar program, albeit with less money.

For a summary of where things stand, click here for Burlington Free Press' latest article.

Early lessons from this? First, single payer -- as much as many of us prefer it -- is simply a tough sell. House Dems said a Commission would determine the level of taxation needed to replace private premiums. Gov. Douglas said his calculations put the new tax at 20%. After that, their plan was a "dead man walking." Second, looks like a payroll tax on employers who don't cover their workers has some political viability -- a core element of the Health Access and Affordability Act promoted by HCFA and the ACT! Coalition. Third, for us junkies, this stuff if never dull.

June 10, 2005

"I've just got to share with you the wild events of today at the State House with GBIO.

"Today is the day that the Commerce Committee (I think it was) held hearings on health care. GBIO had an all-day intervention planned: a press conference in the morning, mass attendance at the committee hearing during the morning, a rally at noon, and more attendance at the committee hearing for those who could stand it.

"As for me, I had to leave after the rally to go to work. And even when I was there, I was multitasking (as Rabbi Jonah Pesner of TempleIsrael called it--I got a chance to meet him too). At least, I think you could call it "multitasking" to simultaneously hold up a banner for Children's Hospital, edit an author's manuscript, and sing "This land is your land, this land is my land, from Boston harbor to the Berkshire highland, we'll be the first state, that's gonna legislate, health care's a right for you and me."

"You can imagine what a zoo the rally (which took place in the Nurses Hall right next to the State House's beautiful marble atrium) was. The press conference in the morning was hardly less rowdy. Moshe Waldok was standing at the front holding one of the half-dozen huge posters that contained the names of five hundred clergy who signed on to support, while singing gospel songs along with the rest of the priests and ministers. Speech after speech raised every banner of moral suasion known to mankind. Then we took off for the state house singing, as we crossed the street, a hymn based on the words of Amos,
"Let justice roll, roll down like water, and righteousness, like a flowing stream..."

"I don't want to leave the impression that GBIO was disorganized, because the opposite is the case. Everything was planned to a T (or I should say from the T, because I felt well chaperoned from the moment I left the Park Street station till I left the State House). They had people with balloons and T-shirts to direct supporters from one place to the next, water bottles to ease the heat of the day, signs, information sheets, little cards to fill out for Travaglini and DiMasi, good sound systems--it was as if they'd done it five or six times before.

"The hoards of attendees was definitely not business as usual that day at the State House--though I wish it was. Whether righteousness streamed or did not, we sure did--streamed in and out of the hearing room all morning and squeezed into the seats when we were lucky enough to find them. Certainly, many other groups and individuals came today, but when one speaker asked GBIO supporters to stand up, it was like an ocean swelling through the room.

"Senate President Robert Travaglini started the testimony, followed by Governor Romney. I must say that Romney lived up to his reputation as someone who governs like an executive. Nothing could be farther from clergy shouting out "Let justice roll, roll down like water" than his charts and statistics. He did convey (at least to me) the impression of someone who had put time into the issue and applied the mechanisms he knows how--committee studies and numerical analysis.

"In between the cheering and the clapping, I did manage to hear a bit of Romney's speech (and was probably one of the few people in the room trying to understand it). There were several interesting aspects to it. For instance, he claimed that doctors and hospitals appreciated Medicaid payments even when they fell short of the costs of care. After all, all these providers have fixed costs, and the Medicaid payments allow them to reduce these--a twist on the old "make it up in volume" argument. It doesn't persuade me that it's OK for the government to demand care below cost. It's not the same as a car dealer giving you a car cheap in order to get it off the lot.

"He found a lot of people well above the poverty level who aren't covered by their jobs and can't afford private insurance; he is asking insurance companies to put together a package that would cost about two hundred dollars a month. He thinks this will bring many of them into the insurance system; I suspect a plan like that would have huge deductibles or other hidden take-aways.

"Romney also recognized that uninsured people end up costing the state a lot because they turn up in the emergency room. He thinks that providing insurance will partly pay for itself in reduced emergency room visits; I have a feeling he's exaggerating the savings there.

