October 18, 2006

If you missed it, you can view last night's debate by the candidates for lieutenant governor on New England Cable News by clicking here. If you click the link for the debate, the 6th segment includes an exchange between Democrat Tim Murray and Republican Reed Hillman on health reform.

In response to a Jim Braude question on health care costs, Murray issues an endorsement of the MA health reform law (Chapter 58) and criticizes Kerry Healey for wanting to eliminate the $295 assessment on employers who don't make a "fair and reasonable" contribution to their workers' health coverage, specifically mentioning firms such as Walmart and Dunkin Donuts. Reed Hillman takes the bait and says he and Healey will seek to eliminate the assessment, asserting it will drive firms out of state. Murray comes right back and says we don't have to worry about Dunkin Donuts and Walmart leaving the state.

Poll after poll shows Patrick and Murray on the side of the public -- three polls since spring '05 show that the public supports taxing employers who don't cover their workers by 65, 67 and 69 percent. This is a winning issue and Murray is right to claim this ground.

October 18, 2006

The Cost and Quality Council held its third meeting on October 17. The agenda consisted of reports from four subcommittees (governance, quality, cost, and communications). The Governance subcommittee presented draft by-laws, and much of the meeting was spent going through them. Highlights:

  • Council membership will be staggered 3-year terms (the legislature or the Governor will determine how to initiate staggering---who of the current Council will serve for 1, 2, and 3 years).
  • Members will elect a Vice-Chair and Treasurer to serve 1-year terms. Elections will take place at the next Council meeting.
  • The Council must meet at least quarterly. Special meetings may be called in to focus on specific items of business.
  • The Council may hire staff and/or consultants. Some members talked about how important it will be to have dedicated staff and/or consultants to coordinate work and to drive the process. Secretary Murphy said the governance subcommittee will draw up a budget, write a job description, and determine necessary resources.
  • The Advisory Committee (Deb Wachenheim will represent HCFA) will meet with the Council at least quarterly and more frequently if requested by the Council. The advisory committee will give input on Council work and will review and comment on reports before they are publicly released. The first meeting of the Advisory Committee has not yet been scheduled. We will post time and location.

The remaining time was spent reviewing work of other subcommittees. Each subcommittee drafted a charter, laying out goals and strategies. The draft charter of the quality subcommittee is ambitious in its strategies for quality improvement across the six Institute of Medicine aspects of quality (safe, timely, effective, equitable, efficient, and patient-centered). Both the quality and cost subcommittees mentioned the need to align their work by, for example, looking at reimbursement rates and how they can help improve quality. The cost subcommittee talked about the need to collect, organize and report cost information and work towards cost containment and lowering costs. The communications subcommittee focused on making the Council the primary MA source for cost and quality information, with regular reports. They mentioned the need to engage various audiences, including providers and consumers. You can now read minutes from the August and September meetings.

The next Council meeting will take place Wednesday, November 15, at the China Trade Center, 2 Boylston Street, 5th floor (please check back for any last-minute changes in time or place). When we are notified about subcommittee meetings, we will also post that information.
Deb Wachenheim

October 17, 2006

Excerpts from today's State House News Service, by Jim O’Sullivan

House Speaker Salvatore DiMasi said Tuesday he was concerned the implementation of the state’s health care reform could flag in reaching its deadlines, which are important for preserving access to federal funds. Widely credited with championing progressive values within the legislation, DiMasi said he was also wary of the development of insurance products for people under age 26 and for those over 300 percent of the poverty level, as well as the extent of coverage offered by employers. ...

The new health care system, aimed at providing affordable and comprehensive coverage to all the state’s legal residents, incorporates Medicaid expansion with an individual mandate and requirements that employers meet thresholds for offering employees coverage or pay fees. Architects say the bill will winnow the state’s so-called uncompensated care pool and control costs.

Acknowledging uncertainties, and attributing them to the law’s pioneering element, DiMasi predicted “very tough times ahead” when people are required to purchase health insurance. He urged the health center officials, “I assure you that if there needs to be a change in this legislation or a policy procedure or any kind of regulation that affects you adversely so that it hinders you in accomplishing the goals of this bill, you come and see me right away. Because I will change it so it will work. And I’m not talking – we wrote this thing, there’s no pride of authorship for any one of us, I can tell you that.”

