December 8, 2017

Governor Baker, along with the governors of Oregon, Montana, and Nevada, today published an op-ed in the New York Times urging Congress to reauthorize funding the Children’s Health Insurance Program (CHIP), the program that provides health coverage to almost nine million children of low-income families across the country. The op-ed emphasized the benefits to kids’ health that CHIP has brought about since its creation in 1997 and the disastrous consequences of allowing the program to expire.

“Since the program went into effect, the percentage of children who are uninsured has dropped from 15 percent to 5.3 percent. Children who would otherwise be uninsured can now visit doctors for the regular checkups all kids should have and get the treatment they need when they’re sick or hurt, whether they’re suffering from a sore throat, a broken bone or a life-threatening illness. CHIP doesn’t just provide insurance coverage for children — it indirectly provides financial stability for many working families who depend on the program to cover their children’s health care. Many of them would otherwise be financially devastated by their kids’ hospital bills.”

Funding for CHIP expired at the end of September, and states will soon run out of the reserve funds they have been using to continue the program. In Massachusetts, CHIP provides coverage for 172,000 children. The Commonwealth will lose $295 million in federal funding if CHIP is not reauthorized. Coverage for many would be at risk, and losing federal funding for the program will be a major blow to the state’s budget. 

Governor Baker has taken a leading role in advocating for the reauthorization of the Children’s Health Insurance Program and for community health centers. Federal funding for community health centers also expired at the end of September. In Massachusetts, community health centers provide primary care to about one million residents, or about one seventh of the state’s population.    

Governor Baker and Oregon’s Governor Brown sent a letter to Congress at the end of November asking for reauthorization of CHIP, funding for community health centers, and funding for a federal home visiting program. The letter explained how, even if CHIP funding is ultimately reauthorized, the delay in funding is already causing harm.

“Absent congressional action, states will be forced to take steps including the notification of thousands of families of the loss of CHIP health care coverage. Taking steps to avoid those worst-case outcomes places a tremendous administrative and financial burden on states and sows confusion among vulnerable populations.”

Health Care For All thanks Governor Baker for his consistent advocacy on behalf of these vital programs.

November 20, 2017

Funding for the Children’s Health Insurance Program (CHIP) expired on September 30. CHIP provides health insurance for children and pregnant mothers who are low-income but are not eligible for Medicaid. States have a limited amount of funds left to maintain the program, but without federal reauthorization, these funds will soon run out. CHIP has been responsible for a massive decrease in the number of uninsured children throughout the country. When CHIP became law in 1997, 14 percent of people below the age of 18 were uninsured. By 2015, this number had decreased to less than 5 percent. In Massachusetts, CHIP covers about 160,000 children, including 7,000 expecting mothers. CHIP has helped the Commonwealth reach the incredible rate of 99 percent insurance coverage for children, which is the highest in the nation. According to updated estimates provided by MassHealth, without Congressional action, Massachusetts will exhaust its federal CHIP funding in mid-January.

Federal funding for community health centers expired on the same day. Community health centers are a vital part of the health care system, and a lack of federal funding will throw these health centers into a finical crisis, affecting a massive portion of the population. Many community health centers, uncertain when funding may reauthorized, are already experiencing considerable financial stress, which is hampering their ability to function effectively. In Massachusetts, community health centers provide primary care to one in seven state residents, or about 1 million people. Community health centers tend to serve large amounts of patients without private insurance, including those covered through Medicaid and those who are uninsured. The most vulnerable members of our society will be disproportionately affected if community health centers are forced to cut services due to a lack of federal funding.

Senator Elizabeth Warren recently posted a video calling for the reauthorization of funds for both CHIP and community health centers. Health Care For All commends Senator Warren for her commitment in fighting for these vital programs. HCFA calls on Congress to work together to forge a clean bipartisan agreement on funding of both CHIP and community health centers, two essential components of our health care system. 

October 26, 2017

This Monday, Health Care For All testified before the Special Senate Committee on Health Care Cost Containment and Reform during a public hearing on the Senate health package (An Act furthering health empowerment and affordability by leveraging transformative health care) released the previous week. This major legislation affects a wide range of topics throughout the health care system. In our testimony, Health Care For All touched on a few of the provisions we think will impact consumers.

Major Items Highlighted by Health Care For All:

Prescription Drugs

Health Care For All supports the provision in this bill which authorizes an evidence-based education program for drug prescribers. To best prescribe to patients, doctors must keep up with a constantly evolving drug market and new clinical research. Meanwhile, the pharmaceutical industry spends billions of dollars in marketing directly to doctors, promoting new, high cost drugs even if these drugs don’t improve outcomes. This education program can help providers prescribe based on clinical data instead of promotional information.

HCFA also supports the introduction of transparency measures for prescription drug pricing. The rapidly rising cost of prescription drugs places major burdens on consumers and the state budget. However, Health Care For All urges for stronger transparency than is currently in the legislation. We believe that any information the state gathers on prices should be made available to the public, and that a substantial penalty should be levelled against any drug company that withholds pricing information.

Dental Therapists

Health Care For All strongly supports the authorization of dental therapists in this legislation. Dental therapists are mid-level providers who are trained to provide basic but vital services, including preventive dental care and basic restorative care such as filling cavities. Authorization for dental therapists will help expand these important services which too many Massachusetts residents are currently unable to access.

Another panel also testified on the importance of dental therapists. Dr. Kerry Maguire of Forsyth Kids spoke on the importance of dental therapists to increase the number of providers that can fill cavities for children, saying that currently, “if every dentist in the state picked up a dental drill and never put it down, we would still not be able to treat all the cavities out there. The problem is simply too great.”

