"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

January 22, 2016

Earlier this month, Health Care for All actively contributed to the Health Policy Commission’s public hearing concerning their ACO (Accountable Care Organization) certification standards. ACOs provide coordinated care through their doctors, hospitals and other clinical and non-clinical staff, working together to improve the quality and affordability of care. HCFA representatives Steve Slaten, Valerie Spain, Brian Rosman, Alyssa Vangeli, and Helen Hendrickson testified at the hearing, offering consumer viewpoints on how to strengthen the proposed standards.

HCFA Leadership Council members Steve Slaten and Valerie Spain testify on ACO standards

HCFA’s Leadership Team representatives Dr. Stephen Slaten and Valerie Spain (pictured above) spoke as consumer representatives at the hearing. Slaten, a psychologist, advocated for the meaningful inclusion of consumers in the governance of ACOs. The inclusion of independent consumers on ACO boards—at least two, he argues—would improve accountability. He spoke from personal experience with doctors who did not keep the patient's best interest in mind. To really shift care to be patient centered, it requires the message from the top be, “no, we really mean it this time.”

Spain, too, spoke for consumer engagement and transparency. She called for meaningful consumer engagement through consumer advisory councils to ACOs, with a built-in feedback loop, public annual reports, and professional support. She urged the Commission to "...be bold. We are at a juncture of great opportunity. Boldness will bring a groundswell of support from disability groups, non-profits, and consumer organizations. Go as far as you can, you’ll have room to step back if needed. Don’t go halfway–if you go halfway everything will coalesce around halfway measures."

HCFA's Brian Rosman and Alyssa Vangeli spoke about the need for ACOs to play a role in population health. "Perhaps the 'C' in ACO should also stand for 'Community'," Rosman said. Because ACOs are responsible for keeping their patients healthy, they should identify the particular needs of its patient population based on criteria that includes social determinants of health, which could include factors such as homelessness or unstable housing, age, primary language, race and ethnicity, geography, gender identity and sexual orientation. ACOs should engage Community Health Workers, who can bridge the needs of patients outside clinical care. Vangeli emphasized that holding ACOs accountable for improved health and experience of care will require quality measures that are focused on outcomes and patient-reported data. She asked that the HPC work with ACOs and payers to monitor and track under-service and underutilization. ACOs should educate their enrollees on what an ACO is, the benefits of care under the ACO, and the responsibilities and rights that accompany receiving care from an ACO.

Helen Hendrickson spoke on behalf of HCFA's Oral Health Integration Project, and advocated for the inclusion of dental care and oral health in the ACO design. The need for improved access to dental care is an imperative, Hendrickson emphasized. “Dental decay is the most prevalent chronic disease among children,” she said attested. Poor oral health has also been linked to chronic conditions, including heart disease, diabetes, and stroke. And there are significant costs to the overall healthcare system. In Massachusetts, MassHealth paid $11.6 million from 2008 to 2011 for emergency room dental care for adults. She suggested PCPs offer oral exams and referrals to dentists when needed. The proposal does not explicitly include oral health providers and Hendrickson urged the Commission to revise several standards.

Written public responses to the ACO plan can be sent to the Health Policy Commission at HPC-Certification@state.ma.us. Comments must be received by 5:00 pm, January 29th.

            -- Jessica Imbro

HCFA Volunteers assist several hundered people with enrollment in Framingham
January 21, 2016

Nearly 300 individuals gathered at Fuller Middle School in Framingham this past Saturday, January 16th, seeking health care coverage enrollment and navigation assistance, as well as other health services. Health Care For All’s ‘Grand Enrollment Event’ featured more than 70 HCFA staff and volunteers, including Spanish and Portuguese-speaking health insurance Navigators and Certified Application Counselors. Volunteers helped 154 individuals, 107 of whom were uninsured upon arriving to the event, to enroll in health care coverage.

Volunteers helping people enroll in health coverage

86% of event attendees self-reported as Portuguese-speaking, while only 10% reported speaking English.

“Massachusetts has the nation’s highest rate of health insurance, with over 97 percent of the population covered; however there are areas in the Commonwealth where many remain uninsured. Framingham, for example, has a significant number of uninsured residents, and we know that many uninsured residents speak a language other than English. Today, we are here to help people navigate the enrollment process in English, Spanish and Portuguese,” said Amy Whitcomb Slemmer, Executive Director of Health Care For All.

