"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

June 3, 2005

Yesterday, the State Medicaid program informed the Legislature that enrollment will be closed in MassHealth Essential, the program for very low income, long term unemployed persons. Enrollment reached 44,000, and now the state will begin accumulating a waiting list. The Senate budget includes funding to permit 10,000 more enrollees in the next fiscal year, while the House budget would keep the cap at 44,000. The Romney Administration estimates that enrollment could grow by as much as 16,000 for Essential, though the Governor has not asked the Legislature to increase enrollment limits.

Everyone in state government expresses support for enrolling the estimated 106,000 persons who are "eligible and unenrolled" in MassHealth, yet there seems to be little political will to open up enrollment to reach this most needy part of that population. Enrolling these folks also takes financial pressure off the Free Care Pool, and helps the financial status of hospitals.

We'll report regularly as the size of the waiting list grows and grows.

June 2, 2005

Their editorial views are not my cup ot tea, but the health journalism produced by the Wall Street Journal is among the best. Here's are samples from four WSJ articles published on Monday, 5/31:

  • "Seeking Insurance, Individuals Face Many Obstacles": While Pres. Bush and others emphasize the "ownership society," it is not clear how expanding the individual insurance market "would help people whose health isn't perfect and who are most in need of help with medical costs." There are "big holes" in the individual market system, and federal protections do little "to protect people" from higher premiums and denial of coverage for pre-existing conditions. While state-run high-risk pools offer some relief for uninsured with high medical costs, these pools have problems such as high premiums and a low enrollment threshold.
  • "Having Insurance Doesn't Guarantee Coverage": A mother attempted to obtain an individual health plan for her baby. After a two-week period of being uninsured, she received coverage through a BlueCross/BlueShield of Arizona plan. Doctors then found the baby needed a $90,000 operation to correct a bone disorder, but BlueCross denied the claim, saying it was for a pre-existing condition and such care was excluded from coverage for 11 months after the plan was purchased. "Buying individual insurance doesn't mean that coverage of medical treatments is guaranteed; [m]uch depends on state rules and a policy's fine print."
  • "Health Insurers New Target": Health insurers including UnitedHealth Group, Aetna and BlueCross and BlueShield plans are realizing that many uninsured residents "are the same relatively healthy Americans they used to cover or administer to in employer health plans" and are targeting them with low-cost health plans. Insurers are marketing "hipster" plans to relatively healthy young adults between 19 and 29; limited-benefit packages to part-time workers, temporary workers and early retirees; and health savings accounts and high deductible insurance to middle class residents.
  • "Coverage Issues: Many Ailments Can Pose Problems": Patients with chronic medical conditions such as HIV, cancer and diabetes might not be able to obtain insurance coverage, but even patients with less severe medical problems can face barriers, according to a study by Georgetown University researchers. Researchers created 7 hypothetical patients with a range of medical problems and applied for coverage at 19 insurers in 8 states. The "patients" applied for 420 plans and were accepted by 266. A hypothetical man with HIV was denied coverage by all insurers, while a man with a knee injury was denied coverage 12% of the time and a 24-year-old woman with seasonal allergies was rejected by 8% of the plans. For knee and allergy patients, health plans often excluded coverage for pre-existing conditions or charged the patients higher premiums.

May 31, 2005

Here's something new. Sen. Ron Wyden from Oregon last year championed the passage of legislation to create a Citizens Health Care Working Group to "provide for a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage" and to "provide for a vote by Congress on the recommendations that result from the debate." Check out the official site for this new group by clicking here. The panel has 14 members, one of whom, Dr. Richard Frank at Harvard Medical School, is from Massachusetts.

The group is beginning public hearings around the nation, and one of them will be held in Boston on August 16, 2005 at a location yet to be determined, with a testimony focus on 1. quality; 2. evidence based practice; 3. the urban safety net; 4. the cost of health care; and 5. strategies to assist purchasers, including consumers, to lower the cost of care.

If we're not mistaken, you read it here first.

