August 14, 2006

Lots of activity coming this week on the issue of affordability for MA health reform and potential enrollees with incomes under 300% of the poverty line ($29K for individual, $60K for family of four). Tomorrow, the Insurance Connector is scheduled to release a draft regulation setting premiums and copayments for policies to be made available to this group.

Folks with incomes under 100%fpl will be eligible for coverage with no premiums or deductibles beginning on October 1. Folks between 101 and 300%fpl will be required to pay premiums and higher copayments (no deductibles) and coverage will be available beginning on January 1. An estimated 200,000 persons will be newly eligible under this program.

We'll post on our ACT website the draft regulations as soon as they are available. We'll also include a posting here to let you know they are available.

The Board of the Connector is scheduled to meet on Thursday at 9am (1 Ashburton Place, 21st floor) where they are expected to approve draft regulations. There will be a public hearing on these draft regulations on September 25th.

August 10, 2006

RE: Our August 8th post on the dispute over the $295 "fair share employer assessment" and what the Legislature meant by "fair and reasonable." The August 8th Boston Globe reported that House Health Financing Chair Patricia Walrath sent a letter (read it here) to the Division of Health Care Finance and Policy disagreeing with their interpretation that would allow many businesses to escape the minimal assessment. Unbeknown to us, Senate Health Financing Chair Dick Moore sent a letter to DHCFP back on July 3 also disagreeing with their interpretation. Mass. Taxpayers Foundation Chief Mike Widmer spoke at Tuesday's DHCFP hearing in favor of the administration proposal and claimed to have the franchise on interpreting legislative intent. Two health reform conferees, Moore and Walrath, are now on the record and both flatly disagree with the proposed DHCFP regulation. Here is Senator Moore's letter: July 3, 2006 Ms. Amy Lischko, Commissioner Division of Health Care Finance and Policy 2 Boylston Street, 5th Floor Boston, MA 02116-4734 Dear Commissioner Lischko: As a sponsor and Senate chair of the conference committee of Chapter 58 of the Acts of 2006, I am pleased to offer my comments with regard to the draft regulations (114.5 CMR 16.00) for the determination of the “employer fair share contribution,” as provided by Section 188 of chapter 149 of the General Laws. •In 16.02, there should be a definition for Part-time Employee since the law envisioned part-time, seasonal, or temporary employees being aggregated as full-time equivalent employees for the purposes of defining employers of eleven or more full time equivalent employees. •In 16.03, it was not the intent of the legislature to exempt employers from the fair share contribution if they simply “offered” insurance to their employees. Consequently, the primary test established in 16.03 (1) (a) should be combined with the secondary test established in 16.03 (1) (b) so that not less than 25% of employees must be enrolled in an employer sponsored health insurance plan and the employer must contribute to that plan or be self-insured in order to meet the Legislature’s intent of a “contributing employer.” •In 16.03 (1) (b), my recollection of the Legislature’s discussions on defining a “fair share employer” was that employers would be expected to contribute at least fifty percent of the premium cost. Furthermore, I would suggest that there be a limit on the size of the any co-pay to not more than $1,000 so that the insurance plan is within range of being useful to the employee. Remember, we are not requiring employers to offer employer-based health insurance or to self-insure, but simply to determine if they are contributing a fair share to the cost of the uninsured through the payment of the $295 per employee per year assessment. •In 16.03(1) (a) 1.b., relative to the total payroll hours of full time employees, the regulations should refer to “full-time equivalent” employees. It was never the intent of the Legislature not to count part-time, seasonal, or temporary employees since they need to be insured as well. It is clear that the Legislature’s intent was to aggregate any less than full-time employees into full-time equivalents. Further, it is the intent of the Legislature to pro-rate the fair share assessment based on part-time or seasonal employees. For example, a seasonal employee who works from June through September would require the employer to pay a pro-rated one-third of the $295 assessment. Similarly, a half-time employee would require the employer to pay one-half of the $295 assessment. •In 16.04, it should be clarified that “fair share” contribution applies only to non-contributing employers and not to employers who currently offer health insurance to their employees or self-insure their employees. The matter of defining an appropriate contribution by contributing, as opposed to non-contributing employers remains as is, subject to any legislative change that might be made based on the recommendations of the special commission established to review the contributions to the Uncompensated Care Pool of contributing employers. If, as Secretary Murphy stated in the June 30, 2006 press release announcing the “fair share” assessment, the Administration’s objectives included respecting legislative intent, then I respectfully suggest that the regulations need to be modified in order to be consistent with legislative intent. I welcome the opportunity to discuss the proposed regulation with you and your staff at some mutually convenient time. Sincerely, RICHARD T. MOORE Senate Chair Committee on Health Care Financing

August 8, 2006

On the 21st floor of Ashburton Place this morning in a small room boasting a great view of the city, hard-core children’s health access advocates gathered to testify at a Medicaid regulatory hearing about Chapter 58 (Health Reform) changes to the Children’s Medical Security Plan (CMSP) that may leave some kids without health coverage rather than improving access opportunities as the health reform law intended to accomplish. (You can see the draft regs by clicking here.)

