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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

September 28, 2015

The recent Blue Cross Blue Shield of Massachusetts Foundation “State of Health Coverage for the Elderly in Massachusetts: Affordability, Access and Satisfaction” event included a productive discussion about the current state of health care affordability and accessibility for seniors in Massachusetts.

Nancy Turnbull, professor at the Harvard T.H. Chan School of Public Health and a Health Connector Board member, gave a presentation describing how supplemental coverage often is needed to cover benefit gaps and high cost-sharing in Medicare. She also pointed out that many Massachusetts seniors are not eligible for, or – if eligible – are not aware of, programs intended to help them overcome these deficiencies.

One finding of a survey of over 500 Massachusetts seniors conducted by Robert J. Blendon (also a faculty member at the Harvard T.H. Chan School of Public Health) is that 18% of Massachusetts seniors in poorer health have had to resort to not filling a prescription due to the cost of prescription drugs.

A panel comprised of representatives from Blue Cross Blue Shield, the SHINE Program, Centers for Medicare & Medicaid Services and Mass Senior Action Council, as well as Nancy Turnbull and Bob Blendon, discussed the survey findings and current efforts to address the gap in health coverage for seniors. The Mass Senior Action Council is leading a legislative advocacy effort to help close coverage gaps for seniors. Let’s keep this vital conversation going!

  -- Wayne Jones (*Updated 9/30/15)

September 17, 2015

Yesterday, the U.S. Census Bureau, as part of its annual report on income, poverty and health insurance, announced that the percentage of people without health insurance fell rom 13.3% in 2013 to 10.4% in 2014.  This means a reduction of the number of people without insurance from 41.8 million to 33 million.

The report notes that between 2008 and 2013, the uninsured rate was relatively stable; but in 2014, the uninsured rate sharply decreased. This decrease occurred during the first year that key coverage provisions of the Affordable Care Act (ACA) were in effect, and it was most dramatic in states that took up Medicaid expansion. Between 2013 and 2014, individual direct-purchase of health insurance, Medicaid and Medicare saw the greatest enrollment increases. According to the report, even "national leader" Massachusetts saw a decrease in the uninsured rate in 2014.

The next open enrollment period for the ACA’s health insurance marketplaces (the Health Connector in Massachusetts) runs from November 1, 2015 though January 31, 2016, providing a new opportunity for the millions of Americans who still lack health insurance to shop for a plan -- and for those who have insurance to review their options and re-enroll.

To learn more about the health care gains made by Massachusetts residents, as revealed by the census report, read this fact sheet created by the Massachusetts Budget and Policy Center.

September 14, 2015

On Thursday, September 10, the Health Connector  Board discussed  readiness for Open Enrollment (OE) 2016,  including outreach efforts, and to deliver the final award of the 2016 Seal of Approval.  Materials from the meeting are posted here

Chief Operating Officer Vicki Coates provided consumer experience updates.  Coates first noted that total Non-Group Medical Enrollment stands at 175,605 members, a 1.2% increase from last month.  Non-Group Dental enrollment is 45,240 members, a 0.8% increase from last month.  Non-Group Enrollment for ConnectorCare is 129,657 members, an increase of 1.4% from last month.  Coates then said that the call center continues to hold the gains made in the last several months, with a lower call abandonment rate and average speed to answer than February and March.  Issue resolution has increased by 5% after holding steady for a few months and there are significantly fewer people reporting that they called more than three times without resolution.  First contact resolution, Coates reported, has increased 4.1% since May.  Overall satisfaction has increased 7% from July to August as lower wait times have resulted in higher satisfaction levels.  Coates also re-iterated that staffing is on track to match the anticipated increase in call volume associated with OE and staff are being trained to support customers’ shopping needs.

2016 Open Enrollment Readiness Update

During Open Enrollment, which runs from November 1, 2015-January 31, 2016, individuals in the non-group market can enroll in or switch plans for any reason without needing a qualifying event.  Currently, the Connector is in the final stages of determining eligibility and renewals for the upcoming OE.  118,000 households that applied for help paying for coverage and are eligible for a Qualified Health Plan (QHP) received eligibility notices.  The notice, it was noted in the meeting, is very “high level” and does not include information on the amount of tax credits an individual is expected to receive.  However, consumers will receive notices of their tax credit values before November 1st.  Once members receive their eligibility notices, they have 30 days to take action to update and finalize their eligibility if they choose. 