May 30, 2005

This week will mark the official closing of eligibility for the part of MassHealth known as MassHealth Essential, which will reach its statutory enrollment cap of about 43,000 poor, long term unemployed individuals. The State will begin collecting names on a waiting list instead of opening the door to medically necessary services for a desperately low income and vulnerable population.

A little history: this program was originally called MassHealth Basic and began in the state's major health reform period commencing in 1997. During the 2002 fiscal crisis, House Speaker Tom Finneran demanded and won the elimination of the program and coverage for 36,000 in the program. In the spring of 2003, Sen. Pres. Travaglini and Gov. Romney persuaded Finneran to accept a new program, with tighter eligibility and even less benefits, called MassHealth Essential to serve this population. Trav and Romney understood the state stood to lose hundreds of millions in federal dollars by not reinstating the program and convinced Finneran on that score. MassHealth Essential opened its doors on October 1, 2003, and re-enrollment at first was slow. It has since picked up and is now reaching its enrollment cap.

By the way, MH Essential is managed by the Mass. Behavioral Health Partnership which does an outstanding job managing all medical services for this needy population. Anyone eligible for Essential and put on the waiting list will still be eligible for the Free Care Pool. So they can use hospital emergency rooms, but may not get primary care.

Last year, Gov. Romney -- as part of his health reform initiative -- said he wanted to enroll about 106,000 persons who are "eligible and unenrolled" in MassHealth. His own administration estimates that at least 24,000 of those 106,000 would come in under Essential. Yet his House 1 budget proposal in January capped Essential's enrollment at existing levels. The House also disappointed in its budget plan, keeping the Governor's cap, and rejecting Rep. Deborah Blumer's amendment to expand. The Senate budget plan would increase Essential's enrollment cap by about 10,000 -- not enough, but a good step forward. Thank you, Senate!

Just like last year, when the Children's Medical Security Plan started a waiting list that totalled 15,000 kids by July, 2004, we're starting a MassHealth Essential Waiting List watch, and we'll let you know as it grows and grows.

Meanwhile, if you would like to help, please contact your Senator and Rep and ask them to support the Senate's higher enrollment cap for MassHealth Essential. Yeah, it's only about 10,000 out of 530,000 uninsured persons in Massachusetts. But it's something YOU can do TODAY that will make a difference in the lives of 10,000 very low income uninsured persons. So how about it?

May 29, 2005

Back in March, bipartisan groups of US senators and reps called for a commission to study ways to achieve savings rather than cutting Medicaid by $16 billion over 5 years, as Pres. Bush and Republican leaders in the Senate and House wanted. Ultimately, both branches had recorded roll call majorities opposed to any cuts and calling for the commission solution. At the end of the budget process, Congressional leaders pushed through $10 billion in cuts and a commission to study ways to improve the program. (See article.)

In the hands of new Health and Human Services Secretary Michael Leavitt, the Commission will include four Democratic senators and reps as non-voting members, and the first charge for the Commission will be to develop a list of recommended ways to cut $10 billion from the program. Democrats are now refusing to participate in the panel.

Good for them! The same budget resolution approved by Congress cutting Medicaid by $10 billion also reduces taxes on millionaires by $32 billion. The same President who signed a law to prevent the removal of Terry Schiavo's feeding tube signed a law as Governor of Texas to permit hospitals to remove life-saving support from patients with no ability to pay -- and we'll see a lot more of these if Congressional leaders have their way with Medicaid cuts.

May 28, 2005

HCFA Board President Chip Joffe Halpern has written another keeper article in his series for the North Adams Transcript. Here's how it starts:

Americans are consistently inconsistent when it comes to their attitudes toward health care. This observation, from a report written by the St. Luke's Health Initiative of Arizona, is one of the reasons why Americans are stalemated when it comes to deciding how to expand health coverage to the uninsured. St. Luke's observes that:

* Most Americans favor providing health coverage to the uninsured, financed by taxes.
* Most Americans don't want to pay increased taxes themselves.
* Most Americans think the health care system is badly in need of reform.
* Most Americans express satisfaction with their personal use of the health care system.
* Most Americans don't trust the government to do the right thing.
* Most Americans expect the government to do something.