State Senator Karen Spilka at HCFA enrollment event in Framingham

State Senator Karen Spilka (above), as well as State Representatives Chris Walsh and Carmine Gentile welcomed the group. Also attending were Louis Gutierrez, Executive Director of Massachusetts Health Connector, and Michael Hugo, Chair of the Framingham Board of Health, as well as Edna Smith, chair of the Community Health Network of Greater Metrowest (CHNA 7).

The ‘Grand Enrollment Event’ was a part of a larger Open Enrollment effort conducted by the Health Connector and MassHealth, as well as numerous community organizations and health care providers statewide. Massachusetts residents have until January 31st to apply, enroll in a health plan, and pay their premium for coverage for 2016. Please call HCFA’s HelpLine at 800-272-4232 if you or someone you know needs help applying or renewing their health care coverage.

January 19, 2016

Last week, the Connector Board met to share progress during open enrollment, discuss proposed policies for a federal State Innovation waiver, and voted on a restructured contract with customer service and billing vendor Dell. Materials from the meeting can be found here.

In addition, the Board bid a fond farewell to Dolores Mitchell, who is retiring after nearly 30 years leading the Group Insurance Commission (GIC), the agency that provides health and other benefits to state and certain municipal employees. Dolores has served on the Connector Board since its inception, and for much of the time has been the Board’s Vice Chair. Thank you, Dolores for your important leadership in health policy formulation and implementation in Massachusetts!

Open Enrollment & Outreach Update

Open Enrollment update 1-14-16

The 2016 Open Enrollment period – November 1, 2015-January 31, 2016 – is going much more smoothly than the past several years. For one, IT systems improvements have made applying and shopping for coverage simpler. Second, Health Connector members enrolled in a plan in 2015 do not have to actively re-enroll if they want to keep their plan – they just need to keep paying their premium. However, they do have the option to switch plans at any point during the open enrollment period.

There are about 189,000 members enrolled in 2016 coverage (January or February start date) through the Health Connector. The retention rate for renewing members is about 92%; the vast majority of whom stay within the same metallic tier as in 2015. Nearly 28,000 of the 189,000 enrollees are new. “New” means that the members were not enrolled in MassHealth in 2015 nor enrolled in the Health Connector through the newer IT system (hCentive) in the past year. Of all new members, 88% reported being previously insured while 12% reported never having had insurance before. According to the Health Connector, preliminary data suggest that their and Navigators’ targeted outreach efforts are prompting the uninsured to sign up for coverage, particularly in the top 10 communities with the highest numbers of uninsured.

Last week, the Health Connector sent a communication to members enrolled in Bronze plans reminding them to review their benefits and that they still have time to switch plans. 1095 tax forms will be sent to Health Connector enrollees who received advanced premium tax credits (APTCs) in 2015; they have already let these members know to wait until they receive this form to file their taxes. In addition, the Health Connector is sending emails, preparing press releases, and supporting Navigator events to educate the public about the January 31st open enrollment deadline, as well as preparing call and walk-in centers for the increased volume towards the end of the month.

In addition, the Health Connector is outreaching to potential members about the possibility of enrolling in health insurance outside the open enrollment period should they encounter life changes, or “qualifying events.” The Health Connector is working with the Division of Unemployment Assistance (DUA) on a mailing to educate employers about Health Connector coverage as an alternative to COBRA for employees leaving their jobs, as well as options for non-benefit eligible employees.

EOHHS Secretary and Board Chair Marylou Sudders asked whether there had been a cost-benefit analysis of the Connector’s outreach efforts, as the rate of uninsurance in Massachusetts has held relatively steady at 3-4% since passage of health reform in 2006. She expressed concern about the sustainability of the state’s programs, including Connector and MassHealth, and the need to discuss cost. Connector Deputy Executive Director Ashley Hague responded that while the uninsurance rate has remained relatively stable, it’s not likely the same people who are included in that rate over time. There is a lot of fluctuation in health insurance coverage as people experience life changes. Audrey Gasteier, the Connector’s Director of Policy and Outreach, added that they are looking at Department of Revenue (DOR) data to determine how many of the 3-4% of uninsured are the same people and whether most uninsured are experiencing gaps in coverage rather than chronic uninsurance.

State Innovation Waiver Update

Basic requirements for a federal 1332 waiver

Section 1332 of the Affordable Care Act (ACA) gives states the option of waiving certain provisions of the ACA. The Health Connector has led a robust stakeholder process to help inform their policy direction for the State Innovation Waiver opportunity, and has a web page dedicated to the topic. After receiving input from various stakeholders, the Health Connector has proposed a two-phase process. For Phase 1, the Commonwealth will seek an application with the federal government to allow Massachusetts to continue rolling enrollment and quarterly rating in the small group market. Under a separate provision of the ACA, Massachusetts was able to keep these features of the small group market until 2018. If accepted, the 1332 waiver would allow Massachusetts to permanently maintain these provisions.