2016 Open Enrollment Outreach Update

The Connector performed a comprehensive consumer survey in July, surveying 1,086 residents representing those  currently enrolled in subsidized and unsubsidized health plans, dental plans, and a group of former enrollees.  The Connector also conducted several focus groups aimed at uninsured, current, and former members.  They held sessions in Lawrence, Lynn and Brockton, areas with high uninsurance rates, to learn about barriers to obtaining coverage and whether people felt comfortable using the Health Connector.

The survey found that, overall, the majority of insured respondents are satisfied with their experience as Health Connector members but room for improvement exists.  Dental plan enrollees were significantly less satisfied than health plan enrollees.  Additionally, satisfaction rates were skewed between lower-income subsidized members and upper income unsubsidized members - with lower income enrollees more likely to be satisfied. 

Uninsured respondents perceived that cost was the biggest barrier but insured members of similar income levels find their coverage to be generally affordable.  Uninsured individuals are more willing to risk not having coverage and show an inherent distrust in the health care system.  Individuals with families, however, were more interested in enrolling in health insurance.  Lastly, respondents emphasized that the process is still often confusing and expressed that having help with their application was useful.  To illustrate this point, the satisfaction rating of Navigators is relatively high compared to those of the Health Connector website or customer service. 

Survey and focus group data on plan selection and enrollment indicate that the top reasons people select the plan they enrolled in are to keep premiums low and have a plan that includes their doctor or provider.  More people report not understanding their benefits than understanding them.  Respondents noted that the enrollment process could be improved through better website design, better trained Customer Services Representatives (CSRs), simpler web navigation, and the ability for more plan comparisons. 

The top customer service issue appears to be linked to phone services, as shown by the number of respondents dissatisfied with long wait times and the fact that some CSRs appear to lack sufficient knowledge.  The Connector is addressing these problems by proactively hiring and training staff to add to the number of available CSRs during OE.  Fortunately, the Connector is emphasizing in-person assistance throughout the state through Navigators, Certified Application Counselors, Issuer Enrollment Assisters, Broker Enrollment Assisters, and new locations for support with trained CSRs.  Springfield, Fall River, Brockton, and Lowell will all be additional in-person centers staffed with trained Health Connector CSRs.  The permanent Boston and Worcester Centers will also have extended evening and weekend hours.

Final Award of 2016 Seal of Approval

September 11, 2015

On September 9th the Health Policy Commission (HPC) Board met primarily to discuss the release in early September of the Center for Health Information and Analysis (CHIA) Annual Report on the Performance of the Massachusetts Health Care System and the upcoming annual Health Care Cost Trends Hearing.  The full slide deck can be accessed here.

Executive Director’s Report

First, Executive Director David Seltz delivered a report to summarize recent activities at the HPC. He began with an update on Material Change Notices, noting that of the types of transactions documented from April 2013 to the present, the most frequent were physician group merger, acquisition, or network affiliation transactions at 26% (Slide 7).

Notices received since the last HPC meeting include an acquisition of Saint Francis Care, a hospital system in Hartford, CT, by Trinity Health Corporation, which owns Mercy Medical Center in Springfield, MA..  Additionally, the HPC received notice of a new clinical affiliation between Tufts Medical Center Parent (Tufts) and Cape Cod Hospital (CCH) under which Tufts physicians will provide substantially all pediatric services at CCH (Slide 8). 

The HPC elected not to proceed with Cost and Market Impact Reviews (CMIR) for the following:

  • Acquisition of Braintree Rehabilitation Hospital and New England Rehabilitation Hospital by HealthSouth Acquisition Holdings. Their analysis indicated there is limited scope for a CMIR due to the fact that the hospitals in question primarily serve Medicare patients.
  • Acquisition of Saint Francis Care by Trinity Health Corporation. The proposed transaction would have a limited impact on operations, prices, and contracting practices at Mercy Medical Center.  While the transaction may result in a small increase in referrals between MA and CT providers, their analysis did not find that such changes would likely have a negative effect on spending or on the competitive market. 
  • Affiliation between Tufts Medical Center Parent and Cape Cod Hospital. The analysis indicated that rates and referral patterns are unlikely to change as a result and, in fact, may improve quality, access, and the ability of CCH to provide consistent pediatric coverage (Slide 9). 

