"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

April 18, 2005

Beginning next Monday, the Mass. House of Reps will begin debating the FY06 state budget. The House budget writers left out a lot of important items to help uninsured folks get coverage and to help folks already on MassHealth get needed services such as adult dental care. You can send an email message to your state rep and senator today in less than two minutes by clicking here. The debate will last until the end of next week so you have lots of time to give less than two minutes -- please pass the link on to others.
President Bush and Republican leaders in Congress want us to believe that “health savings accounts” are the answer to the problem of uninsurance and health costs. These policies, aggressively marketed across the nation, include high deductibles of at least $1000 for individuals and $2000 for families, combined with a $500 personal savings account that can be rolled over from year to year. HSAs were established by Congress in the 2003 Medicare Modernizatin Act.

We consider the trend toward “consumer driven” health care policies a scam, designed to lure unsuspecting consumers into products that provide fewer benefits with higher cost sharing – with no regard to ability to pay.

Now the Congressional Research Service, in a new report, concludes HSAs will reduce utilization by stopping policy holders from seeking medically necessary care, and they are not likely to cut the number of uninsured or reduce health care spending, in an April 14th report. "It would be unreasonable to expect them to produce a significant reduction in the nation's health care costs," the report stated. Five percent of individuals account for about 50 percent of health care costs, and 20 percent account for 80 percent, the report said. "HSA plans with their relatively low out-of-pocket maximums will have little impact in reducing the health care spending for these groups," CRS said.

Some question whether it is fair that the biggest tax savings under HSAs "will likely flow to healthy, higher income taxpayers," the report said. "Some might also question whether the revenue loss is an appropriate use of federal health care resources, given the many people in the country who have no health insurance whatsoever."

April 16, 2005

t didn't get much play on its release, so I'd like to give it a hand. Uninsured in America is a new book by Susan Starr Sered and Rushika Fernandopulle, published this year by University of California Press, exploring the real-life experiences of 120 of America's 45 million uninsured. They write about the working poor, victims of divorce and domestic violence, folks injured in the workplace, self employed, the mentally ill, the young, and all the special categories of those who fall between the ever-growing cracks in our health care non-system. I said it on the dust jacket, so I'll say it here: "The next time someone tells you the United States has 'the best health care system in the world,' ask them to read this powerful, heartbreaking book. Never have the real stories of America's uninsured been told with such clarity and insight." Click here to go to Amazon's page for the book, and give it a look-see.

April 15, 2005

One of HCFA's three awardees at our annual celebration is the Island Health Plan, an innovative mix of programs to provide decent and affordable health care services to the thousands of uninsured folks on Martha's Vineyard. A good sized group of folks took the long trip to Boston to participate in the event, including a journalist from the Martha's Vineyard Times who wrote a good account of the event and a nice description of the Island Health Plan. Click here to see the piece, and happy weekend.

April 14, 2005

Count 'em ... 43 US House Republicans (37 of whom voted for last month's budget resolution) have signed a letter urging House budget conferees to include no cuts to Medicaid in the Conference Committee's upcoming budget resolution. Last month, the House voted to include $20 billion in cuts, at least $16 of which would come from Medicaid. The Senate, in a dramatic fight, last month voted 51 to 49 to oppose the same cuts.

While it's gratifying to see a critical mass forming to oppose cuts to the nation's critical health program for poor Americans, it's hard not to catch the whiff of hypocrisy. The day before, all of the 43 voted for permanent elimination of the estate tax, which would drive the nation's economy deeper into economic serfdom. Call me old-fashioned, I remember when fiscal conservatism meant honest budgeting -- now it means cut taxes and damn the consequences.
Everywhere in health care, increased cost sharing is the rage: copays, premiums, and most insidiously, deductibles: not little ones, $1000, $2000, $5000, and even $10,000. Lots of people don't even know they're on the hook until they get sick and the hospital has to deliver the news and collect the damage. The other day, a local physician described her frustrations being left on the hook for much of this cost sharing, and seeing lots of patients with no ability to pay. We're kicking off a process to get to the real story behind today's cost sharing nightmares and invite you to participate. Please use the form below to send us anecdotes, stories, impressions, insights or whatever. This is just the start.

