September 18, 2017

The effort to repeal the Affordable Care Act is back.

A legislative proposal introduced by Senators Lindsey Graham and Bill Cassidy to repeal Obamacare may go to a vote before the end of the month.

The Graham-Cassidy bill would end subsidies to help consumers pay for private insurance and would roll back the Medicaid expansion. States would receive lump-sum payments to put towards health care instead, but overall funding would greatly decrease. The effects of this bill would be similar to that of the other failed repeal attempts: millions would lose health insurance and health care costs would increase. This proposal would also remove important federal protections for consumers that require insurers to cover essential health benefits and to provide coverage regardless of preexisting conditions.

The bill has been picking up steam in the Senate. Senator Cassidy claims that there are already 48 Republican senators supporting it and Senate Majority Leader Mitch McConnell has reportedly announced that he will bring the bill to a vote if he believes that 50 senators back the effort.

However, there is an important timeline restriction. At the end of the month, the Senate can no longer use the reconciliation process to pass repeal; a process that currently allows the Senate Republicans to pass a bill with only 50 votes, assuming a tie-breaking vote by the Vice President. After this period, they would need 60 votes to avoid being blocked by a Democratic filibuster. 

The last repeal attempt hinged on a single vote. Putting enough pressure on key senators can completely change the outcome of repeal, so we need to apply as much pressure as possible before the end of the month. 

How you can help as a Massachusetts resident: 

Our congressional delegation is with us in the fight to protect the ACA. Senator Ed Markey and Senator Elizabeth Warren firmly oppose any attempts to repeal the ACA. You may wonder if there is anything you can do as a Massachusetts resident to block this new effort to take coverage away from millions of people nationwide. The good news is that you can still make a difference by joining our friends and family campaign!  We are urging residents in the Commonwealth to contact friends and relatives in other states and have them reach out to their own senators.

Below is a list of some of the major senators to target, and numbers to their D.C. offices. You can also tell friends and family in other states to use the dialer on https://www.savemycare.org/ They can just click on the box labeled “call your senators” and provide their zip code and phone number, and they’ll get a call that will connect them directly to their senator’s office. 

Important targets:
Alaska: Senator Lisa Murkowski: (202) 224-6665

Arizona: Senator John McCain: (202) 224-2235

Colorado: Senator Cory Gardner: (202) 224-5941

Kansas: Senator Jerry Moran (202) 224-6521

Maine: Senator Susan Collins (202) 224-2523

Nevada : Senator Dean Heller (202) 224-6244

North Carolina: Senator Thom Tillis (202) 224-6342

North Dakota: Senator John Hoeven (202) 224-2551

Ohio: Senator Rob Portman (202) 224-3353

West Virginia: Senator Shelley Moore Capito (202) 224-6472

You can also access this website www.trumpcareten.org and use the call scripts there as a guide to contact these and other senators. There is also a general call script for any senators for which the website does not have a specific script. 

We have blocked similar efforts before, and we can stop this new attempt to repeal the Affordable Care Act. Call Now!

Republican Governors can also play a major role in influencing Senators. People who live in two states in particular are urged to call their Governor's office and ask that they express their opposition to the Graham-Cassidy bill. They are:

Maryland: Governor Larry Hogan (410) 974-3901
Vermont: Governor Phil Scott (802) 828-3333

 

Integration Sought for Dental, Health Care

Advocates call for closer integration of dental care with other forms of health care at clinics. Interview for BNN News with Dr. Neetu Sing of Health Care For All and Shannon Wells of the Mass. League of Community Health Centers. Aired August 30, 2017.

Mass. health insurers uneasy over Trump’s threat to cut subsidies

“The cost-sharing reduction payments are critical for keeping coverage affordable for people buying individual coverage for themselves and their families,” said Brian Rosman, policy director at Health Care For All, a Boston nonprofit. “We know that uninsurance would increase in Massachusetts if the payments are not made.”

 

August 2, 2017

State Senate Majority Leader Harriette Chandler of Worcester, co-chair of the Massachusetts Legislature’s Oral Health Caucus, is a longtime advocate for oral health and a strong supporter of Health Care For All. Today, she published an op-ed in the Worcester Telegram and Gazette. In her article, Senator Chandler highlights the barriers currently preventing many Massachusetts residents from accessing necessary oral health care services, and encourages the state legislature to take action to address these issues. We are deeply grateful to Senator Chandler for her ongoing leadership on all health care issues, particularly her deep devotion to improved oral health. Here is her op-ed:

As I See It: Closing MassHealth gap in oral health coverage

First as a representative and later as the senator for the First Worcester District, one of my priorities has always been to make sure that people have access to the health care they need and deserve. I know that many are paying close attention to what’s happening in Washington where the future of the Affordable Care Act is on the line – and with it the access to insurance and care for hundreds of thousands of residents of the Commonwealth. We are all worried, yet access to coverage doesn’t solve all the health care problems we face in the state.

There are many other battles that we need to fight to ensure that people can get the treatments and preventive care they need. Even with more than 97 percent of the Massachusetts population covered by medical insurance, many still struggle to access oral health care – which is just as important. They struggle because our fragmented system of care separates the mouth from the rest of the body. For too many, health coverage stops short of comprehensive dental care. Quite simply for them, dental services are out of reach.

