August 17, 2015

We've come a long way since 2006, but still have a distance to go. That's the message of an opinion piece in the Tauton Daily Gazette by Audrey Shelto, President of the Blue Cross Blue Shield of Massachusetts Foundation. She notes that census data indicate that, still, four percent of Massachusetts’ population – more than 250,000 people – remain uninsured.

The number of uninsured is much higher in some areas of the Commonwealth. In April, the Foundation released a report that found that uninsurance rates are sharply higher in certain pockets of the state. In one section of Framingham, the average estimated rate was 19 percent, while a slice of East Boston stood at 24 percent uninsured.

Shelto also discussed the 2013 Massachusetts Health Reform Survey report released this June, which found that:

  • While many Massachusetts residents who previously lacked insurance have obtained public coverage, barriers remain in obtaining access to health care services that offer the quality and affordability that all Bay State residents deserve.
  • Those with public insurance plans are nearly three times more likely to have difficulty finding a provider who is accepting new patients. They are nearly five times more likely to struggle to find such a provider who accepts their insurance. And even when they do, they are nearly three times as likely to face delays in finding a primary-care doctor.
  • Even when those using public insurance plans do manage to get the care they need, they often report a lower quality of care and lower satisfaction with that care than do those on employer-sponsored plans.

Shelto concludes by emphasizing that Massachusetts is noted for its medical expertise and excellence, as well as for being a “national leader in moving the uninsured onto the rolls of the insured,” but “serious gaps persist in delivering quality health care, at affordable rates, to all.... The commonwealth hasn’t yet reached its goal of truly universal coverage, but that day is closer than ever.”

The full article can be found here.

             -- Michelle Savuto

August 12, 2015

The Gallup Poll does big national surveys asking people if they have health insurance. It's not as rigorous as our state surveys, but it's more frequent and provides a good snapshot that allows one to compare states.

Their latest results for the first half of 2015 were released this week. Nationwide, the uninsured rate fell from 17.3 percent in 2013 to 11.7 percent through the first half of this year. Here's the amazing bottom line:

Through the first half of 2015, there are now seven states with uninsured rates that are at or below 5%: Rhode Island, Massachusetts, Vermont, Minnesota, Iowa, Connecticut and Hawaii. Previously -- from 2008 through 2014 -- Massachusetts had been the only state to be at or below this rate.

It's all about the ACA. The poll notes that, collectively, the uninsured rate in states that chose to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace declined significantly more since 2013 than the rate in states that did not take these steps.

Poll shows a bigger decline in uninsurance rates among states that implemented the ACA

According to their numbers, the uninsured rate in Massachusetts is 3.0%, putting us second best, behind Rhode Island at 2.7%. Now in reality, the margin of error for the survey ±1 or 2 percentage points for us, and ±3 or 4 points for small states like Rhode Island. So, Massachusetts continues to set the pace for other states to lower their uninsured rates through expanding coverage.  There are no losers in the movement towards universal coverage. 

        - Michelle Savuto

July 30, 2015

Medicaid started in Mass in 1966

Happy Birthday, Medicaid and Medicare! Today is the 50th anniversary of the signing of Social Security Act of 1965 which created both programs. Massachusetts has had a particularly important role in influencing the evolution of Medicaid at the federal level and among the states. In honor of the day, the Blue Cross Blue Shield Foundation created a spectacular interactive timeline to showcase major milestones in Medicaid history in Massachusetts .  Notably, many of the expansions and innovations of the past 30 years are the result of the advocacy legacy of HCFA.   

Under Governor John Volpe and Lieutenant Governor Elliot Richardson, Massachusetts became the 23rd state to implement Medicaid in 1966, originally covering about 380,000 adults and children. In 1972, Massachusetts became one of 35 states to make all Supplemental Security Income (SSI) recipients eligible for Medicaid.  In the 1980’s, Massachusetts Medicaid expanded to cover many services and groups including:

  • medically necessary abortion services
  • home and community-based long-term services and supports to residents who would otherwise require institutional care
  • coverage at the maximum income level allowed under federal law for older people and people with disabilities with incomes up to the federal poverty level
  • pregnant women and children under age 8 with income below 185 percent of the federal poverty level

The timeline also highlights Chapter 203 of 1996, which expanded Medicaid to serve all children under age 19 with family incomes below 133 percent of the federal poverty level and to cover children under 12 with family incomes up to 200 percent of the federal poverty level. Our leadership led directly to Senator Kennedy conceiving of and pushing the federal CHIP program, which now covers almost 6 million kids nationally. Chapter 203 also authorized coverage expansions for adults who were not parents, and officially renamed the Massachusetts Medicaid program to MassHealth. In the 2000s, new programs for seniors ("Senior Care Options") and people with disabilities took off, and then Chapter 58 in 2006 further expanded coverage and restored benefits which had been cut. HCFA was involved in all of these policy initiatives.

Of course, our pioneering 2006 innovations combined with the earlier expansions provided the test bed for the ACA.

The most recent entries in the timeline showcase the 2013 launch of One Care, which combines Medicaid and Medicare benefits and financing for disabled adults who are eligible for both programs.  Additionally, but not the least important,  Massachusetts implemented the Affordable Care Act in 2014 which includes the creation of MassHealth CarePlus for newly eligible adults with incomes below 133 percent of the federal poverty level.  Today MassHealth covers around 1.8 million Bay Staters.

growth in Medicaid spending and enrollment

Many challenges remain. But we'd urge everyone to reflect on the inspiring history of Medicaid in Massachusetts, which can be explored on the very cool timeline on the Blue Cross Foundation website: bluecrossmafoundation.org/publications/ma-medicaid-50th.

      -Michelle Savuto

July 28, 2015

Yesterday,  the legislature's Committee on Health Care Financing approved  H. 2048 / S. 608 An Act to eliminate racial and ethnic health disparities in the Commonwealth. The bill now goes to the House Ways and Means Committee. Its lead sponsors include Representatives Jeffrey Sánchez and Byron Rushing, and Senator Jason Lewis.

Health Care For All has long supported this legislation ever since we helped draft the original bill in 2009 with a broad coalition of disparities advocates in our Disparities Action Network.

The bill creates a permanent Office of Health Equity in the Executive Office of Health and Human Services, focused on health disparities. The Office will provide a framework for a comprehensive approach to health disparities. The focus encompasses all the activities of state government, such as housing, transportation, education and economic development. It requires that the Governor's annual state budget submission identify major state initiatives that affect health and health care, and specify their impact on health disparities. It also calls for an annual report card on progress in reducing disparities.

Health Care For All is committed to working to eliminate health disparities. If your Representative is a member of the House Ways and Means Committee (look up the committee membership here, and find your legislators at WhereDoIVoteMA.com), please contact him or her in support of this important bill.

         -- Michelle Savuto

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