As coordinator of the Children’s Health Access Coalition (a statewide group of over 50 community, business, consumer, provider and advocacy organizations,) I assembled coalition partners to urge our state Medicaid Director to consider retaining the option of CMSP coverage for MassHealth kids who lose coverage for an arrearage in premiums. Prior to July 1 2006 this was the practice. Post- Chapter 58, if a family is eligible for MassHealth, the children are auto-enrolled in this better program and the family is then expected to pay higher premiums.

Although enhanced health services are good, in some cases the new premiums are three times what families paid before for CMSP. The reality is that at the end of the month this may be the expense in the household that becomes expendable and kids suffer the result of lost health coverage. CHAC applauds the Romney Administration for their commitment to expand access for kids; we are worried that there will not be a safety net to catch kids whose families are unable to adjust to higher premiums required by MassHealth.

We hope Medicaid will carefully monitor what happens to families facing transition from CMSP to MassHealth- and will be take remedial action if a significant number of families are unable to make this conversion successfully. As advocates, CHAC members are thankful for the opportunity to be heard. As watchdogs, we know change requires flexibility and we want to work with the folks at Medicaid to make sure kids don’t drop off the health insurance rosters. We hope that you will be watching too.

Click here to check out CHAC.

Written by HCFA's CHAC Coordinator, Mindy Cohen.

August 3, 2006

Today's Boston Globe reports that a portion of coverage expansion originally scheduled for October 1 will be postponed until January 1. Click here for article.

C-CHIP stands for Commonwealth Care Health Insurance Program. It is the subsidized coverage program for uninsured folks with incomes below 300 percent of the federal poverty line (about $29,000 for an individual and $60,000 for a family of four. For eligible folks with incomes below 100%fpl, C-CHIP coverage will have no premiums or deductibles. For this group, estimated at around 100,000 persons, coverage will become available as scheduled on October 1.

For the group 100-300%fpl, another 100,000 folks, they will obtain C-CHIP coverage without deductibles and with premiums on a sliding scale basis depending on family income. Creating this class of coverage, because of the need to create premium collection systems and other issues, needs more time. We don't think this delay is unrealistic. The original timeline was quite ambitious.

Our big concern involves the level of premium support for folks 100-300%fpl. That will be the issue of greatest concern for the immediate future and we will know the Connector's initial proposal on this by August 15th. The board will vote on an initial premium support plan at its August 17th meeting.

The Connector Board will hold a public hearing at Gardner Auditorium at the State House next Wednesday, August 9, beginning at 11am (first come, first serve sign up). They will hear testimony as long as it takes.

Don't you just love the lazy days of summer?

July 31, 2006

The House passed a bill making "technical corrections" to the health reform statute late Thursday. The bill number is H. 5240. The Senate may take the bill up tonight, the last day of formal sessions, or it may consider the bill during the informal sessions that will continue through the rest of the year.

The bill is a must-pass, because some of the federal funding associated with health reform depends on some wording changes required in the federal waiver approval.

The House-passed bill is a major improvement over the administration's informal submission. It does not include the proposal to allow changes to free care pool regulations that would have blocked access to coverage for low-income people not enrolled in C-CHIP plans. We had argued that the repealing the legislature's moratorium on pool changes was unfair during the transition to a new, complex health system. The House bill also rejects the administration's proposal to add the Secretary of Health and Human Services to the Connector Board, and does not include some provisions harmful to immigrant access.

The House bill does include some good provisions to clarify and strengthen chapter 58, including
clarifying the payment from firms that provide health coverage if a low income worker seeks CCHIP coverage and fixing a number of inconsistent effective dates.