Katherine Soal, a dental hygienist and former president of the Massachusetts Dental Hygienist Association, spoke on how dental therapists could help treat problems before they become severe. She gave the example of a patient she knew with cerebral palsy who developed an extreme dental issue and needed hospitalization, and she said that the hospitalization could have been prevented by early treatment from a dental therapist.

Maura Sullivan of The ARC of Massachusetts spoke on the benefits dental therapists could have for people with developmental disabilities. She said she has worked with the state to ensure dental therapists will have training in providing oral health care to people with these disabilities. She spoke on the difficulty she has had in finding a dentist for her own children, and said that dental therapists with this training could benefit many patients who currently have trouble finding dentists who are willing to treat individuals with developmental disabilities.

MassHealth

Health Care For All was also pleased by the decision to not include damaging provisions in this legislation. Last summer, the Governor proposed a series of MassHealth cuts that would have reduced eligibility, limited benefits, and imposed barriers to keeping coverage and continuity of care. Many of these cuts required legislative authorization, and the Senate referred the issues to this Senate special committee. The committee did not include these provisions in this legislation, which shows their disapproval of the proposed cuts.

Prevention and Wellness Trust Fund

Health Care For All commended the Senate working group for including reauthorization of the Prevention and Wellness Trust Fund in this legislation. The PWTF is a successful pilot program which promotes public health through preventive care and promotion of healthy behaviors. Public health is an extremely important area of focus as it improves quality of life and cuts down on costs. It’s generally much cheaper to invest in keeping people healthy than paying for costly care when people become sick. Health Care For All urged the Senate to include a permanent source of funding for the program in this legislation.

Hospital Readmissions

October 19, 2017

The Massachusetts Senate issued its comprehensive health care reform bill this Tuesday, and Health Care For all participated in the release of the legislation. Health Care For All’s executive director, Amy Rosenthal, spoke during the event and highlighted some of the priorities of consumers in the current system. The bill contains over 150 sections, and many elements of the bill align with the needs of consumers.

Watch our executive director's full comments on the legislation here.

Public Health and Social Determinants of Health 

The bill was put together by a Senate working group, who spoke on different aspects of the bill. Senator Jason Lewis emphasized the importance of public health, saying that “the social determinants of health are absolutely critical in determining health outcomes and health disparities.” He pointed out that promoting health outcomes also helps to decrease health costs, as healthier populations require less care.

This legislation promotes public health in several ways. It reauthorizes the Prevention and Wellness Trust Fund, a successful pilot program which promotes community disease prevention by supporting healthy behavior and increasing preventative care.

The legislation also addresses housing as an important social determinant of health by establishing a housing security task force to investigate housing programs, including prioritizing shelter beds for homeless patients discharged from emergency rooms, and by allowing housing providers and health care plans to coordinate location-based care.

Amy Rosenthal also emphasized the importance of public health, saying “We focus too much on curing people when they’re sick, and not enough on prevention and keeping them healthy.”

Telemedicine

This legislation would help promote telemedicine services by permitting the coverage of telemedicine services through MassHealth and updating requirements for commercial health plans to provide coverage for telemedicine.

Telemedicine has been proposed as a way to help increase access to services for those with limited mobility and for those who live far away from medical professionals, particularly in rural areas. Behavioral health is often considered to be one field where telemedicine may be particularly effective.

Dental Therapists

Senate Majority Leader Harriette Chandler spoke on the importance of promoting dental health. “Dental health is just as important as any other health care pursuit, but so many people in this state lack access to this service.

This legislation aims to increase access to dental health by establishing a dental therapist certification. Dental therapists are mid-level providers who are trained to provide basic but vital services, such as preventive dental care and filling cavities. This bill would allow dental therapists to deliver care in community settings, such as schools and nursing homes, which would help ensure access to populations who may have a difficult time traveling to the dentist’s office. “With dental therapists,” said Senator Chandler, “dental health services are delivered directly to those in the most need.”

Dental therapists would also help to decrease health care costs. Because they are mid-level providers with a more restricted scope of practice than dentists, dental therapists generally charge less for services than dentists do. Increasing access to preventive dental care will also help lower costs by decreasing the number of patients who utilize the emergency department for oral health issues.

Amy Rosenthal also spoke on oral health, saying that “We need to get people the oral health care that they need, and get them out of emergency departments when that’s not where they should be.”

Prescription Drug Costs

Prescription drug costs are one of the main drivers of rising health care costs, and growth in prescription drug spending is one of the most rapidly increasing parts of health care spending.

This legislation takes several steps to address these costs. The legislation increases transparency for providers and consumers. It would establish an academic detailing program to educate prescribers on drug outcomes based on medical evidence and not pharmaceutical advertisements. It would also require pharmacists to inform a consumer if the amount they are paying for a drug through insurance is higher than the direct retail rate that they would pay without insurance, which is sometimes the case due to the complex and hidden factors in drug pricing. If the price with insurance is higher, the consumer would be able to buy the drug at the lower retail rate.

The legislation would also create reports on the impact and potential cost saving of the state engaging in prescription drug bulk purchase consortiums.

Surprise Out-of-Network Billing

Amy Rosenthal said that “We need to… shut down surprise medical bills.” Surprise out-of-network billing refers to a situation where a patient is receiving care in a hospital that is in their insurance network, but is treated by a specific doctor who does not accept that insurance, resulting in an unexpected and large fee for the patient. This is a major financial stress for consumers. This legislation would guarantee that the patient would not have to pay an additional copay or deductible when this happens.

- Sean Connolly 

Pages

Subscribe to Health Care For All RSS