October 11, 2006

The Special Commission to Study the Merger of the Nongroup and Small Group Health Insurance Markets will meet tomorrow, Thursday, October 12, 2006 from 10:00 am to 12:00 noon. The meeting will be held at the Division of Insurance at One South Station, Boston. Hearing Room. Go to the fifth floor and proceed directly to Hearing Room B. The purpose of the meeting is to discuss the assumptions going into the study. It should be an interesting and important meeting.

October 11, 2006

Didn't get any significant play from what we can see, but Deval Patrick and Kerry Healey had themselves a dust-up on health reform yesterday. Patrick criticized Healey's opposition to the health reform law's $295 assessment on employers who do not make a "fair and reasonable" contribution to their employees' health insurance premiums.

Here's an account of the exchange, embedded in an AP campaign trail story, included in the Boston Globe website, and not in today's Globe:

...Patrick instead focused on the state's new universal health care law, meeting with medical professionals at the East Boston Neighborhood Health Center to talk about expected challenges with implementing the program.

He criticized Healey for opposing a $295 fee on businesses that do not provide health insurance coverage, calling it a vital element in the "delicate balance" of the law.

Patrick helped craft the measure and has endorsed the law that emerged from House and Senate conferees, although he has conceded there will be problems that have to be addressed.

Rival Chris Gabrieli said during the Democratic primary campaign that the $295 fee may have to be increased to encourage companies to provide insurance, a concept Patrick did not rule out during a question-and-answer session with reporters.

"I think that's a question for a different day," he said. "I mean, it's a fair question, but it's not one that I think I want to take on right now, because I really want to try to make this work within the framework of we have right now."

Healey has said "it terrifies me" to think what would happen to the bill if Patrick was elected, telling an audience in Dedham earlier this month, a "health care bill that held so much promise is going to turn into socialized health care overnight."

On Tuesday, she said of a fee hike: "It's just a bad idea. ...The more penalties, the more assessments we pile on top of our small businesses, the more jobs are going to leave the commonwealth."

Does this issue have longer legs than a one day story? Hard to see. Could pop up in one of the three remaining debates. Looks like this is one issue where both candidates are quite comfortable being on opposite sides.

October 11, 2006

The brand new Newsweek has a fantastic set of articles addressing fundamental and systemic quality problems in US hospitals. Whole set of articles available by clicking here.

Here's a bonus -- a parade of Massachusetts stars who play leading roles in our Commonwealth, across the US, and around the world in helping medical care to cure itself, including:
--Drs. Don Berwick and Jim Conway of the Institute for Healthcare Improvement
--Linda Kenney and Dr. Rick Van Pelt, founders of Medically Induced Trauma Support Services (MITTS)
--Drs. David Bates and Anthony Komaroff at Harvard Medical School and Brigham & Women's
--Dr. Lucian Leape, Harvard School of Public Health
--Brigham and Women's Hospital
--Cooley Dickinson Hospital in Northampton

I know -- way too much Harvard. Still, have we got talent in this state or what? Question for all of us -- are we using this amazing talent as well as we can?

October 10, 2006

We asked our phenomenal Helpline manager, Kate Bicego, to write a blog entry describing last week on the Helpline -- the first week folks are able to sign up to enroll in Commonwealth Care subsidized health insurance coverage. Here's Kate's account:

Looking back, I stepped into the office Monday, October 2nd, 2006 quite naively. I anticipated a flurry of calls like we had never seen before and knew that I had to be on the top of my game. But I did not have any clue how much I would learn throughout the process of the launch of the Commonwealth Care Health Insurance Program. I hoped that all of the preparing that I had done in the past few months by listening, reading, and asking a lot of questions would make me a valuable resource for the callers.

The first call came in at 9:34 AM and they didn’t stop until I finally turned my phone off at 7:27 PM. Then it was time to respond to the additional online requests for information that had piled up in my inbox throughout the day. Call volume intensified throughout the week until we reached the highest number of calls in one week we have ever recorded: 405!

It wasn’t the record number of calls that made last week so memorable for me. Instead, I will always remember the way the residents of this state responded to this stage of health reform.

Almost every single person that I spoke with last week was aware that the state had launched a new health insurance program to which most referred to as the, “Health Care for All Program” or more simply, “the insurance.” The majority of people also assumed that they were already eligible because they considered themselves to be “barely paying bills” and had heard that this program would cover all low and medium-income people. Many were angry that their premiums and co-pays would be so high, while their employer would have nothing or very little to contribute to their health insurance costs.

However, even when angry, each caller, with desperation in their voices, expressed their hope that this program would finally allow them to obtain and maintain affordable health insurance coverage. I will always remember the man who hasn’t had health insurance coverage since he graduated high school in 1984. I was able to tell him that in January he will be eligible for the Commonwealth Care Health Insurance Program. He said that this will allow him to receive his first check-up in twenty two years.