December 23, 2015

Last week Health Care For All submitted comprehensive recommendations to MassHealth regarding their development of Accountable Care Organizations (ACOs). ACOs represent a new way to pay for and organize health care delivery, by bringing together doctors, hospitals and other health care providers who work to give coordinated, high quality care to their patients. 

MassHealth is engaged in a process of consultation with health care stakeholders and the public to establish the contours of their ACO transition. You can read more about MassHealth's thinking on ACOs in this presentation. Here are two of their slides:

MassHealth ACO slides

We agree that MassHealth has an opportunity to promote approaches to payment reform that fundamentally transform the way care is delivered. ACOs should deliver high quality, high value care that treats the individual as a whole person and ensures coordination of care, improved communication, member support and empowerment, and ready access to health care providers, services and community-based resources and supports. The goal is not just better health care, but better health for the entire state.

There’s a lot of detail in our full recommendations (download the document here (warning: 29-page pdf)), along with examples from other states. Below is a much-abridged summary of our recommendations:

Member Protections

  • Monitor and track underutilization: ACOs should establish internal monitoring mechanisms for under-service to safeguard against potential incentives to deny or limit care, especially for members with high risk factors or multiple health conditions. MassHealth should monitor under-service by assessing claims data and health outcomes over time to identify patterns of variation.
  • Protect member choice of providers
    • Network adequacy: Members should have access to care across the continuum, which includes reasonable access to a sufficient number of primary and specialty care physicians, facilities, and other providers, as well as benefits delivered in a timely fashion within a reasonable distance. ACOs should have continuity of care provisions for contracting with providers outside of the ACO.
    • Attribution methodologies: Attribution methods should involve member choice to the maximum extent feasible. MassHealth should not establish a lock-in period forcing members to remain in their ACO for a particular period of time.
  • Ensure robust appeals and grievances procedures: ACO grievance and appeals processes should be easily accessible. MassHealth should establish a single source of information and accountability for under-service through an ombuds program model.

Member Engagement at Multiple Levels

December 16, 2015

Good dental care is critical for overall healthOn Monday, the bill to authorize dental hygiene practitioners was reported favorably out of the Joint Committee on Public Health. The bill (reported as a new draft, S. 2076), sponsored by Sen. Majority Leader Harriette Chandler and Rep. Smitty Pignatelli, establishes a new mid-level dental provider that would help increase access to needed dental care across the Commonwealth.

Known in some other states and countries as dental therapists, dental hygiene practitioners would be able to provide basic dental services, including fillings and simple tooth extractions, and help increase access to dental care for people who struggle to find dentists in their area and/or whom accept their insurance. Though MassHealth covers 40% of the state’s children, most dentists do not accept it, and a shocking proportion of children have untreated oral decay, affecting their ability to eat, learn, and play, and costing the state millions in expensive emergency room visits. Massachusetts also currently has 64 Dental Health Professional Shortage Areas (DHPSAs), with the problem only expected to get worse.

We need dental providers that can deliver care to those who need it the most. Dental hygiene practitioners could work in settings such as schools and nursing homes to make sure those who have a hard time accessing care can receive it. They may also work directly with dentists, allowing practices greater financial flexibility to see more MassHealth patients.

HCFA’s Executive Director Amy Whitcomb Slemmer recently published an Op-Ed in both Quincy's The Patriot Ledger and The Enterprise in Brockton discussing the importance of mid-level dental providers in improving access issues.

We are happy that our policymakers are pushing forward this bill and are excited to work with the Dental Care for Mass Coalition to support this legislation. The bill was referred to the Joint Committee on Health Care Financing, and we urge them to quickly report it out favorably.

    -- Kelly Vitzthum

December 11, 2015

Yesterday, the Health Connector Board met to discuss two topics: 2016 open enrollment and transitioning to the federal risk adjustment program. Materials from the meeting are posted here: https://www.mahealthconnector.org/about/leadership/board-meetings.

Over 180,000 enrolled, halfway through open enrollment window

2016 Open Enrollment Update

Half-way through open enrollment for 2016 health coverage, which runs from November 1, 2015-January 31, 2016, more than 180,000 individuals are enrolled in a qualified health plan (QHP) through the Health Connector for January 1, 2016 – inclusive of ConnectorCare, QHP with Advanced Premium Tax Credits (APTCs) and unsubsidized coverage.

