July 22, 2015

Yesterday advocates, consumers, health providers, and legislators convened at the Joint Committee on Financial Services public hearing to provide testimony in support of S. 557 / H. 871, An Act to protect access to confidential health care. The bill would eliminate frighteningly common confidentiality breaches in health insurer communications by allowing patients to choose where and how they receive explanation of benefits (EOB) forms.

Insurers routinely send out EOBs detailing the type and cost of medical services received to the primary subscriber of a health insurance plan, not the individual patient who accessed services. Sensitive health information is frequently disclosed in these forms, violating the basic right to privacy for anyone enrolled as a dependent on another’s policy, such as a young adult, minor, or spouse. As we heard from bill sponsors Representative Hogan and Senator Spilka, Attorney General Maura Healy, Representative Brodeur, and four separate panels of experts, providers and consumers, the effects of this can be devastating.

The first to offer testimony in support of this bill were lead sponsors, Representative Kate Hogan and Senator Karen Spilka. They set the stage by emphasizing the moral impetus to provide confidential health care, also alluding to the negative outcomes of confidentiality breaches via EOBs such as greater likelihood to delay or forgo care, retaliatory abuse from a spouse or family members, and higher costs to publicly-funded community clinics. As Senator Spilka noted, sending member-level EOB forms as this bill proposes is a common sense solution for a shockingly simple problem -- and since some health insurers are already doing this, “clearly it should not be an issue”.

Attorney General Healey testifying at hearing for privacy protection legislation 7-21-15Following Representative Hogan and Senator Spilka was Attorney General Maura Healy (photo at left courtesy of Shira Schoenberg / The Springfield Republican). In addition to reiterating the importance of confidentiality and the negative effects of confidentiality violations, Attorney General Healy also commended the public education aspect of the bill, which would inform patients and consumers of their rights to alternative private EOB communication methods and how to go about requesting those. Her eagerness for the AG’s office to work with the committee on this legislation was palpable and we look forward to having her expertise engaged on this issue!

After hearing from public officials (including Representative Paul Brodeur who voiced his support), four separate panels spanning an array of health issues brought a human face to the bill, offering firsthand testimony about the very real effects of confidentiality breaches through EOB forms. We heard from providers at university health clinics, domestic violence and sexual assault advocacy and service organizations, behavioral and physical health providers, and patients themselves.

Advocates testifying at hearing on privacy protection legislationMany providers described the chilling effect of confidentiality concerns on their patients’ health practices, including forgoing mental health counseling and medication or sexual health services such as STI testing out of fear of reprisal from a parent or spouse. In one personal patient testimony offered on behalf of an anonymous young woman from Andover, the fear of her parents finding out she’d been to the gynecologist to treat an ovarian cyst -- fear influenced by shame, stigma, and poor communication -- was so fierce that she delayed treatment until her ovary ruptured, almost causing her to lose an entire ovary at age eighteen.

Advocates from the domestic violence and sexual assault fields also testified on the negative effects of confidentiality breaches through EOB forms. A number of service providers offered accounts of patients who had been sexually assaulted and were forced to prematurely disclose their assaults to parents or a partner when they received EOBs detailing the services received. In the case of domestic violence survivors, the consequences could be even direr. Annie Lewis-O’Connor from the C.A.R.E. Clinic at Brigham & Women’s Hospital recalled a patient who, while fortunate enough to access confidential care using a workaround, had initially lied about the cause of her injuries fearing reprisal from her husband if he learned she’d sought treatment through an EOB being sent to their home. In the patient’s own words, her husband had threatened to kill her if she went to the hospital.

July 20, 2015

On Friday afternoon, Governor Baker issued his line-tem vetoes for the Fiscal Year 2016 budget, which started on July 1.