Seltz then gave an update on the HPC’s Registration of Provider Organizations Program, a project meant to create a database to capture ongoing changes in the provider market Thus far 59 provider organizations have completed the first part of initial registration and are expected to complete the second part this Fall. The registrants represent behavioral health, hospital systems, physician groups, and an “other” group solely including Quest Diagnostics (Slide 11).  The provider organizations must submit their part 2 materials to the HPC by October 30, 2015.  Provider organizations can now access the online submission platform and the HPC encourages providers to schedule one-on-one meetings with them.

Next Seltz turned to the HPC’s Community Hospital Acceleration, Revitalization, & Transformation (CHART) Investment Program, which is progressing with both Signature Healthcare and Berkshire Health Systems moving into the contracting and launch phases respectively.  At Northern Berkshire Neighborhood of Health, part of Berkshire Health Systems, the $4M project has now launched and is serving patients from Northern Berkshire County.  The project primarily aims to reduce 30-day readmissions by 20% and, secondly, reduce 30-day returns to the emergency department from any bed by 10%.  They hope to achieve these goals by utilizing a number of strategies like individual care plans, addressing underlying social issues, and investing in technology to support care coordination.  The project also hopes to integrate many services into the community (Slides 17-18).

Lastly, Seltz reported on an important amendment passed in the FY2016 budget that strengthens consumer protections for patients who face medical bills and who exercise their rights to pursue internal or external appeals of certain health insurance coverage decisions. The amendment prohibits health care providers and their agents from providing information about unpaid charges for health care services to a consumer reporting agency while an internal or external review is pending or for 30 days (increased from 15 days) following the resolution of the internal or external review. The amendment further prohibits health care providers and their agents, including any collection agency or debt collector from initiating debt collection activities relative to unpaid charges for health care services while an internal or external review is pending or for 30 days following the resolution of the internal or external review (Slide 20).

CHIA Annual Report

Executive Director of CHIA, Áron Boros, began by delivering the major finding of CHIA’s Annual Performance Report that total health care expenditures (THCE) per capita rose 4.8% from 2014, which amounts to $8,010 spending per person. The greatest source of the percentage change is reported to be MassHealth/Commonwealth Care spending. However, there was much debate among the Board members as to what this fact actually meant when examined more closely and its impact on the total spending change number. 

March 10, 2015

Health Care For All new logo - blue Massachusetts red Health Care For All text
September 19, 2014

It’s fall and that means it’s a season of change. Health Care For All is moving its office. After September 20th, you can find us at One Federal Street, Boston, 02110! 

We are also opening our celebration of the 30th Anniversary of Health Care For All. The anniversary has us reflect on some of the major victories that Health Care For All has won over the course of three decades. Again and again, the work of HCFA has led Massachusetts to lead the country in health care:

The universal coverage law in 1988 under Governor Dukakis. The expansions in Medicaid to form MassHealth, and new help for prescription drugs for seniors. Patient protections in managed care plans, and ending pre-existing conditions exclusions for groups and individual plans. More kids enrolled in coverage. Landmark health care reform under Governor Romney, providing a model for the Affordable Care Act signed by President Obama. The 2012 comprehensive payment and delivery system reform law, changing the focus of our system towards value and health.

We are proud of this week's census report that we still lead the nation in health coverage, including virtually universal coverage for children.

The policy victories have been coordinated with a best-in-the-nation HelpLine and outreach and education effort, integrated with our policy work.

We have come a long, long way in 30 years. But, there's still lots more to do.

To mark this occasion, and to mark our move, today we are unveiling a brand new logo.