One of the reasons Open Enrollment is going more smoothly this year is that the Health Connector is conducting auto-renewals. While members enrolled in Health Connector coverage in 2015 can switch plans at any time during Open Enrollment, members who did not actively choose a plan in November were automatically enrolled into a plan for 2016. Put simply, if a Health Connector member likes their plan, they do not need to do anything – except pay the updated premium – to keep that plan in 2016.

According to the Health Connector, customer service performance has greatly improved from the last Open Enrollment period, and the launch of additional walk-in centers throughout the state and the ombudsman services provide consumers with additional ways to get help with the eligibility and enrollment process.

Risk Adjustment Update

The Affordable Care Act (ACA) requires implementation of a Risk Adjustment (RA) program, which provides payments to health insurance carriers with plans that have higher-than-average risk (i.e., members with more health care needs) funded by transfer payments from health insurance carriers with plans that have lower-than-average risk. Both federal and state methodologies for RA result in significant transfers of money among carriers, as some will have to pay and others will receive payments.

Massachusetts is the only state to run its own RA program, administered by the Health Connector, in collaboration with other state agencies. The federal Centers for Medicare and Medicaid Services (CMS) runs the RA program for every other state. The Commonwealth’s authorization from CMS to operate a state-based RA program runs out at the end of 2017. Health Connector staff proposed that Massachusetts transfer over the RA program to the federal government after the state-based program ends.

Various factors played into this recommendation, including the requirement for a federal extension of authorization to operate the state-based program, federal approval of the payment methodology (which currently very closely follows the federal methodology and would need to be replicable in other states), and higher costs. The RA program is funded through an assessment on carriers, which is twice as expensive as the federal rate for the state-based program, the cost of which is ultimately passed on to consumers. Thus, the Health Connector is not planning  to pursue federal authorization to operate the state-based RA program for the 2017 benefit year and beyond. However, upon urging from Secretary Marylou Sudders and a few Connector Board members, the Health Connector will notify CMS that they may explore re-establishing a state-based program in the future.

The next Connector Board meeting is scheduled for Thursday, January 14th at 2:00pm at 1 Ashburton Place, 21st floor, Boston.

               -- Suzanne Curry

December 2, 2015

Good dental care

Last Friday (Nov 25) the Boston Globe published an Op Ed by Harvard University Dentist Lisa Simon supporting legislation, introduced by state Senator Harriette Chandler and Representative Smitty Pignatelli, that would create a new mid-level dental provider: Dental Hygiene Practitioners.  Dr. Simon describes the overwhelming need for dental services she has seen in her years treating vulnerable populations, explaining “Dental clinics in Massachusetts are tremendously overburdened” with long wait times for dental care. Many find it difficult to locate a dentist at all.  “The suffering is heaped disproportionately on the poorest and most vulnerable in our communities, including children and low income seniors.”

Dr. Simon supports creating a Dental Hygiene Practitioner to provide basic dental services, freeing up dentists to “focus on treating the more urgent and complex needs of their patients.”

Read the full article here

HCFA is participating in a new coalition, the Dental Care for Mass Coalition. The coalition is supporting the Massachusetts legislation, S. 1118 / H. 249, which would authorize dental hygiene practitioners, a midlevel professional that is similar to physician assistants on a medical team.

For a national perspective on creating midlevel dental providers, see a recent journal article published in Dimensions of Dental Hygiene.

      -- Helen Hendrickson

November 24, 2015

On November 18th, the Health Policy Commission (HPC) Board met to discuss a number of new developments that relate to rising healthcare costs and quality improvement in the Commonwealth. The full slides from Wednesday’s presentations can be found here.

The meeting started with a presentation from Executive Director David Seltz summarizing recent activities at the HPC. Mr. Seltz outlined recent successes from the CHART Investment Program – a program to improve hospital outcomes through an aggressive series of awards, coaching, and technical assistance. This month, eight new awards were launched focusing on reducing emergency department reutilization.

