"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

May 11, 2005

Yesterday, in a back room in the Massachusetts State House, eight senators and reps along with about ten legislative aides, met with oral health advocates to establish the first state legislative oral health caucus in the nation. Oral health? You mean teeth? Yes, and a lot more. Oral health, good dental care, is intimately tied to one's overall health. Yet medicine and public policy have encouraged a separation which leads to awful policy choices such as the elimination of adult dental services from the Mass. Medicaid program in late 2002. So here's how it works now -- MassHealth will only pay for dental services for adults when teeth get so rotten they need to be pulled -- aka, extractions. After they're pulled, the state no longer pays for dentures to replace them. Blenders and straws become essential items of daily living. That's why we tip our hats to: Chairs -- Sen. Harriette Chandler and Rep. Kathy Teahan, and Co-Chairs -- Sen. Bruce Tarr (R!) and Rep. Cheryl Rivera. These folks get it, and we appreciate their leadership. We're making a big push right now (right now!) to restore adult dental benefits in MassHealth. Please help us by taking 53 seconds to send an email to your state senator to support this. Click here, and thanks!!

May 10, 2005

American journalism's prince of darkness, Robert D. Novak, wrote on Sunday's Boston Herald that Gov. Mitt Romney "in a recent secret Washington meeting with national political operatives, signaled he probably will forgo seeking re-election in 2006 in order to pursue the 2008 Republican presidential nomination. Romney did not flatly reveal his future intentions, according to sources who were present. but he did say a presidential race would be difficult if he were concentrating on a 2006 campaign for governor and were still in that office in 2007-08."

Tied with other recent Administration moves -- Health & Human Services Chief Ron Preston departure this summer, Romney's Admin & Finance Secretary Eric Kriss leaving this fall -- we wonder, what effect will all this have on the prospects for comprehensive health reform between now and the end of 2006?

The Administration needs to develop major health access legislation to propose to the House and Senate or risk losing hundreds of millions of dollars tied to the new federal Medicaid waiver. The brain drain, potential lame duck status, and potential loss of a state focus do not auger well for such a high intensity/high profile initiative. This would leave legislative leaders in a much stronger position to direct a reform agenda -- and leave the Governor with only a veto to make his mark.

In some ways this resembles the last major health reform drive in 1996 when Gov. Bill Weld, seeking to win Sen. John Kerry's seat, was a passive observer of that year's health reform, and his veto was easily overridden by the House and Senate in July 1996. It's impossible to predict how this will play out. The one certainty, if Gov. Romney becom

May 9, 2005

It's feast or famine time for health reform. Vermont, Maryland, Maine among others push the limits to expand coverage while Tennessee, Missouri and others push backwards. Last Thursday, California rejoined the former set when a Senate Committee voted 7 to 4 to approve a single payer tax-financed health reform bill. This same committee approved a similar bill in 2003 which passed the full Senate in scaled down form. Ultimate, both branches passed an employer insurance mandate which was repealed narrowly by voters in November 2004.

Click here to read details from Associated Press. Little trivia -- lead sponsor is State Senator Sheila Kuehl who, in an earlier life, played Zelda Gilroy on the 50s TV show, Dobie Gillis. California has a curious history on health reform, especially when it comes to ballot initiatives. In 1992, the voters rejected an employer mandate; in 1994, they rejected a single payer plan, 73-27%; and in 2004, they again rejected an employer mandate, 51-49%. That's a tough crowd to please out there!


May 8, 2005

INDEPENDENCE, Mo. -- A state senator from Independence is going to extremes to protect Missouri's new budget, KMBC's Bev Chapman reported Friday. Sen. Victor Callahan announced he is giving up his state-funded health insurance to draw attention to the thousands of people without medical insurance. The Democratic senator said that lawmakers shouldn't ignore the growing number of uninsured people. "I'm doing this today because I don't want to be a hypocrite. I intend to join the other 74,000 Missourians without health care," Callahan said. Changes in Medicaid eligibility in this year's budget will eliminate between 70,000 and 100,000 people from the program. Callahan, who represents Independence and Raytown, estimates more than 30,000 people in his district will be affected by Medicaid cutbacks. A spokesman for Gov. Matt Blunt's office said the program has grown beyond the taxpayers' ability to support it. He said the program provides coverage for one out of five Missourians. Callahan wants the governor to join him in quitting health care. "I'm calling on Gov. (Matt) Blunt today to lead by example -- to join with me coming off state health care until we resolve the issue," Callahan said. In addition to giving up his state coverage, Callahan has also stopped receiving benefits from his regular employer. Check it out here if you don't believe me.