July 31, 2006

Spent the latter part of last week in Colorado at the invitation of the Colorado Health Foundation. Folks out there are interested in kicking the tired on the MA health reform plan. I tried to give 'em just the facts and let them draw their own conclusions. Some observations:

Lots and lots of interest in what we did. A Denver Chamber of Commerce lunch drew over 300 folks. Four health care foundations -- all resulting from non-profit to for-profit conversations -- are collaborating to jump start reform interest in the state which has about 17% uninsured compared with our rate of under 10%. Several hundred state legislators and health industry folks at an annual symposium were genuinely eager for details and understanding.

Reform is held back in Colorado because of something called TABOR -- taxpayers bill or rights -- which strictly limits state spending increases and requires voter approval of nearly all tax increases. Surprisingly, the business community is trending increasingly anti-TABOR as the inability to increase public investments thwarts improvement in health care, education, and infrastructure.

I met with the Dem candidate for governor, Bill Ritter, Denver DA, who is now surprisingly ahead of Republican Congressman Bob Beauprez, with the latter losing business support because of hardline TABOR support. Ritter's a sensible guy who wants to move a health care agenda.

Lots of desire evident to address health coverage as a critical state need. Not a lot of certainty how to do it. The Massachusetts plan has some interesting facets that could be helpful in CO. But they are starting from a much more difficult place and have a much higher hill to climb.

July 28, 2006

Today members of the Connector Board’s Affordability Committee and a few hard-core Connector groupies traveled to Shrewsbury. With all of Bruce Butler’s talk of signposts, directions and parking lots, it felt like we were starting a journey. Between the heat and gas prices, I’m reluctant to travel too much, but there was one advantage of the trip: with only eight audience members, there were finally enough chairs.

Covering Ground
The Connector seems to be making some headway, setting firm dates, and developing substantial positions. Jon Kingsdale said the Board will have to make decisions about affordability and premium assistance at its August 17th meeting. Kingsdale also distributed a draft outline of proposed benefits for CCHIP plans based on his discussions with MMCOs. Unfortunately the outline is thinner than MassHealth Essential and proposes copay ranges that could be quite high. (The benefits outline along with other materials distributed are available here)

Giving Directions
Committee chair Bruce Butler noted that the Committee’s role is to give guidance to the Board, not to make decisions. To that end, the Committee did not make any substantive decisions. Rather it decided that it would present info to the Board next week, then investigate the topic further and present the Board with two or three options to choose from on August 17th. The key guideposts for each option will be the CCHIP premium for the bottom end of eligibility, 100% of the federal poverty level (fpl), and the premium for the high end, at 300% fpl. Then drawing the line in between the two will be possible.

Road Map
The Committee spent most of the meeting discussing a draft of Jon Kingsdale’s presentation for August 3rd, which is meant to be a road map to guide the Board through calculations of enrollee contribution and premium assistance. The Committee talked a lot about who will have to make up the difference in costs if an enrollee opts for a plan other than the lowest premium plan in an area. Celia Wcislo argued that the state should pay the same percentage of cost, no matter which plan the enrollee chooses, while Kingsdale’s presentation assumed the enrollee would pay the full difference between the cost of the lowest premium plan and the chosen plan. Kingsdale admitted that this structure is meant to drive people into low premium plans. Celia worried that the lowest premium plans would be low quality and have high cost sharing. The other members responded that regulating benefits, cost sharing, and networks could preserve quality. In the end, the members decided that Kingsdale should present Celia’s concerns along with his proposal.

Note that the draft presentation presents as an example premiums ranging from $20/month to $135/month. Kingsdale emphasized that this was done as an illustration of the math and that he "pulled numbers out of the air."

Which Path to Choose?
The Committee also discussed a memo by Jon Gruber regarding three methods of estimating affordability. The first method was to calculate how much money an enrollee needs for necessities; the amount left over is then available for premiums. Gruber said he liked Paul Dryfoos’ methods of estimating the necessary costs for a family, but disagreed with some estimates; primarily Dryfoos’ estimation of costs for child care. The second method, Gruber’s preferred method, was to look at what people actually spend on health care. Although he admits that his data sources are not ideal, he concluded that it is reasonable to require people at around 200% of fpl to pay 5% of their income toward health insurance. This would mean premiums of about $82.00 per month for an individual earning $19,600 a year, although later Gruber modified this to mean that total out of pocket costs including premiums should not exceed 5% at the middle of the CCHIP income range. A third method, which was less appealing to Gruber, was to refer to premiums charged in other government programs.

Everyone concluded that there many tough issues involved (Kingsdale called it a morass) and that finding the best answer may be impossible in the short time available.

Cross Country
The Committee next discussed the premium contributions required by other states’ insurance plans for low income people. The most common range of premium contributions seemed to be approximately 1-6% of income. Celia noted that the most successful plans have no co-pays for preventive care and below market co-pays for other services.