HPC Slide on Performance Improvement Plan process 11-18-15

Two Commission staffers introduced the payer and provider Performance Improvement Plans (PIP). A unique feature of the Massachusetts 2012 health care cost control law, PIPs provide a mechanism for the HPC to identify and respond to payers and providers who exceeded the state’s health care cost growth benchmark. For 2015, that benchmark is 3.6 percent. The Center for Health Information and Analysis (CHIA) has provided a confidential list of potential offenders to the HPC. HPC then will notify the identified entities and may require them to file a PIP to implement options to reduce cost growth such as investing in efficiency measures, changing prices or referral practices, and more. The HPC revealed that CHIA has already created this list based on data from September 2012 to September 2013 along with preliminary 2014 data and identified under twenty providers and under five payers who may have exceeded the cost growth benchmark.

Health and Human Services Secretary Marylou Sudders voiced concern that payers and providers would be automatically blacklisted if they went even “0.0001 percent” over the cost growth benchmark and urged the Commission to instead look at the trends and stories behind the numbers to determine their validity. Secretary Sudders also pointed out that certain factors out of payer and providers’ control, such as rising drug costs, could present a warped image of actual cost growth. Secretary Sudders also reiterated the importance of having regulatory guidance prior to notifying identified payers and providers.  After a brief back and forth with Commissioner Stuart Altman who emphasized the need for transparency with the public, the Board agreed to an amended version of the process that included drafting regulatory guidance and conducting preliminary screening and analysis of payers and providers identified by CHIA.

HPC PCMH Prime process slider 11-18-15

Next, the board briefly discussed their criteria for Patient Centered Medical Homes based on national standards advanced by the National Committee for Quality Assurance. The hope is that strong standards will send a signal to patients that they can get the highest quality medical care by choosing a practice that meets the state's definition. After months of stakeholder design feedback, the HPC settled on behavioral health integration as their initial additional domain for PCMHs, going one step beyond the national PCMH standards. Of the thirteen preliminary criteria, PCMHs will have to meet at least seven to become certified by the state. The criteria were approved unanimously.

The final action item was another standards-related vote, on preliminary ACO certification criteria. After explaining the process used to develop the initial criteria and outlining the goals of the certification program, HPC staff discussed some of the common themes they encountered throughout their stakeholder engagement. Many agreed that there was a balance between being too prescriptive and allowing providers to innovate the best ways to improve care while lowering costs. At the same time, many stakeholders reiterated the importance of incorporating behavioral health and long term support services into ACO criteria. Notably missing was the inclusion of oral health or dental benefits. The full criteria will be released for public comment in January and hopefully finalized by February of next year.

HPC slide on OPP case resolutions 11-18-15

October 28, 2015

Advocates for health and child well-being gathered at the Massachusetts State House on Tuesday, October 20th, to support H.429/S.94: An Act Relative to Ensuring the Wellbeing of All Children in the Commonwealth, sponsored by Senator Montigny and Representative Livingstone. The bill aims to integrate assistance for children and families who need improved access to food, housing, and medical care. Support for the legislation is led by the Healthy Food, Healthy Homes, Healthy Children (HHH) Coalition, a group of service providers, researchers, and advocacy groups who take a holistic approach to childhood wellbeing, with the belief that housing, health care, and hunger are all inextricably linked.  The legislation aims to promote childhood wellbeing by improving access to – and integrating – food, shelter, and medical care.

Prior to the hearing, HCFA hosted a press event to highlight the importance of the bill, and introduce the legislation to the public. At the press event, supporters of the bill spoke about how in order to address health problems among children, it is necessary to tackle poverty as the root cause. The event featured several speakers, including HCFA Executive Director Amy Whitcomb Slemmer,  Representative Jay Livingstone, Dr. Megan Sandel from Boston Medical Center and Children’s HealthWatch, and Diane Sullivan, the Policy Director of Homes for Families, who spoke about the issue from personal experience. Ms. Sullivan had previously been a homeless mother, and spoke about how, without access to proper resources and support, families cannot be expected to lift themselves out of poverty. Representative Livingstone, the lead sponsor of the bill in the House, spoke about how although so many children have health coverage, that does them little good if they lack the basic necessities to lead healthy lives. By viewing access to health care, housing, and food as integrated issues, the bill aims to provide children the necessary foundation to lead healthy lives.

