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.

July 22, 2006

Take a look at this new opinion survey by Harris for the Wall Street Journal. Interesting and sometimes contradictory (see questions 4 and 6) results. In general, Democrats and Independents seem more closely aligned than Republicans and Independents. Also, (question 1), there seems a real shift in public attitudes about people's lifestyle choices. Seems like the foundation of support for the concept of social insurance is still running strongly.

1. People who have healthy lifestyles, don't smoke, exercise frequently and control their weight tend to incur fewer health care costs than people with unhealthy lifestyles. Do you think it would be fair or unfair to ask people with unhealthy lifestyles to pay higher insurance premiums than people with healthy lifestyles

2003 2006
Fair 37 53
Unfair 46 32

"Please tell us whether you agree or disagree with the following statements about health care."

2. People who are unemployed and poor should be able to get the same amount of quality of medical services as people who have good jobs and are paying substantial taxes.

All D R I
Agree 56 66 45 59
Disagree 18 12 27 21

3. The government should do whatever is necessary, whatever it costs in taxes, to see that everyone gets the medical care they need.

All D R I
Agree 53 68 34 57
Disagree 23 11 41 27

4. It's fair that people who pay more in taxes (or in health insurance premiums) should be able to get getter medical care than those who pay little or nothing.

All D R I
Agree 28 19 40 29
Disagree 51 60 41 54

5. It's unfair to take money through taxes from the young and middle-aged who work to pay for the medical care of those who are old and sick.

All D R I
Agree 22 20 28 22
Disagree 51 58 44 58

6. If the only way to make sure that everyone can get the health care services they need is to have a substantial increase in taxes, we should do it

All D R I
Agree 28 43 15 30
Disagree 42 32 57 45
July 22, 2006

Interesting article in the July 21 issue of Forward, the progressive Jewish weekly, on the role played by the Greater Boston Interfaith Organization in Massachusetts health reform: "Religious Liberals Take Lead In Massachusetts Health Debate." The article discusses GBIO's role going forward into implementation, as well as the national context of GBIO's work and the debate over the role of faith-based organizations in US politics. Click here to read.

July 20, 2006

Terrific piece in this week's New England Journal of Medicine on language competency (or lack thereof) in US hospitals -- written by Dr. Glenn Flores of the Medical College of Wisconsin, and a former pediatrician at Boston Medical Center. Click here for free access to the article. Here's the start:

A 12-year-old Latino boy arrived at a Boston emergency department with dizziness anda headache. The patient, whom I'll call Raul, had limited proficiency in English; his mother spoke no English, and the attending physician spoke little Spanish. No medical interpreter was available, so Raul acted as his own interpreter. His mother described his symptoms:

"La semana pasada a el le dio mucho mareo y no tenía fiebre ni nada, y la familia por parte de papá todos padecen de diabetes." (Last week, he had a lot of dizziness, and he didn't have fever or anything, and his dad's family all suffer from diabetes.)

"Uh hum," replied the physician.

The mother went on. "A mí me da miedo porque el lo que estaba mareado, mareado, mareado y no tenía fiebre ni nada." (I'm scared because he's dizzy, dizzy, dizzy, and he didn't have fever or anything.)

Turning to Raul, the physician asked, "OK, so she's saying you look kind of yellow, is that what she's saying?"

Raul interpreted for his mother: "Es que si me vi amarillo?" (Is it that I looked yellow?)

"Estaba como mareado, como pálido" (You were like dizzy, like pale), his mother replied.

Raul turned back to the doctor. "Like I was like paralyzed, something like that," he said.

One study estimates that no interpreter was used in nearly half of visits to US emergency departments by folks with limited English proficiency. This is an important issue, and growing in importance every day.

July 18, 2006

In 2000, HCFA filed a federal civil rights lawsuit against the Commonwealth of Massachusetts charging that the MassHealth dental program for kids violated federal law. On July 14, 2005, Federal District Judge Rya Zobel agreed with us, and ordered the Commonwealth to work with us to develop a workable remediation plan. Our crack law firm, Health Law Advocates, has carried this effort every step of the way. They have put out a brief overview of progress made in the past year. See below:

One year after a federal judge ruled that Massachusetts had “fallen far short of meeting statutory obligations” to serve the dental needs of children on MassHealth, progress is being made toward providing these children with the dental care they need and deserve.

July 14th marked the anniversary of the U. S. District Court’s decision in Health Care For All v. Romney, in which Health Law Advocates achieved victory for the plaintiffs. Last February Judge Rya Zobel incorporated the parties’ detailed remediation plan in a final judgment. Notable accomplishments since that time include:

•Amendment of MassHealth regulations to eliminate requirements that dentists get approval before providing certain services to children and permitting provision of preventive and restorative dental care during an emergency visit.
•Near completion of an agreement between MassHealth and Delta Dental of Massachusetts, under which Delta will run the MassHealth dental program.
•Increased reimbursement for many dental services provided to children on MassHealth.
•The appointment of Dr. Catherine Hayes of the Harvard School of Dental Medicine as the independent remediation monitor. Dr. Hayes is committed to improving access to dental care for low-income children and will ensure that the remediation plan is fully implemented and evaluated.
•The formation of a committee, consisting of plaintiffs’ experts and state officials, to evaluate approaches to improving children’s access to dental care, including through expansion of dental services in schools and pre-schools and integration of dental screenings into pediatric well-child visits.