Our new logo reflects the Massachusetts focus of the work we do to bring quality, affordable health care to all people in the Bay State. We are a truly statewide organization. We help answer questions from all corners of the Commonwealth on our HelpLine. This fall we will again knock on doors to reach out to hundreds of thousands of our neighbors to make sure they get covered.

Today, the 30 Winter Street team of Health Care For All, Health Law Advocates, and Community Catalyst are busy packing up to move to One Federal Street. Our phone numbers and emails will stay the same. And so will our determination to work for three more decades of health care advocacy, education and service for access to quality, affordable care - for all.

Cameras on the Kids Count Press Conference
July 24, 2014

This week, we were proud to participate in the release of the Kids Count report, placing Massachusetts at number one in the nation when it comes to overall child well-being. The Annie E. Casey Foundation report covers a wide spectrum of data when it considers children’s wellbeing, and of course access to health care is one of the main metrics in addition to early education, child poverty, and more. With just only about 1% of children uninsured, Massachusetts does extremely well on access to coverage.

The report says that “Children have a greater opportunity to thrive and succeed in Massachusetts than in any other state,” according to our friends at the Mass Budget and Policy Center. You can read MassBudget’s full report here.

But there is more work to do. One in seven -- seven -- children in Massachusetts live in poverty. That number is too high. Governor Patrick spoke passionately about the work that lies ahead. “The question before the Commonwealth, and the country, isn't what to do - we know what to do,” said Governor Patrick. “The question is whether we mean what we say, whether all means all - opportunity for all, equality for all, a fair chance for all.  If we mean it, then we have to do the things we know work." To see the Governor’s full remarks, watch his YouTube clip.

Our Executive Director, Amy Whitcomb Slemmer had this to say: "The Commonwealth's focus and forward-thinking financial investments are paying off for our children. Covering 99% of our children with health insurance as part of our commitment to providing comprehensive, affordable, accessible high quality care for all is unprecedented and unparalleled in the country.”

The facts are clear that despite our number 1 ranking, we are far from finished nationwide or at home. There is a national poverty gap that breaks along racial and ethnic lines. In America, 40 percent of black children and 34 percent of Hispanic children live in poverty while 14 percent of white children do.

In Massachusetts, despite having almost universal access to health care, there are other health concerns. For example, Massachusetts children are about as likely to abuse drugs and alcohol as kids anywhere else in the country. And we know that no issue is separate -- all the issues are interconnected. How well a child does in school often depends on his or her health, for example. 

As Amy Whitcomb Slemmer said: “The Kids Count report also highlights the work yet to do. We must close the gaps for non-English speaking children and for immigrant communities across the Commonwealth. We must uproot the entrenched causes of poverty that make being born in certain zip-codes a health hazard.  We must continue to push so that our world class health delivery system to which nearly every child in Massachusetts has access, translates into having the healthiest children in our nation."

The report garnered a lot of press coverage, and you can read just some of the coverage here. Again, Health Care For All is proud of Massachusetts’ number 1 status. It did not happen by accident. We got to where we are because of hard work, a commitment to universal health coverage, early education, and more. Now the work continues to make sure that we lift all children out of poverty to ensure that they lead the healthiest, happiest lives possible.

--Ari Fertig

July 18, 2014

“We have succeeded in covering millions of people – now we have to keep them covered” was a message we heard numerous times throughout Enroll America’s State of Enrollment conference.  The days at #SOE2014 were jam-packed with informative workshops and plenaries offering innovative, creative, and experience-driven ideas about how to successfully engage the remaining uninsured and keep those that have enrolled covered. And we know Navigators, Certified Application Counselors (CACs), and other assisters will be critical to ensuring this work is done and done right!