May 7, 2005

Had a response to an earlier posting from Bart Laws of the Latin American Health Institute who has his own blog, Healthy Medicine (click here):

"We need to think not only about out-of-pocket costs for low income people and families, but also about how subsidies for the system are financed. Progressive financing is absolutely essential if any plan to expand coverage -- and preferably, provide universal coverage -- is to represent real social progress. That is a major problem with employer mandate strategies. Most of the cost will come out of wages, in the real world, and cutting low-income workers wage income in order to provide them with health care is just going to mean that they can see a doctor after their bad housing, bad diet, emotional stress and bad community conditions have made them sick. From a public health standpoint, we always need to remember that 90% of medical care is a last resort."

No doubt figuring out how to pay has been the major impediment to all coverage expansions, incremental or universal. And no argument that progressive financing is the fairest and most ethical way. Question: What should we do when progressive financing options are blocked? For example, the fairest income tax is graduated -- higher income folks pay a higher rate than lower income folks. Yet five times between 1962 and 1994, Massachusetts voters rejected Constitutional Amendment proposals to eliminate our flat tax in favor of a grad tax, never giving it more than 28 percent of the vote. Do we stop pushing for funded-health access reform until the public changes its fickle mind on progressive taxation? Food for thought. And thanks, Bart.

May 6, 2005

Today's New York Times has a good overview of the debate on employer responsibility for employee health insurance. Click here to get it (you may need to register for free). In Massachusetts, our Moore/Blumer Health Access and Affordability Act (S.738, H.2777) proposes that all employers must provide some support for workers to obtain health coverage. It's not just here. Maryland, Connecticut, New Jersey, California, Oregon and other states are part of this growing conversation -- as is that little chain store called WalMart.

It's going to be an energetic debate. The public hearing on the HAAA, as well as Senate President Travaglini's health reform proposal, has been scheduled for June 8 starting at 10am in Gardner Auditorium in the MA State House. Expect to hear a lot more about this.

May 5, 2005

Word spread quickly today that MA Health & Human Services Secretary Ron Preston will be stepping down sometime this summer. I wasn't going to mention it here until I got a call from a Boston Globe reporter for a quote. So witness the first HCFA Blog news scoop -- and let's take a moment for some reflection.

First, Ron had his share of critics, and HCFA had our share of beefs with him. Here's my large assessment. Ron facilitated the most significant reorganization of EOHHS in its 34 year history, transforming the Secretary from a powerless figurehead to the immensively powerful manager of half of state government. The reorg has good and not so good points, yet give Ron credit for pulling off an amazing achievement, and leaving a transformed H&HS landscape behind. Second, he surrounded himself with a cast of first rate commissioners and managers who do great work with insufficient resources -- not their fault. Third, he put health reform on Gov. Romney's agenda and kept it there -- not the way we (or he!) would have preferred; still the Governor's active engagement is a key reason something big may happen in the next 18 months. So Ron, here's a tip of the hat for your energetic leadership, your passion, and your dedication to doing the right thing.

Now, the future! Omigosh! The State has an urgent need to develop a new plan to use $1.3 billion in federal dollars to create a new "Safety Net Care" program for the uninsured. Ron has been the point person in this effort -- we've yet to see a bill that will require extensive legislative and federal review, with an implementation deadline of July 1, 2006. The new level of uncertainty concerning the Secretary's position puts a lot on the line and a lot in jeopardy. We hope the Governor finds someone exceptional to fill Ron's shoes.

May 4, 2005

In early 2003, with the state in the midst of a fiscal crisis, dental services for MassHealth adults were eliminated, except when teeth become so rotten, they need to be pulled. After that, tough luck because the state also stopped paying for dentures. About 550,000 adults -- 180,000 of them poor seniors -- are affected. The cost to restore coverage -- about $58 million ($29 million of which would be federally reimbursed). With state revenues now about $1 billion over estimate, we can think of three good reasons to restore coverage:

First, poor adults are experiencing incredible suffering and pain because they can't obtain medically needed services. Second, the state is wasting millions providing acute medical services that are preventable with adequate dental care. (One Holyoke man spent ten days in intensive care directly related to untreated gum disease.) Third, low-income parents on public assistance are unable to obtain jobs because of the condition of their mouths.