In addition, Health Care For All is developing a blueprint for expanding dental services in schools and preschools, which will be detailed in a report to be issued later this year. It is hoped that the plan will serve as a model for expanding access to dental care for underserved children.

Despite the foregoing successes, much work remains to be done. The federal court found that children with MassHealth encounter “extraordinary difficulty in obtaining timely dental services.” It will take years to fix the longstanding deficiencies in access to dental care for low-income children in the Commonwealth. The litigation will have succeeded when children on MassHealth can obtain quality dental care without barriers.

Congrats to HLA and the State for working together to make this progress. Much, much more to be done. And good progress to date.

July 15, 2006

Has anyone noticed the increasing use of the word "granular?" I'm starting to hear it more and more, and wondering if I just missed some cultural milestone. Anyway, in the interest of joining and spreading this trend, check out this "granular" look at real life consumer experience with Health Savings Accounts provided by United Health Care. Story provided courtesy of Joe Paduda and his excellent Managed Care Matters blogsite.

An $800 dollar medical charge, discounted to $250 by United, still costs the consumer $800 when paid as part of the deductible obligation.

The reader comments are also worth a look a look.

Do you have your own stories to share? Let's hear them...

July 9, 2006

This morning Governor Romney took out his veto pen and whacked away at the state budget for fiscal year 2007 (which started on July 1).

In general, the health reform access programs were not affected, although the Governor did veto $114 million in payments to hospitals and community health centers that were connected with the MassHealth waiver. About $75 million in MassHealth spending was cut, mostly for particular providers.

However, the Governor did find and veto most of the smaller initiatives we had been working on in the budget.

Among the vetoes and spending reductions were:

  • a provision directing DPH not to charge for birth certificates requested in order to prove citizenship for MassHealth eligibility
  • a provision requiring legislative approval before the administration cuts benefits or increases premiums or other cost sharing for the existing MassHealth program. The federal 2005 Deficit Reduction Act allows states to impose changes in base Medicaid populations previously protected from benefit cuts or new cost sharing.
  • a provision championed by CHAC, the Children's Health Access Coalition, extending MassHealth coverage to 19-year olds aging out of the foster care system. The Governor vetoed the $1.5 million this program would cost.
  • one of the Oral Health Task Force's priorities authorizing a pilot program in Hampden county to provide oral health screening to preschool children.
  • a provision clarifying that MassHealth will pay for all emergency and non-emergency medically necessary ambulance trips
  • the open enrollment period for the Prescription Advantage program
  • a $10 million rate increase for Community Health Centers was reduced in half to $5 million

The last few weeks of formal legislative sessions (which ends July 31) will be devoted to overriding the many vetoes issued in the budget and other bills. We urge the legislature to include these items in the list of overrides.

(written by HCFA's Brian Rosman)

July 5, 2006

Today, the MassACT Coalition announced it will not file the final set of signatures to qualify the MassACT ballot initiative for the November 2006 state ballot. Coalition members collected more than 25,000 of the needed 11,000 signatures to qualify. (138,000 signatures collected, fall and spring, all by volunteers.) The deadline for filing is today at 5pm. The decision was announced at a noon press conference in front of the State House that displayed the final set of signatures.


Chiefly, the health reform law passed in April met most major goals of the MassACT campaign - especially expanded and affordable insurance coverage for most Massachusetts uninsured, restored benefits for 600,000 poor adults on MassHealth, fair payment for health care providers, and more. The major unmet goal - employer responsibility - was only minimally met by the new Health Reform Law, known as Chapter 58.

In brief, the accomplishments of Chapter 58 are good enough for now, and the organizations making up MassACT are working hard on full and fair implementation. A ballot campaign in November would be a major distraction for everyone from the important implementation work ahead.

Then why did MassACT go through the final signature collection phase? Good question.

The key reason was to make sure, as much as possible, that the promises of Chapter 58 were kept:

We wanted to make sure all Gov. Romney's eight vetoes were overridden by the House and Senate - and they were.

We wanted to make sure health reform was fully and fairly funded in the FY07 state budget - and it is.

We wanted to make sure the Romney Administration adequately implemented the MassHealth benefit restorations and eligibility expansions - and they did.

One missing piece - we wanted to make sure the Bush Administration fully funded the federal waiver to pay for health reform - and we're still waiting.

Romney officials assure us the hang-ups are temporary, technical and not substantive, and will not undermine Chapter 58 implementation. Because the filing of signatures is not reversible, coalition members voted unanimously to give the Administration the benefit of the doubt.

Importantly, MassACT members voted unanimously not to dissolve the Committee. The issues of employer responsibility and fair financing of Chapter 58 will not go away. Indeed, they will become more urgent and compelling in 2007 and 2008. The elements of the business community determined to protect and defend employers who don't provide health insurance to their workers know this issue is far from over.