Those who are lucky have two insurance cards: one to see a medical doctor and another to see a dentist. However, even with the right card, many people cannot afford the out-of-pocket expenses that accompany much needed dental services, leading many to forego this care altogether.

I recently read an “As I See It” column published in this section written by a well-respected member of our community highlighting the challenges immigrants face when accessing oral health services. In her article, Anh Sawyer, executive director of the Southeast Asian Coalition, rightfully points out the need for increased awareness and for better integration of services, although cost remains a problem.

I agree. Educating consumers about the link between oral health and chronic conditions is critical.

Under the Affordable Care Act, Massachusetts has expanded Medicaid through the MassHealth system. The new MassHealth Accountable Care Organizations are a great opportunity to integrate dental and medical services. ACOs focus on community health, and are expected to lower prices and incentivize a healthier population. However, we must do more. I see people around Worcester every day facing high barriers to getting the care they need, especially those with limited resources. Many dentists don’t accept MassHealth due to low reimbursements. Even if they can find a dentist, many critical services are not covered because of previous state budget cuts.

MassHealth has progressively restored dental benefits, piece by piece, since they were stripped a decade ago. Yet today, 800,000 individuals – including 120,000 seniors and 180,000 people living with disabilities – still do not have coverage for the treatment of gum disease, known as periodontal treatment. They also lack coverage for specific services like root canal treatments (endodontic services), crowns and bridges (prosthodontic services), and some oral surgery procedures such as the removal of benign lesions, which are currently only available to MassHealth members under age 21 or those who are eligible for Department of Developmental Services. Unfortunately, the lack of comprehensive adult dental coverage (which would include all of the services just noted) leads to pain, tooth loss and preventable high-cost emergency department usage, to name a few.

We need to restore those benefits as soon as possible, as they are causing needless pain, suffering, and illness. The legislature has an opportunity to start the process now. I am pleased that the provision to prepare a schedule and cost estimate for restoring MassHealth adult dental care was approved as part of the final Fiscal Year 18 state budget. In addition, Representative John Scibak and I filed legislation to effectively restore all full dental benefits for adults on MassHealth. He and I also co-chair the Legislature’s Oral Health Caucus – the first such legislative caucus in the nation, focusing solely on oral health issues.

July 25, 2017

Oral health matters. Adequate oral health reduces emergency department utilization and enhances health equity. Knowing these benefits, Governor Baker included an amendment in the proposals he sent to the legislature in connection with his budget vetoes that authorizes dental therapists in Massachusetts, a proposal we strongly support. By allowing mid-level dental therapists (DTs) to deliver basic but critically necessary care, this amendment would increase access to dental coverage for underserved Massachusetts residents. At Tuesday's hearing on the health provisions of the budget veto amendents, we urged the legislature to support the Baker administration and approve this much-needed reform:

Oral health is integral to overall health, and poor oral health is a risk factor for diabetes, heart disease, stroke and low-birthweight children. Yet, one in ten Massachusetts residents lives in a dental shortage area. As a result, about half of our children do not get annual dental care, and some 60% of our seniors in long-term care have untreated tooth decay. Qualified, trained, professional dental therapists can fill this gap by providing basic oral care in vital locations such as in schools, in senior centers, and in community health settings, all under a dentists’ supervision. Dental therapists would increase access to oral health care, improve overall health and save money.

Although almost everyone in Massachusetts has medical coverage, many struggle to access dental care. Common obstacles include the inability to find a dentist that accepts public insurance, the prohibitive cost of dental care, or challenges in traveling to a dentist’s office. Dental Therapists can help with all of these issue. Access to good dental health is major problem for low-income people in Massachusetts. Dr. Don Berwick outlined oral health disparities in the Boston Globe:

Kids on Medicaid visited emergency departments for preventable oral health problems six times more often than commercially insured children; for MassHealth adults, the figure is seven times. Over half of the residents in Massachusetts nursing homes have untreated dental decay. In 2014, low-income seniors in Massachusetts were seven times as likely to have lost all their teeth as those with means. Nearly a third of adults with special needs are missing six or more teeth.”

EOHHS Secretary Sudders also testified in favor of the proposal, pointing out that in addition to improving care, dental therapists would provide savings to the state by reducing inappropriate use of emergency rooms for preventable oral health issues:

The Health Policy Commission (HPC) has been examining some of these cost drivers including avoidable emergency department visits.  The most recent data published by HPC indicates that 40% of all ED visits could be avoided if there was greater access to care.  In 2014, there were more than 36,000 visits for preventable oral health issues, costing the state upwards of $36 million.  MassHealth was the primary payer of these oral health emergency department visits that year, paying upwards of $17 million.  Emergency department visits for oral health complaints represents suboptimal use of a very costly setting. 

DTs would work under the general supervision of a dentist, using technology to share X-rays and patient records with the dentist and consult on complicated cases. This would allow DTs to deliver critical dental services directly to people in schools, nursing homes, and other community settings.

Moreover, DTs offer low-cost interventions that could prevent more costly illnesses. They would be reimbursed by MassHealth, which would expand access to dental care for people who have some coverage but are still unable to receive appropriate oral health care.

We urge the state legislature to follow Governor Baker’s lead and prioritize the oral and overall health of Massachusetts residents by adopting the DT amendment included in the Governor’s recommended budget amendments. 

                                                                                                                                                   -- Ben Agatston

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