HCFA's incredible Oral Health Advocacy Task Force is getting ready to make their first major policy push to convince the Senate to restore coverage in their upcoming FY06 budget plan. What do you think? Worth the effort? Are you ready to help? Use the form on the right to let us know your reactions and thoughts.

May 3, 2005

Last Friday, the MA House finished work on its version of the FY06 budget, to start July 1. It was a conservative document with no new initiatives, and conservative estimates on taxes and spending. Their treatment of health issues was illustrative.

Governor Romney proposed cutting funding for the Free Care Pool by $120 million from this year's amount -- despite rising numbers of uninsured. Hospital leaders were caught off guard when House Ways and Means accepted the Governor's number and worked furiously to restore funding to the FY05 level. On Friday, House leaders put back $85 of the $120 million, though not before cutting $18 million to fix the "20 day withhold" problem. Back in 2003, the State stopped paying for any Medicaid patient who stays in a hospital longer than 20 days (imagine the reaction if Blue Cross or Harvard Pilgrim pulled this trick?). After putting in $18 million to fix this mini-disgrace in the Ways and Means version, House leaders pulled back this money as they reinserted $85 of the $120 million Pool funding.

On access, the House increased funding for MassHealth outreach from $250,000 to $500,000, removed objectionable language relating to health services for legal immigrants, and restored funding for public health programs. They refused to: 1) Remove enrollment caps that will keep thousands of needy low income persons out of MassHealth next year, 2) Restore essential benefits such as adult dental services, 3) Lessen high premiums for the Children's Medical Security Plan, and 4) Permit open enrollment in the Prescription Advantage program.

Special thanks to Reps. Debbie Blumer, Kathy Teahan, Steve LeDuc, John Scibak, Jim Marzilli and others for their tireless efforts in behalf of health care access. It's still early in the tenure of the new House leadership team. These discouraging signs leave us hoping there will be more encouraging news later this year.

May 2, 2005

Here's a good summary of the federal Medicaid budget fight by Families USA's Ron Pollack:

The Medicaid Fight: What Happened?

Even though Congress passed a budget resolution that includes $10 billion in cuts to Medicaid, the budget doesn't specify any policy requirements for achieving those cuts. In other words, the budget doesn't say what will be cut within Medicaid. Those decisions will be made by the Senate Finance and House Energy and Commerce committees during the reconciliation process, which we expect will be completed by or before mid-September. Our staff has produced a table that shows how much cuts of this magnitude could cost each state, and how many kids and seniors could be covered with that amount of money in one year. Click here for the document.

During the budget negotiations, there was much discussion about the creation of a Medicaid commission that would be charged with recommending Medicaid cuts to the congressional committees. At this point there's no decision about the framework, composition, scope and timeline of this commission, but it's an issue we're watching closely. The commission may issue some recommendations as early as September. It may be a very partisan, sham commission, but that is not yet clear.

Where We Go From Here

While it's hard to feel good about a budget that is balanced on the backs of the poor while adding to the fortunes of the wealthy, it's important to take a step back and look at the big picture as well. Yes, we are all disappointed; this budget will undoubtedly hurt millions of the most vulnerable among us. However, from the perspective of where we started last December (when we expected enormous structural changes in Medicaid and tens, if not hundreds, of billions of dollars in program cuts), the approximately $10 billion in Medicaid budget cuts is a far cry from what we feared. Because of your hard work and dedication, together we have prevented enormous and irreparable harm to millions of people who would otherwise have become uninsured and lost their health care.

We have a lot of work ahead of us in the coming months, but one thing remains clear: we are an extremely powerful voice when we work together. Make no mistake: your calls, e-mails and other efforts made a real difference during this fight. During the coming months we'll keep you informed about the latest developments in this fight, and will continue to ask for your help. I look forward to our work together in the coming months.

Ron Pollack, Executive Director, Families USA