Under Chapter 58, employers who don't cover their workers will still have an economic advantage over employers who do. And employers who cover their workers will still be required to pay their share of the $160 million employer assessment to finance coverage for firms that don't cover. And the financial shortfalls predicted to emerge in FY2009 assure that employer responsibility will continue to be front and center.

MassACT will be around to make sure of that.

* * *

Special thanks to the organizations who comprise MassACT: Coalition for Social Justice, Families USA, Greater Boston Interfaith Organization, Health Care For All, MA Building Trades Council, MA Business Leaders for Quality Affordable Health Care, Neighbor to Neighbor, Service Employees International Union Locals 615 and 1199, and United Food & Commercial Workers Union.

Thanks to thousands of individuals who collected nearly 140,000 signatures in fall '05 and spring '06. This was a volunteer effort start to finish.

And a word of praise for Lisa Vinikoor, the indefatigable MassACT campaign director who poured her heart and soul into this campaign since last July. She and former co-director David Jordan (now Sen. Pat Jehlen's chief of staff) organized one heck of a campaign. Lisa is heading for work as a new organizer for the Greater Boston Interfaith Organization. Thanks Lisa!

July 1, 2006

We've always known we would have agreements and disagreements with the Romney Administration as they move to implement health reform. Chalk this one up in the Disagreements column. And click here for today's Boston Globe story on this issue, written by the always perceptive Jeff Krasner. Click here to obtain the notice and proposed regulations.

Here's HCFA's press release on the proposed regulations issued yesterday by the State's Division of Healthcare Finance and Policy defining which employers will have to pay the $295 assessment on "non-offering" employers:

The State’s Division of Health Care Finance and Policy today released regulations setting “unfair and unreasonably low standards” for the amount of health insurance employers must provide to avoid a $295 per-employee, annual fee under the new Massachusetts health reform law, according to Health Care For All.

Under the proposed regulations, employers must only provide coverage to 25 percent of full time workers. Employers can evade this requirement by offering to cover 33 percent of the cost of an employee health plan. If 25 percent of employees take the coverage, there is no requirement that the employer pay any part of the premium, that any family members be covered, or that the insurance be of any quality or value. The Division was charged to create regulations to define the law’s requirement that employers make a “fair and reasonable” contribution to their employees’ health insurance coverage or pay a fee up to $295 per employee per year.

“The proposed regulation is not fair and not reasonable,” said John McDonough, Executive Director of Health Care For All. “The proposed regulation does not give employers an incentive to make a significant contribution to their employees’ health coverage, or any incentive to provide coverage to part time, seasonal or contract employees. Under the regulation, part time, contract and seasonal employees are not included. “The proposal ignores two populations health reform was meant to help: full time workers whose employers don’t offer coverage and part time and seasonal workers who can’t get coverage,” added McDonough.

Health Care For All and the Affordable Care Today Coalition, in testimony last week, called for requiring employers to cover at least 50 percent of the cost of their employees’ coverage, still below the current average of 70 percent, and to pro-rate this for their part time workers. The administration’s proposal falls significantly below this standard. John McDonough concluded, “This proposal would allow most employers to make no change in their health insurance offering and avoid the fee. It fails to increase the number of people with employer sponsored coverage or raise significant money to provide government sponsored care.”

Legislative conferees estimated the $295 assessment would generate $48 million to finance health reform. The Administration estimates the new requirement will generate only $26 million. “By ignoring the intent of the Legislature, the proposal undermines the financial stability of health reform,” added McDonough.

June 30, 2006

The conference committee finished work on the FY 07 budget at 6:30am this morning and rushed it to a vote in both chambers today, where it was approved overwhelmingly. The Governor now has 10 days to submit vetoes, and we expect many. Here is a quick summary of health related items adopted today.

Medicare Part D Safety Net Extended!: The budget included extension and clarification of a law that allows Medicare Part D enrollees who also receive MassHealth or Prescription Advantage to receive medications through those programs if Medicare Part D does not work for them. Almost 200 people a day rely on this law, which was due to expire today, June 30th. The law has been extended until December 31st.

Foster Children’s Coverage Expanded: The budget included a long-awaited provision to expand MassHealth coverage through age 19 to kids aging out of DSS custody. As a result, 600 foster kids annually will be eligible to extend MassHealth coverage for another year.

Children’s Medical Security Plan Premiums Set For Another Year: Included in the budget is the annual authorization for the affordable fee structure for the Children’s Medical Security Plan (CMSP) as passed by the Legislature in last year’s budget. CMSP provides basic primary care coverage to uninsured children who are ineligible for MassHealth.

All Priorities of the Oral Health Advocacy Task Force Included in the Budget: The legislature earmarked $500,000 for the creation of a Preschool Oral Health Pilot Project in Hampden County. The Department of Public Health’s Office of Oral Health is fully funded at $1.8M.

Full Funding for Health Reform: As promised, the FY 07 budget included funding necessary for Chapter 58 of the Acts of 2006, the comprehensive health reform package passed earlier this year. The legislature also changed the effective date for the MassHealth provider rate increases to make them effective tomorrow, as originally intended


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