"The whole thrust of Romney's proposals (as one of the following panelists pointed out) was to solve the problem through the free market. He and Travaglini want to trim down the Health Access and Affordability Act before it passes. I imagine we'll end up with
something where all sides can claim victory and some people see real benefit.

"Jim Marzilli was on the committee, as I was proud to see (because he's my representative), and I had a moment to speak to him briefly; he thinks the health care bill could galvanize a lot of people politically.

"The momentum behind improved health care is unstoppable. Even the head of the Massachusetts Taxpayers Association and other critics were reduced to saying essentially, "We like this bill, but..."

June 10, 2005

Yesterday's blog entry did not include the full story on MassHealth Essential -- the program now insuring about 44,000 very low income, long term unemployed adults. We were disappointed that the final budget did not lift the enrollment cap now in place. On the Senate floor. Sen. Ways and Means Chair Therese Murray stated that House and Senate budget negotiators made a commitment to raise the enrollment cap in a supplemental budget to be approved in the fall. Sen. Murray's words on the floor:

"We have agreed to an increase in Mass Health for an additional $20 million in a supplemental budget this September." There's no more honorable or classy a senator as Sen. Murray. We thank her and legislative leaders for keeping this essential need in mind.

June 6, 2005

"STATE HOUSE, BOSTON…..Organizers expect more than a thousand Bay Staters to climb Beacon Hill Wednesday with their growing concerns about the cost and availability of health care. For years those concerns have topped the worry list of most Americans but cost shifting has prevailed over permanent solutions. Now, with the cost of insuring workers skyrocketing for the government and private companies that provide such coverage, the number of uninsured growing, and more families finding the cost prohibitive, Beacon Hill has collectively decided it's time to act. Every few years the state addresses some facet of the problem. Nearly two decades ago, Massachusetts placed an employer mandate on the books in hopes that it would lead to universal coverage here. But the requirement that companies not offering insurance pay a per-worker fee toward covering the uninsured was wiped off the books before it ever took effect. Then in the early 90s, the Commonwealth made deregulatory changes that enabled managed care to take off and lower health care inflation for a while. But the perennial problem persists and the US Congress is also a battleground for all the special interests involved in the complex system. While elected officials are eager to ease the health care burden for consumers, there are other groups, like hospitals, doctors and insurers, pressuring them for consideration.

"All the voices in the health care debate will be heard Wednesday when the new Committee on Health Care Financing takes testimony on half a dozen bills to overhaul the system by expanding coverage and improving access to care. A coalition of groups plans to spend the day rallying and lobbying for change. Earlier this year, House and Senate leaders deemed the problem important enough to create a whole new joint committee to address it. Sen. Richard Moore (D-Uxbridge) and Rep. Patricia Walrath (D-Stow) chair the panel. Moore, who previously chaired the Health Care Committee, has his own name attached to five of the proposals being heard Wednesday, including the one sponsored by Senate President Robert Travaglini (D-East Boston). But Republican Gov. Mitt Romney's proposal to expand health coverage to the 460,000 to 650,000 people estimated to lack it is not on the list to be aired since lawmakers detoured it to a different destination - the Financial Services Committee, which has not scheduled a date to hear it. The governor's bill deals primarily with reforming the non-group and small group insurance markets to make lower cost insurance plans more widely available. A hearing date has not been set on that bill."

The hearing starts at 10am in Gardner Auditorium in the State House. There's a clergy press conference at 9am across Bowdoin Street. 12 noon rally in Nurses Hall. Check in all day in State House Room 222 for activities and updates. More info -- phelps@hcfama.org.<

June 3, 2005

Douglas rejects 3 tax option for health care
By Nancy Remsen, Free Press Staff Writer

MONTPELIER -- The Democratic leadership of the Legislature gave Republican Gov. Jim Douglas an ultimatum at noon Thursday in a dramatic flare-up of a long-expected political battle over health care reform legislation. In a letter delivered to the governor's Statehouse office, Democrats offered Douglas three options to pay for health care for uninsured Vermonters and two hours to make his choice. Douglas made his decision in minutes.