April 13, 2005

Brockton – The City of Champions — had another winner last night: a powerful “speak-out” with 150 chanting, cheering “working family” members urging legislators – Reps. Christine Canavan, Geraldine Creedon and Kathy Teahan – to challenge Gov. Romney as “he runs for President on the backs of the poor.” Our Southeastern Massachusetts partners, the Coalition for Social Justice, did a fantastic job organizing the event – complete with fact sheets, noisemakers, chants and a “Tax Fairness” song to the tune of “The Hokey Pokey”.

The three biggest applause lines: “Let Governor Romney try a low-income person’s life a little before trying to get every last nickel and dime from them!” “Don’t shop WalMart!”; and, (from a local business leader): “I don’t mind paying my fair share of taxes. I do mind the Governor reneging on his promise to not cut Mass Health and other essential services because he won’t force multi-state and multi-national businesses to pay their fair share”!

Go Brockton!!
The Ways and Means Committee of the Mass. House of Reps. released their budget proposal today. It was disappointing for many health and human services groups, including HCFA. We will seek through amendments to: restore benefits such as adult dental services, dentures, and eyeglasses; lift enrollment caps on key MassHealth programs such as Essential, CommonHealth, and the HIV Program; reinstate coverage for 10,000 low income, elderly, and disabled legal immigrants cut in 2003; and more.

April 12, 2005

Tomorrow, the Mass. House Ways and Means Committee releases its budget proposal for state fiscal year 2006 starting July 1. The House debate will occur during the week of April 25. Senate Ways and Means is expected to release its plan in early May with debate during the 2nd or 3rd week of May. We're not expecting to see cuts in health access programs -- key will be the extent to which either branch will restore some of the cuts from prior years or undertake any access improvements for key health issues such as MassHealth Essential, legal immigrants, or adult dental coverage. We're still waiting for any word on the scheduling for hearings on the health reform plans now before the Legislature: Governor Romney's, Senate President Travaglini's, or the Moore Blumer Health Access and Affordability Act. There's also the possibility that Gov. Romney's bill will be referred to a different committee than the other two, creating some early confusion about who's on first in the Legislature's review. Lots and lots going on between now and the end of July when everyone can take a breather.

April 11, 2005

This morning about 250 persons attended a forum in downtown Boston to learn about the new Medicaid "waiver" which will establish funding rules for the program for three years beginning on July 1. The broad outlines of the agreement were announced in late January by Gov. Romney and Sen. Kennedy following their negotiations with the federal Department of Health and Human Services. The Mass. Medicaid Policy Institute, today's forum sponsor, issued a well-done report in layperson language to describe the waiver. Click here to obtain it. Some bottom lines:

* For eight years, waiver funds have been an essential source of funding to expand affordable health coverage. Under the new deal, there is less money, and it's capped.
* Unless key aspects of the agreement are renegotiated with the federal government, the state may lose significant federal revenues.
* The new waiver will require the state to develop a new plan -- albeit with limited funds -- to develop a new access plan by July 1, 2006. This plan will require approval from the feds and the state legislature to move forward.

During the Clinton years, the point of waivers was to give more money to encourage expansion. In the Bush years, the point is to reduce federal funds to states.
Check out today's Paul Krugman column in the New York Times for a health care reality check. The real crisis facing our country is not Social Security, and it's not Medicare or Medicaid, it's health care, and the answers aren't easy.

April 10, 2005

In 1993, Tennessee reinvented its Medicaid program under the name "TennCare" to cover hundreds of thousands of the state's uninsured. Because of funding pressures, Democratic Governor (and former HMO executive) Phil Bredeson (who promised in 2002 to protect TennCare) is pushing to disenroll 323,000 and to cut benefits from 400,000 more. It's looking increasingly like he will get away with this -- stay tuned and we'll know by July.

The TennCare Saves Lives Coalition has put together a booklet with personal stories of TennCare enrollees at risk. Meet two of them:

Bart Comisky from Donelson TN is 61 and has had five bypasses. His wife, Atha, (51) has had kidney cancer and has Crohn's disease. Both are uninsurable. They own a small business and, if dropped from TennCare, will not be able to obtain healthcare unless they can pay thousands per month. They will probably be forced to sell their home if Atha cannot find a job with health benefits. "We need you to solve the problem because it's not going away. Will our ER visits save taxpayers money?"