Upcoming Tour Dates
The Committee plans to meet again on August 3rd after the Board meeting in Boston. Then they will meet on August 10th in Lowell, followed by a return to Boston on August 17th for the full Board meeting to approve draft premium regulations. This will permit a hearing on the premiums on September 25, and final approval on September 28, two days before the legal deadline. When faced with the meeting schedule Gruber said, “this is destroying my summer vacation.” To which Kingsdale responded, “welcome to my life.” Life is tough when you’re in such high demand.

written by HCFA's Eric Benson

July 28, 2006

The State hasn't posted the waiver documents yet, but we have them. Dig in, health reform wonks.

Also, State House News reported this afternoon that the health reform technical amendments legislation may move today (Thursday). One reason for urgency in moving the bill is a waiver provision that prevents the state from getting certain federal reimbursements until a technical correction is enacted. We'll try to post anything we get as soon as we can.

Friday, the Affordability Committee of the Connector meets to discuss affordability issues, particularly C-CHIP premiums. The meeting, open to the public, is at 10:00 at the Hoagland-Pincus Conference Center in Shrewsbury. We'll have an update on that meeting, too.

Friday morning addendum
: The House and Senate were in late last night (House 'till 11:37, Senate past midnight), but no technical corrections bill emerged on the floor, and the House passed a 56-section technical corrections bill. Both branches meet for the last day of formal sessions next Monday. A bill could be passed during the "informal" sessions that continue for the rest of the year, but unanimous consent would be required.

July 25, 2006

US Sen. John Kerry is sponsoring a health care dialogue at Boston's Fanueil Hall on July 31 at 12 noon. Here's the invitation:

Dear Friends,

On July 31, I hope you'll join me to wade into a debate that underscores everything that's at stake here at home -- the struggle for health care that works for everybody. Few problems in our country have remained more intransigent, or have found less political leadership willing to tackle them, than health care. While Washington remains cautious, the problem gets worse. Over the last six years, six million more Americans have joined the ranks of the uninsured. Right now there are more than 46 million people uninsured in this country, including 11 million children. In the last five years health insurance premiums have gone up 73 percent. Health care costs for a family of four now cost more than a minimum wage worker earns in a year.

Health care related costs are the number one cause of personal bankruptcy, and for millions of Americans with care, the costs are going through the roof while the benefits keep getting squeezed. We've gone from an economy where our parents could count on a job coming with health care to an economy where many companies that do provide health care struggle to remain competitive while other big companies are deciding not to provide health care at all. We can't afford to tinker around the edges. We need to take the health care issue head-on.

Join me at noon on July 31 at Faneuil Hall so we can jumpstart the dialogue we need to have about health care in America. Please arrive by 11:30 a.m. Tickets are free. Join the discussion: RSVP to attend on July 31.

Faneuil Hall is the birthplace of American democracy -- the place where the big issues have been confronted, not avoided. That's why I'm returning to Faneuil Hall to talk about health care. Your support and encouragement for our shared vision of a stronger America is critical. We need to make it clear that we won't allow Washington or Wall Street to ignore the health care crisis any longer. Thank you, and I look forward to seeing you on Monday, July 31.

John Kerry

July 25, 2006

Congrats to Service Employees International Union 1199 for a huge legislative win. Yesterday, the House and Senate overwhelmingly overrode Gov. Romney's veto of the so-called PCA bill.

The new law will establish a central clearinghouse for disabled persons to find qualified personal care attendants, and will allow PCAs to obtain decent benefits, including health coverage. It will set up Personal Care Attendant (PCA) Quality Workforce Council, helping reduce turnover among PCAs and ensuring that people with disabilities and the growing number of seniors can access the care they need to live at home in Massachusetts. It will result in a higher quality PCA workforce, and it will cost more money, because PCAs are now paid disgracefully low wages without benefits. SEIU had threatened to pass this law on the November 2006 state ballot, and withdrew the question after the House and Senate approved the law unanimously.

Last Friday, Gov. Romney vetoed the legislation. In his veto message, Romney called “several provisions … deeply disturbing,” and said the bill “appears to be designed exclusively to benefit a particular union by supplementing its membership with private sector and not-for-profit employees at the taxpayers’ expense.” Romney charged the bill could qualify as many as 20,000 people for public-sector employee benefits. Amendments Romney sent back two weeks ago were rejected.

Great piece of work by 1199 that got just about no media attention.


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