What will it take to breakthrough the stalemate that has allowed 45 million Americans to go without health insurance?

May 27, 2005

ast night, about 1,000 persons attended a health care action rally organized by the Greater Boston Interfaith Organization, backed more than 65 churches, synagogues, temples and other organizations. The rally was held at Temple Israel in Boston and was noteworthy for many reasons, high among them the extraordinary energy, commitment, and diversity on display. Two state senators (Jarrett Barrios and Dianne Wilkerson) and six reps (Jim Marzilli, Ruth Balser, Debbie Blumer, Gloria Fox, Brian Wallace, Carl Sciortino) joined the event. Earlier yesterday, GBIO got a front page story in the Boston Globe on their work.

One of many highlights -- each of the 65 participating congregations surveyed their own members on health insurance problems. In rapid succession, each of the 65 took the microphone to announce their community's presence and tell a brief story about their own members' difficulties with health care access. Also, Rev. Ray Hammond -- JP's Bethel AME Zion Church -- blew the roof off the place with his stirring speech -- "There can be no Commonwealth without common health -- and their can be no common health without common wealth." He gets it.

GBIO is a leading partner in the ACT! Coalition (Affordable Care Today) this is supporting the Health Access and Affordability Act sponsored by Sen. Richard Moore and Rep. Blumer along with more than 70 other legislators. The legislative hearing on this will be held on Wednesday June 8th at the State House -- activities begin at 9am and the hearing starts at 10am. Check out the ACT! page for more information.

May 26, 2005

Spent yesterday in Washington DC catching up on health reform activities around in other states around the nation. Some tidbits:

In Maine, the Dirigo health reform plan is being implemented, though national conservative groups such as the Heritage Foundation and Americans for Tax Justice are setting up state operations to attack and undermine the plan. Dirigo is a voluntary plan that offers a lower cost option to small employers and uninsured persons, and has enrolled over 6,300 persons since early this year.

In Illinois, hearings are getting off the ground in each of the state's congressional districts to develop a plan for universal coverage -- a process that will take well over a year to result in a final plan, and one that is gaining momentum and attention across the state.

In Vermont, the House in April passed a planning process to develop a single payer system and the Senate has yet to pass their plan, though they are leaning toward a new tax on employers who don't cover their workers. Senators are getting attacked from the left and the right.

In Maryland, the Assembly and Senate passed legislation requiring all employers with more than 10,000 workers to pay at least 8% of payroll for health insurance for workers -- called the "Walmart" tax because the giant retailer is the only entity in the state that would be required to pay. Gov. Erlich has vetoed the bill, and it is expected the legislature will override his veto next January or in a special session earlier than that.

May 24, 2005

A new report on reforming the nation's health care system projects savings as much as $182 billion annually within 10 years, according to an analysis released May 23 by a coalition of businesses, unions, consumer groups, and health care providers. The savings would be realized after reform was instituted at a cost of between $71 billion and $272 billion over four years, the analysis said.

The National Coalition on Health Care said the savings would be realized in any of four health reform options: mandating employer coverage for workers; expanding existing public health programs; creating a new public health program modeled after the Federal Employees Health Benefits Program; and establishing a universal, publicly financed health care system. In all four cases, the cost of a reformed health care system would be less than the price of continuing the current health care system, the analysis said.

The analysis shows "unambiguously" that, "done right, health care reform will save America a great deal of money--while at the same time assuring health coverage for all Americans and improving health care," coalition President Henry E. Simmons said at a briefing. "In short, health care reform is a good investment--a crucial investment--for our nation and our people," he added.

May 23, 2005

This Thursday evening from 7-9pm at Temple Israel in Boston (Riverway and Longwood Avenue) the Greater Boston Interfaith Organization (GBIO) hosts a public meeting on health reform in Massachusetts. GBIO is a grassroots, church/synagogue/temple based social justice organization with a deserved reputation for effective action. About 1,000 persons are expected to attend -- and you're welcome to be one of them. GBIO is an active part of the Affordable Care Today! (ACT!) Coalition which is sponsoring the Health Access and Affordability Act.

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