Following the press event, a number of experts testified in support of the bill at the hearing before the Joint Committee on Children, Families and Persons with Disabilities.  Testimony covered the various sections of the bill, including:

  • A ‘common application’ for core Massachusetts safety net benefits, including MassHealth and SNAP benefits
  • Establishing a working group to assess methods for providing meals to homeless families temporarily housed in hotels and motels
  • Changing administrative processes to reduce ‘churn’ – the closing and reopening of benefits eligibility due to recipients’ income fluctuation

Particularly compelling testimony came from Dr. Lois Lee, a physician in the Division of Emergency Medicine at Boston Children’s Hospital, and an Assistant Professor of Pediatrics at Harvard Medical School. Dr. Lee spoke about family eligibility for emergency shelter. Currently, families must spend one night in a setting not meant for human habitation before they can be eligible for placement in emergency shelter.  Dr. Lee spoke about how this rule puts unnecessary stress on both the families that must satisfy this requirement, and the hospitals that end up assisting them. These families seeking shelter are almost always single mothers with children under the age of 5, and the hospital is obligated to provide them with a room. When space is scarce, the obligation to provide these families with a room often means that there is not a room for another patient that may be in need. Dr. Lee also noted that while in these rooms, families are confined and limited in their ability to move around because a hospital is not suited for the needs of sheltering children and their families. For many, it’s not just a question of short-term or situational health: “Homelessness affects not just physical health, but can cause long-term developmental issues”, she said, emphasizing the importance of this comprehensive bill.

Led by Health Care For All, advocates across the spectrum of health and children’s wellbeing will continue to work to move this legislation forward so families and children have the resources to lead healthy lives. If you would like more information about the HHH coalition or the legislation please visit the coalition website.

                           - Ben Koller

October 15, 2015

At Tuesday’s Joint Committee on Health Care Financing public hearing, legislators heard testimony from advocates, consumers and health providers on a number of important bills, including three of HCFA’s priority bills:

  • H. 984/S. 606, An Act to keep people healthy by removing barriers to cost-effective care;
  • H. 964/S. 595, An Act to preserve affordable health coverage for Massachusetts residents; and
  • H. 1025, An Act relative to preventing unnecessary medical debt.

Senator Lewis and Representative Farley-Bouvier testified first in support of H.984/S. 606, An Act to keep people healthy by removing barriers to cost-effective care, also known as the No Co-pay Bill. The bill, which is one of HCFA’s main legislative priorities, would eliminate co-pays for certain high-value, cost-effective drugs and treatments for people with chronic conditions. As Senator Lewis explained, cost is a major barrier for many patients. While price tiering is a useful method to prevent overutilization, it harms those with chronic conditions who have no choice but to take multiple medications to stay healthy. In the long run, Representative Farley-Bouvier stated, this approach, based on the premise of value-based insurance design, will provide a large health benefit for consumers at a comparatively low cost.

Next to testify in support of the No Copay bill was Ruthie Liberman from the Crittenton Women’s Union (CWU). As Ms. Liberman noted, CWU, whose mission is to promote the economic independence of women through housing and employment programs, doesn’t typically testify on health care bills. However, a study by CWU based on surveys and interviews found that medical debt was a critical factor keeping many families in the cycle of poverty. Specifically, the prohibitive cost of copays and deductibles was a source of debt for over one third of survey respondents. Ms. Liberman emphasized the importance of affordable medical care in eradicating poverty for Massachusetts residents.

Finally, we heard from a panel of HCFA grassroots activists introduced by HCFA senior health policy manager Alyssa Vangeli. Their personal stories illustrated the devastating effect high co-pays can have on patients and made a strong case for eliminating cost-sharing for certain high-value drugs and treatments. Mercy Nunez, for example, has a number of different conditions, including high cholesterol, congestive heart failure, and type I diabetes. She has to take over 14 medications, and her poor health prevents her from holding a job. Struggling with the high cost of her copays, Mercy was unable to afford all of her medications; as a result, she had a medical emergency that landed her in the ER, where she was admitted to the hospital for two months. The cost of her entirely preventable hospital admission was far higher than if she had been regularly taking her medications.

Maria Melendez is another patient who, burdened by exorbitant copays, tried to take her health into her own hands because of high out-of-pocket costs. Maria has type I diabetes and has to pay over $200 each month for daily treatments to manage her disease and stay healthy. A few months ago, feeling pinched economically, she began undereating in order to reduce the amount of insulin she needed. After an appointment where her doctor detailed the devastating effects her behavior could have on her health, she began adhering to her medication plan. The added cost, however, forced her to move back in with her mother. Valerie Spain also shared her story of struggling to pay for diabetes supplies due to high copays.

In addition to oral testimony, HCFA submitted written testimony, a policy brief, and a sign-on letter, with support from a number of organizations including Atrius Health, Boston Children’s Hospital, Health Law Advocates, Joslin Diabetes Center, National Alliance on Mental Illness MA, AIDS Action Committee, Crittenton Women’s Union, 1199 SEIU and American Heart/American Stroke Association.

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