Here are some of our key takeaways to helping consumers keep coverage that we brought back to Massachusetts:

  • Less is more — It is essential that people know that they need to renew their coverage and how to complete the process. However, it is also important not to overwhelm people with too much information during the initial conversation about renewing or changing coverage.
  • See every interaction as an opportunity — Just as every change in a household could cause a gap in health care coverage, every contact with a consumer is an opportunity to remind people about the need to update their marketplace account with any information about life changes and to review their coverage every year to ensure successful renewal.
  • Meet people where they are — Borrow an existing audience rather than trying to build one, and use it as an opportunity to educate folks about getting covered and staying covered.
  • Fight against churn — Accidental gaps in coverage may happen, but they are something we all have to work to combat. It’s the only way to ensure people can consistently access the health care services they need!
  • Think creatively about retention — Many states are using unique strategies to combat coverage gaps or disenrollments. For example, Massachusetts offers Navigators, CACs, and other assisters the opportunity to receive carbon-copy notices of renewal that are sent to applicants they have assisted. This allows them to make outgoing calls and to send texts and emails to their clients reminding them that it’s time to renew.

#SOE2014 was a first-of-its-kind event convening hundreds of health care stakeholders committed to health coverage enrollment and retention. The opportunity to learn from and share promising and best practices with so many informed people from all over the country was informative and exciting. There’s no doubt that the takeaways we brought back to Massachusetts will ensure that hundreds of thousands of people get, and stay, covered during the upcoming open enrollment period!

-Kate Bicego and Hannah Frigand

Crossposted to Enroll America's blog here.

July 1, 2014

Our friend and Board member Chip Joffe-Halpern wrote a column for the Berkshire Eagle (State health reform for the long haul), explaining some of the challenges and successes in Massachusetts’ implementation of the Affordable Care Act. Chip runs Ecu-Health Care, a non-profit which helps the uninsured and underinsured residents of North Berkshire access affordable health care.

His op-ed today puts into context where we are, and where we are going. He concludes that, “Massachusetts has implemented policies that go beyond the federal guidelines and will more effectively achieve the objectives of the Affordable Care Act.” Here’s Chip:

Massachusetts has struggled implementing the Affordable Care Act, highlighted by a problematic computer system and an inability to process thousands of applications. Given that Massachusetts pioneered near universal coverage with its 2006 landmark health care law, the state has received much criticism for its inability to make the changes needed to accommodate the federal health coverage expansion.

Massachusetts has not received the recognition it deserves though, for taking important steps that augers well for the long-term success of health reform.

When it became apparent the computer problems could not be easily solved, the state decided to enroll over 227,000 individuals in temporary health insurance. Health coverage was also extended to an additional 100,000 individuals who were previously enrolled in the state's Commonwealth Care and Medical Security Plan health insurance programs, Massachusetts has received approval to extend coverage for these individuals through December 31, 2014.

oing forward, Massachusetts is also keeping health care cost sharing at affordable levels for individuals and families with incomes under 300 percent of the 2013 federal poverty guidelines ($34,476 for one, $70,656 for four). These individuals will be eligible for MassHealth, or Connector Care, a health insurance that has no annual deductibles. ConnectorCare members will also receive additional assistance to lower the cost of health insurance premiums and cost-sharing so that costs are similar to what individuals currently pay under Com monwealth Care.

The Affordable Care Act embraces the principle that all Americans deserve affordable health coverage. While the federal law includes cost-sharing support for individuals whose incomes are under 250 percent of the federal poverty guidelines, each state has the latitude to implement policies that will determine both the cost of health insurance premiums and the amount of cost sharing for individuals who will qualify for assistance under the federal law.

Chip is so right on. Read the entire explanation here

-Ari Fertig

June 25, 2014

Our fiscal year ends on June 30th – there are just five days left to help Health Care For All this year!

calendar - 30th


Please help us provide health care education, enrollment services, and advocacy that the people of Commonwealth deserve. In order to continue the important work we do and improve the quality and accessibility of health care for all Massachusetts residents, we depend on your generosity.

We invite old and new friends to consider making a gift today.

If you have not already made a donation to our annual fund and appreciate the work we do, please help out.


To make a tax-deductible donation:

• Click here to make an online donation
• Mail a gift to: Health Care For All, 30 Winter Street, Boston, MA 02108
• Dial a pledge at 617-275-2926

Celebrate and Remember
What better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2926 to give today!

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Support HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today!

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Join your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC # 111147) and the City of Boston Employees Charitable Campaign (COBECC #2015).

Thank you again for considering a donation to Health Care For All.  Because of your generosity, HCFA’s good work can continue.