DiMasi and an aide said the office is monitoring the formation and meetings of the various advisory boards and commissions created under the legislation, which was signed in April. “We’re watching implementation very carefully and one of the things we’re watching is the timeline,” DiMasi health care policy adviser Chris Hager said. Hager pointed to the Commonwealth Health Insurance Connector Authority’s decision to enroll people below the federal poverty line forcibly, if they don’t correspond with the authority, as an example of a regulation implemented, but not prescribed in the legislation. She called it an example of “administrative flexibility.”

Formulating the bill consumed the Legislature for much of the end of last year and the beginning of this year, and lawmakers often cited a “bottleneck” effect in explaining why other legislation seemed stalled. The House and Senate missed a string of deadlines, and the state was late submitting its plan to the federal Center for Medicare and Medicaid Services, though DiMasi at the time dismissed the federally imposed deadline as artificial.

In a News Service interview in the Colonnade Hotel lobby, DiMasi rejected reports of tensions between himself and Senate President Robert Travaglini. In his 21-minute speech, DiMasi mentioned neither Travaglini nor Gov. Mitt Romney, but briefly credited the Senate with working hard “to make this legislation work.” During his speech, to a roomful of the health center’s supporters, DiMasi recalled the praise and attention heaped on the legislation in the wake of the bill-signing, quipping, “They quoted my speech in Time Magazine, that was pointed out to me. Of course, I wasn’t very happy about where it was placed. The quote of the week – my quote was placed between Giuliani’s and Saddam Hussein’s. I didn’t know which one I was closer to. And I didn’t want to be close to either one of them, but that’s OK.”

We knew it to be the case, nonetheless it's encouraging to see the Speaker so closely engaged with making health reform get implemented well. His commitment to doing this right has not wavered at all.

October 17, 2006

The Special Commission appointed to study the anticipated effects of the merger of the non-group and small group insurance markets, and the firm they have hired to do the study, have wisely determined that much of their analysis hinges on decisions within the control of the Connector. (What types of products will be offered by the Connector? How expensive will they be? How broadly will the Connector apply the individual mandate, just to name a few.) The merger commission has invited Jon Kingsdale and Bob Carey of the Connector staff to join them for their next meeting, and they have agreed. Of course, the Connector staff can not entirely predict what the Connector Board will approve, particularly if there are significant changes to the Connector Board after the gubernatorial election, but we see this type of communication and consultation as a good thing. It should be an interesting meeting.

Thursday October 19th
9:30 to 10:30 am
Division of Insurance
One South Station, 5th Floor

October 17, 2006

You can get the Romney Administration's Six Month Implementation Report to the House and Senate by clicking here. No surprises or curveballs we could see, lots of good and nitty gritty information, especially on public health restorations.

October 16, 2006

From our colleagues at Mass. Law Reform Institute:
You have an opportunity to tell MassHealth how to improve new rules for US citizens to verify citizenship and identity on October 20, 2006 at 10 a.m.
Conference Room 3, 21st Floor, One Ashburton Place, Boston, MA.

Written comments will be accepted until 5 p.m. October 27, 2006. Mail comments to EOHHS, Office of Medicaid, One Ashburton Place, 11th Floor, Boston, MA 02109 or E-Mail comments to masshealthpublicnotice@state.ma.us

Click here for a copy of the proposed rules & notice of hearing (go to MassHealth regulations and other publications, then go to Proposed rules).

Background: In July 2006 new federal rules took effect requiring most U.S. citizens to submit proof of citizenship and identity to get (or keep getting) medical benefits. MassHealth adopted emergency rules in July to comply with this new rule. People have an opportunity to comment on the MassHealth rules in October before the rules become final. The first denial notices for failure to supply proof will probably be coming in November. Speak up! Now is our opportunity to be heard.

Key concerns:
o The regs should say people can get more time to supply documents if needed.
o The regs should say that MassHealth workers will help if people cannot get documents on their own, particularly if people cannot get documents on their own because of physical or mental incapacity.
o In other states, Medicaid workers are ordering documents and paying fees when needed.
o The regs should say individuals who fail to supply documents by the deadline will not be denied or terminated so long as they have asked for help (or MassHealth knows they need help because of a disability) and are cooperating with MassHealth in getting documents.