Today I checked my mail in anticipation of receiving some of the first Commonwealth Care notices. It will now be my pleasure to call each one of the clients to inform them that they now have comprehensive health, dental and vision insurance. Is this finally a light at the end of the tunnel for the most vulnerable of Massachussetts residents? We sure hope so.
Kate Bicego

October 10, 2006

How did we get drawn into this one? Today's Herald runs an editorial criticizing Question Two on the November 7th ballot which would permit candidates for office to be listed on more than one party's line. Somehow -- don't ask us -- the Herald editorial writers decided to bring us in on the fray:

We must have missed the memo detailing the crisis of getting politicians to pay attention to the demands of special interests. Funny, in our experience, that’s what pols do best. It’s getting them to pay attention to the concerns of regular citizens they have trouble with. But increased attention to slivers of activists is one of the motivating forces freely admitted by the backers of Question 2, which would allow cross-endorsement or “fusion” voting here.

“Cross-endorsement should lead to the flourishing of robust independent parties that can use their ballot lines to fight for the issues their supporters care about, and then hold the politicians accountable on those issues,” the Mass. Ballot Freedom campaign’s Web site reads. If the practice were already law, by way of example, voters in this gubernatorial election could pull the lever for Deval Patrick under the Democrat ballot line or, say, the Health Care for All Party’s ballot line. Add Patrick’s votes together, and, supporters hope, you hand the candidate a win, avoiding the problem of fringe parties playing the spoiler role by drawing off votes from the major party candidates (read: Grace Ross).

For the record, HCFA has taken no public stand on Question Two. But, hmmmm, the Health Care For All party??? For the record, we don't endorse candidates either.

October 9, 2006

As he promised, Paul Levy's Running a Hospital blog is heating up. See the October 7 entry on Religion and Union Organizing, and see the September 29th entry on Transparency. Locking horns in a public space with SEIU 1199 and Partners Healthcare. This is getting interesting...

October 6, 2006

Here's a quick overview of upcoming public meetings associated with health reform implementation.

Connector Board Meeting
Thursday, October 12, 9-12:30pm, Ashburton Cafe, 1 Ashburton Place, Boston
Next Connector Board meetings -- November 9, November 30, December 14

Private Market Merger Commission Meeting
Thursday October 12, 10am-12 noon, Division of Insurance, One South Station

Connector Board's Outreach Subcommittee
Tuesday, October 17 -- details forthcoming

Quality and Cost Council Meeting
Tuesday, October 17, 1-2:30pm, China Trade, 2 Boylston, Boston

MassHealth Payment Advisory Committee -- first meeting
Friday, October 27 -- details forthcoming

October 5, 2006

The always excellent Mass. Medicaid Policy Institute (disclosure -- I'm a member of their board of directors) has released a brand new report on details of the federal 1115 waiver approved by the feds last July. The waiver is an essential part of the financing structure for the new health reform program. Here's the MMPI announcement:

This issue brief looks at the terms and conditions of the MassHealth waiver
that will run through FY 2008, as it was approved this past July. The July
waiver approval incorporates the provisions of the health reform law, which
enacted some of the changes required in the initial approval of this waiver
renewal, in January 2005. MMPI produced an analysis of the initial approval
last year; this brief updates the earlier one to reflect the terms of the
waiver as they now stand.

Here's one thing I didn't realize -- negotiations on a new waiver (the current one expires on 6/30/08) begin in earnest in July 2007. Whew -- no time to breathe in this game.
John McDonough

October 4, 2006

A four-part series called “Remaking American Medicine” will be airing on public television stations across the country starting Thursday evening. The series focuses on critical problems in health care quality and efforts to improve quality. Some of our local stars -- including Dr. Don Berwick of the Institute of Health Care Improvement -- are featured.

Click here to find more information. Click here to find a list of local air dates.

October 3, 2006

First rate editorial in today's Globe assessing the progress in implementing Massachusetts health reform since Chapter 58. Balanced and on target. Reprinted in full below.

Step forward on health

THE BIPARTISAN campaign to expand health coverage in Massachusetts passed a milestone yesterday when the first person applied for comprehensive insurance under the health reform law. This law is less than six months old, and changes will be necessary as experience dictates. But so far, progress in implementing it has been impressive.

The goal is to substantially reduce the number of uninsured people in the state, which the Romney administration estimates at 372,000. One of them is Madeline Rhenisch of Brighton, who with Governor Mitt Romney at her side filed her application for a new Commonwealth Care insurance policy at the Neponset Health Center in Dorchester.

These policies are first being offered to people who earn less than the federal poverty level -- $9,800 a year for a single person -- but do not qualify for MassHealth, the usual insurance for poor people. They are a bargain, with premiums defrayed by the state. Romney hopes to enroll 50,000 people.

A tougher challenge begins Jan. 1, when the state will offer subsidized policies to those earning up to 300 percent of the poverty limit, who will pay part of the premium on a sliding scale. There are gaps in the law, as the Globe reported yesterday. Children from families that earn up to 300 percent of the poverty level are covered in another program , and need to be enrolled separately.

Romney, a staunch advocate, will be leaving office. Deval Patrick, the Democratic candidate for governor, is committed to the new law. GOP nominee Kerry Healey has not yet come out vigorously in support. Leadership from the next governor will be essential, as will continued support from the Legislature.

The new Commonwealth Health Insurance Connector has done a skillful job of rolling out the policies. Three board members were chatting amiably at the Neponset center yesterday. If people as politically diverse as union activist Celia Wcislo, Romney budget chief Thomas Trimarco, and Dukakis administration veteran Dolores Mitchell can stay united on the same goal -- covering the uninsured -- this law has good prospects for success.



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