One of the vetoes took us by surprise:

Governor Baker vetoes all Academic Detailing funds

"Academic Detailing" is the somewhat obscure name for a valuable, money-saving state program. Here's how we've explained it before

Academic detailing helps doctors stay abreast of current information while avoiding the biases of pharmaceutical-sponsored education. How does it work? Doctors, nurses, or pharmacists are trained to understand comprehensive and unbiased clinical data. They then visit physicians’ practices to pass this information on to practitioners. Academic detailers do not have a financial stake in the drugs that they are recommending, and thus serve as a counterweight to industry-sponsored information. Academic detailing has the potential to achieve two goals, both of which are good for Massachusetts:

  1. Promoting better patient outcomes. Academic detailers will present a more complete view of the available clinical data. This stands in sharp contrast to the selective marketing techniques used by pharmaceutical representatives, who focus on highlighting a drug’s strengths while glossing over its weaknesses.
  2. Reducing healthcare costs. Academic detailers recommend off-patent drugs when evidence shows that they are a safer and more effective treatment option. Pharma has no incentive to market off-patent drugs because, for them, that’s not where the money is. One study from Harvard Medical School and Brigham and Women’s Hospital found that each dollar spent on academic detailing saved two dollars in prescription drug costs. This means substantial savings on prescription drug expenditures statewide— potentially big enough for Massachusetts to recover most or all of what it spends to fund an academic detailing program.

Much more details on the program, and how it works, is here.

We call on the legislature to swiftly override this veto, which would deprive doctors of objective information on prescription drugs, and only benefits high-priced drug manufacturers who are able to market better than the competition. Join us in contacting your state legislator and asking him or her to support an override of this veto.

                 -- Brian Rosman

HCFA's Report Card on Insurers' Consumer Costs Web Sites

In 2012, the Commonwealth of Massachusetts enacted comprehensive legislation aimed at controlling health care costs. The law included a provision that requires insurers and third party payers to provide a toll-free phone number and website to members with real time estimated prices and the member’s estimated cost sharing (deductible, co-pay) for a proposed admission, procedure, or service.

June 25, 2015

Today's 6-3 Supreme Court decision has Massachusetts health reform written all over it, right up front. After describing past failures to effectively reform health care coverage policy, Chief Justice Roberts turns to us, on pages 3-4 of the opinion:

Supreme Court ACA opinion mentions Massachusetts

We couldn't be prouder of the role Massachusetts has played in the formulation, passage and implementation of the ACA. We were the incubator of the ideas, the test bed for the policy, and, of course, our delegation, led by Senator Kennedy, was crucial in the law's passage. Now our success is pivotal to upholding the law, establishing it as part of the American landscape.

Today's court opinion leans heavily on the successful Massachusetts experience. As we are in the midst of implementing the next phase of health reform, exemplified by Chapter 224 from 2012, we're also encouraged by the ongoing role Massachusetts policy continues to play nationally.

     - Brian Rosman

June 16, 2015

We've done a bunch of posts on the topic of the ACA is good for Massachusetts. The ACA does much more than just switch RomneyCare to ObamaCare. Under the ACA, we've been able to provide premium assistance for more people, allow children to remain on their parents' health coverage longer, eliminate limits on benefits, provide free preventive care, including contraception, in insurance plans, and improve drug coverage for seniors on Medicare. The ACA has improved care quality, funded community health centers, workforce development, community prevention and 52 patient-centered research projects (out of 400 nationally).

And dramatically improved the state budget.

Mass Budget report

The numbers are in a brief released today by the Mass Budget and Policy Center, blandly titled "New Federal Revenue Affects State Spending Trends" (pdf), but providing blockbuster information.

In 2015, spending on health care grew, both due to medical inflation and expanded coverage. The increased cost was around $1.17 billion. But the ACA provided much more new revenue to Massachusetts, some $1.02 billion, covering almost all of the new spending.

We actually saved money on MassHealth coverage: "[Due to the ACA], the state is seeing a net bottom line savings of $245 million as a result ($338 million in new federal revenue minus $93 million in new net costs associated with MassHealth coverage.)"

The study correctly identifies health spending growth as the most critical ongoing budget problem. The boost in federal funds doesn't affect long-term growth trends. We must continue to take steps to reduce health care cost growth.

But the ACA's increased federal revenue is good news for the state budget, and for everyone who cares about providing affordable health care to everyone who needs help.

   - Brian Rosman



See the amendments we support in the State Senate budget debates

Oral Health

More than 800,000 people, including 120,000 seniors and 180,000 people with disabilities, are without access to dental care beyond cleanings, fillings, extractions, and full dentures.  Left untreated, dental disease can lead to systemic infection, hospitalization, and significantly worsened medical conditions that would have been otherwise easily prevented. 


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