Key concerns with current practice
o People get requests for information after they have sent in the documents
o There are unreasonably long waits to get through to the MECs (MassHealth Enrollment Centers) to find out if documents were received or if documents were acceptable
o Decisions on applications are being delayed

For more information or to discuss additional concerns, contact Vicky Pulos at MLRI: vpulos@mlri.org.

October 15, 2006

We've posted 3 presentations from last Thursday's Connector Board meeting. None of these were distributed at the meeting, nor are they currently available on the Connector web site:

  • the "Actual Enrollee Contribution Range" presentation shows the spread in premiums that enrollees will pay in the various Commonwealth Care plans. Remember, the enrollee monthly premium schedule approved by the Connector ($18-$40-$70-$106 for each 50% increment of poverty between 100% and 250%) only applies to the lowest-cost plan in each region. If an enrollee picks a plan that charges the state more, the enrollee must pay all of the difference (with one complicated exception). This chart is the first disclosure of how high the premiums will range. For example, premiums for the lowest income category will range from $18 to $74 per month, depending on which MCO is selected. You can see the price differentials of plan charges in the detailed spreadsheet posted by the Connector last week, which shows the charges for each plan type for each region of the state.
  • the presentation on private insurance issues is an introduction to the complex policy issues the Connector will face next. Under chapter 58, the Connector is to facilitate the purchase of coverage by uninsured individuals over 300% of poverty and small businesses. In deciding which plans to offer, the Connector will play a key role in structuring our health insurance market. The presentation sets up an ambitious schedule - plan criteria are to be developed by November, carriers are to outline their plans for Connector review by January 2007, and the Connector Board is to review products and issue its "Seals of Approval" by March 2007.
  • the final presentation projects the Connector's administrative budget through 2007.

Two more interesting documents should be out later this week. The latest EOHHS health reform progress report for the legislature is due early this week. It should be posted by EOHHS here. Towards the end of the week, the Connector is promising to post its first "Frequently Asked Questions" document about Commonwealth Care. Some 80 questions are pending. The Qs and As will be posted on the Connector site, www.mass.gov/connector.
Brian Rosman

October 13, 2006

Sad and shocking news. Today, Framingham Rep. Deborah Blumer died of a heart attack while driving her car.

Debbie was a true and devoted public servant. She cared passionately about her Metrowest district and worked at her job as hard as anyone. She was a loyal friend of health care access, the lead House sponsor of the Health Access and Affordability Act, the legislation promoted by the Affordable Care Coalition, many of whose elements were included in Chapter 58, the new health reform law. She made a real difference and has left an indelible mark on the Commonwealth.

Debbie was a great person and a true friend. She didn't have a bit of egotism, always interested in what was best for the issue at hand. We will miss her terribly, and we extend sincere condolences to her family and to the constituency she served so well.

John McDonough

October 12, 2006

Not to be missed -- Martha Bebinger's excellent report on health care and the gubernatorial campaign. Click here to connect with WBUR's website.

Here's Kerry Healey: "...even now I can see forces in the state organizing to shanghai this bill..."

Is she talking about us? C'mon and say it ... we dare you!

Healey also states her opposition to one of the cornerstones of Chapter 58, the responsibility for employers who don't make a "fair and reasonable" contribution to their employee's health insurance to pay a $295 per worker assessment to the state.

Deval Patrick makes it plain he supports the "shared responsibility" ethic underlying the law. "...if we blow up the employer assessment, we will blow up health reform."

Hey, this is good. Let's have a more conversation about this. This issue will matter in the coming years, and it's good to have this conversation now.

By the way, definition of "shanghai" from answers.com: To kidnap (a man) for compulsory service aboard a ship, especially after drugging him. C'mon, let's not bring drugs into this!

October 11, 2006

RI Lieutenant Governor Charlie Fogarty is the Dem Candidate for Governor in Rhode Island (click here for his site), running against incumbent Don Carcieri, the Republican. Carcieri has been ahead through most of the year, though recent polls have them running neck and neck.

Fogarty recently released a health reform agenda. Click here for his health plan. His plan is to cover all kids first, then do employer fair share assessments on all employers with more than ten workers, create a subsidized plan with sliding-scale premiums for low-income residents, and an individual mandate if coverage does not increase enough. His TV ad is heavy on the individual mandate, and doesn't mention the employer requirement, but it's in the plan. See for yourself.

Holy Massachusetts!

The long legs of the Chapter 58 keep moving.


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