"The tax measures being offered," he declared without hesitation at his weekly news conference, "are simply unacceptable to me." Each of the three options included a payroll tax, which Douglas vehemently opposes. One option also relied on a tax on insurance premiums, Douglas' preference, but that wasn't enough to win his support.

Rebuffed, the House and Senate teams negotiating the health reform bill met and quickly announced they had agreed on a financing plan that would raise $43.8 million to provide primary and preventive health coverage to 35,000 Vermonters who have no health insurance. Their agreement calls for businesses that don't offer health insurance to their workers to pay a 1 percent payroll tax if their payroll totals less than $50,000 or a 3 percent payroll tax. Also, Vermonters without health insurance would pay a 1 percent income tax.

The House and Senate negotiators also have agreed on all the other provisions in a compromise health reform package -- including measures to:
Curb the growth of medical spending in hospitals.
Save on prescription medicines,
Change insurance to reward healthy lifestyles.
Revise medical malpractice law.
Conduct studies that would scope out the feasibility and potential benefits of moving from a private market health insurance system to a totally government-financed system.

The Senate is expected to vote on the compromise bill this morning, then send the package to the House for an up-or-down vote. House and Senate negotiators also struck deals on the budget and numerous other bills Thursday, increasing the likelihood the Legislature would adjourn this weekend.

Douglas has promised to reject the health care bill because of its payroll tax. Legislative leaders are ready with a back-up plan to salvage provisions that they and Douglas support along with the studies the Legislature needs to support future health care initiatives. They have added these sections to the budget bill -- just in case.

"A governor's veto isn't going to stop us from doing what we need to do to keep this discussion going," said Rep. John Tracy, D-Burlington, chief negotiator for the House.
"Vermont is on the threshold of becoming the first state where every Vermonter will have a doctor and every Vermonter will share responsibility for paying for health care," Senate President Pro Tempore Peter Welch, D-Windsor, proclaimed to a crowd of politicians, lobbyists and reporters. Welch laid responsibility for achieving this goal on the governor's shoulders. "Are we going to make the move toward universal health care or not?" Welch asked. "Jim Douglas has to decide whether he is going to do the right thing or do nothing."

Frustrated they couldn't reach agreement in recent closed-door meetings with Douglas and his staff, legislative leaders made their final offer in public. "We need a response to the challenge," said Sen. Jim Leddy, D-Chittenden. "We need to move beyond the rhetoric."
Half an hour later, Douglas answered in kind. "This is a theater at the end of the session as many of you veterans understand," Douglas told reporters. "To be perfectly blunt, I think what we are seeing is amateur hour."

"As we inch toward adjournment, it becomes increasingly clear that the conferees are less interested in achieving meaningful, bipartisan reform," Douglas said. "If a bill comes to my desk that is a Trojan horse for government run health care, if a bill comes to my desk that is paid for with hundreds of millions of new dollars in taxes, I will protect the people of Vermont and reject that tax proposal."

Health care tax

House and Senate negotiators have agreed on a way to pay for basic health insurance for 35,000 Vermonters currently without coverage.
WHO PAYS? Only employers who don't offer health insurance to their workers or spend less than 3 percent of their total payroll on insurance, and Vermonters without health insurance who aren't eligible for Medicaid.
EMPLOYER TAX: Employers with payrolls of less than $50,000 would pay a 1 percent payroll tax. Larger employers would pay a 3 percent payroll tax. If they offer health insurance but spend less than 3 percent of payroll on it, they would pay the difference between what they spend and 3 percent of their payroll.
INDIVIDUAL TAX: Uninsured Vermonters would pay 1 percent of their income for health insurance.
BENEFIT PACKAGE: A no-frills package of preventive and primary health services would be covered. Hospital coverage wouldn't be included. A commission would report to the Legislature next January what health services should be covered.
STARTING DATE: Coverage would begin July 1, 2006.