Lori Smith (39) from Nashville has multiple sclerosis (MS), lupus, and has had two abnormal pap smears. Without TennCare, she will lose her ability to work and remain self supporting, and will have to file for bankruptcy. Lori works full time and qualified for TennCare because she is "uninsurable." She pays monthly premiums and co-pays for doctor visits and prescription drugs. Her MS and Lupus require regular monitoring and continuous drug therapy, enabling her to work full-time and remain self supporting. Her doctor wants her to start a drug for her MS, but this drug costs over $1300 per month. "I want to continue to work and support myself and not become disabled, but I need insurance medical care to do it."
Last Friday, HCFA hosted our 20th anniversary celebration and awards dinner, honoring Dr. James Mongan of Partners Healthcare, Dr. Mark Doherty of the Dorchester House, and the Island Health Plan. Special thanks to all our generous sponsors and to the 600 who came to the event. Looking across the crowded hall, it's clear there's a real movement in our state to address the issue of health care access for all. Thank you!

April 8, 2005

HCFA's Bob Marra passed on the following report from a public meeting on the real problems faced by lower income consumers seeking decent dental care:

"Tears, frustration at the slow pace of change, and determination to address the dental crisis were in evidence last night at the Western Mass. Oral Health Public Forum in Holyoke (and the night before in Worcester). The Oral Health Advocacy Task Force (coordinated by HCFA's Stacey Auger) with Partners for a Healthier Community (Frank Robinson and Catherine Benoit) and State Reps John Scibak and Cheryl Rivera brought together 50 consumers along with health care and community leaders for two hours of stories of dental pain, lost teeth and oral infections resulting in expensive ER and inpatient care. A near-death experience was shared by the medical director of the Mason Square Health Center in Springfield. One of his well-controlled adult diabetic patients made many phone calls over 10 days trying to find dental care for an abscessed tooth. He finally went to the hospital ER when his infection spread to his throat. He nearly died while being intubated and was hospitalized in intensive care on a respirator for 10 days. This and other testimony was described by Rep. Scibak as the most powerful testimony he ever heard. He commended the Task Force for bringing this crisis to the attention of government leaders and the general public."

Check out more about HCFA's Oral Health Task Force by clicking here.
The ever fabulous Mass. Medicaid Policy Institute has produced another gem of a report at just the right time. "Eligible but Uninsured: Challenges to Getting and Keeping MassHealth" describes current enrollment initiatives and examines barriers state residents face to getting and retaining MassHealth benefits. Margaret Oakes, the author, interviewed representatives of organizations that work directly with people enrolled in or applying for MassHealth. The brief reports on their views of how recent changes in the administration of MassHealth have resulted in problems with enrollment and retention.

The issue brief concludes that the State's current efforts, while effective, are not sufficient to enroll all those who are eligible for MassHealth. It calls for the creation of an Outreach, Enrollment, and Retention Workgroup to develop information about specific populations most likely to be eligible but unenrolled, and to craft strategies for reaching out and bringing them into the program. Get the report by clicking here.

April 7, 2005

Everyone hears lots of criticism about the state of local television news, much of it well deserved. So it's worth noting when a local TV station goes above and beyond the call of duty in digging into a complex and difficult public policy issue such as health coverage for the working uninsured. So it's only right to issue a strong and sincere compliment to WCVBTV Channel Five for an indepth and serious look at the problems of real Massachusetts residents struggling for affordable coverage, as well as a serious look at various policy solutions.

Dr. Tim Johnson and Natalie Jacobsen put in lots of time and effort into making this a serious and worthy series and they succeeded admirably, topped off by a town meeting on Wednesday evening, attended by Gov. Mitt Romney and many members of the Mass. Health Reform Coalition, including a large contingent from the Greater Boston Interfaith Organization.

For access to transcripts of the weeklong series, please click here.

For information on Gov. Romney and Sen. Travaglini's plans, please check out HCFA's Health Reform home page. I'll have more comments on both plans over the next few days.