April 27, 2017
 
The American Health Care Act (AHCA) was first introduced by House Speaker Paul Ryan on March 20th, 2017. The latest proposal keeps all of the bad features of AHCA, such as the $880 billion cuts to Medicaid and plans to strip more than 20 million people of their health insurance. Added to that it would allow states to gut the main consumer protections of the ACA and return to a time when insurers could discriminate against those living with preexisting conditions – charging them higher premiums and selling them plans that don’t meet their health needs by limiting benefits and increasing out-of-pocket costs.
 

Even though Congress is trying to avert a government shutdown, the health care debate remains critically important as Speaker Ryan roams the halls looking for votes in support of his bad bill.

We have a real chance to stop this. 
 
In Massachusetts, our congressional delegation has already committed to defend our gains in health care, but we can still make a difference in this battle. 
 
We're asking everyone to please contact your friends and family who live in states with Republican US representatives. You need to ask them to get in touch with their members of Congress to ensure that they don't support this dangerous bill!
 

 

Tell them how health reform has been a success, and direct them to http://bit.ly/CallCongressCC

Thank you to our partner organization Community Catalyst for the information, resources, and leadership they provide in this fight. 
April 13, 2017

The state House of Representatives released their draft budget this week. The budget funds the state's MassHealth and other health programs, and includes many provision supported by HCFA. Our friends at the Massachusetts Law Reform Institute released an outstanding summary of the provisions affecting low income residents, including MassHealth and other health concerns. House budget debate starts on April 24.

Net state spending for MassHealth is just 14% of state budget

We want to offer an important correction to a misleading fact often cited in the press. It is claimed that MassHealth, our Medicaid program, consumes 40% or more of the total state budget, leading policymakers to decry out of control spending for Medicaid. Yet this statistic ignores the fact that that the vast majority of that spending comes from the federal government, and doesn't come out of state revenue. It's just a pass-through.

The real numbers are that Medicaid costs make up just 14% of state spending from state revenue. The rest is all federal money, that comes into Massachusetts, and is then spent in our economy, benefiting Mass residents. See the graphs on this presentation from the Blue Cross Foundation, chart 5, reproduced above. So, claiming that Medicaid costs us 40% of the budget is very misleading

HCFA is pleased that the House budget proposal includes a reinstatment of the state's employer responsibilty law. This will assess a fee on large employers who do not provide health insurance coverage to their workers. A similar fee was included in chapter 58, the 2006 health reform passed under Governor Romney, and was also part of the Affordable Care Act. The state fee was repealed several years ago, and with the ACA fee in danger of being repealed, or nor enforced, it's important for the state to step in and make sure that employers are prompted to provide coverage.

HCFA is supporting a number of important amendments to improve the budget. Please, call your state Representative, and urge him or her to support HCFA's budget priorities. Here's our list:

Improve Children's Health Coverage

Thousands of children who are not eligible for MassHealth and do not have access to private health insurance through their parents can get basic coverage through the Children's Medical Security Plan (CMSP). However, CMSP benefits have strict limits on coverage that are inadequate to keep a child healthy; for example, a $200 limit on prescription drugs and a 13-visit limit on mental health services. The FY2018 budgets proposed thus far cut funding for CMSP from $17.4 million to $12.4 million. Please support Rep. Barber's amendment to restore $5 million in funding for CMSP and to direct EOHHS to develop a plan to improve the scope of benefits (adding language and $5 million to line item 4000-0990).

Ensure Access to Transportation for Medical Appointments

Non-emergency medical transportation provides access to and from medical appointments for MassHealth enrollees who do not have other means of transportation. EOHHS has indicated it plans to seek a waiver to eliminate this benefit except for travel to substance use disorder (SUD) treatment services for MassHealth CarePlus (Medicaid expansion) enrollees. About 13,000 MassHealth CarePlus enrollees used non-emergency medical transportation for non-substance use disorders (SUD) services last year. Please support Rep. Gentile's amendment (#100) to ensure that MassHealth CarePlus enrollees continue to receive appropriate transportation to all necessary medical appointments (adding language to line item 4000-0940).

Restore Periodontal Treatment Coverage for Adult MassHealth Enrollees

Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss leading to eventual tooth loss and also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth. Therefore, coverage for the treatment of periodontal disease is critical to improving the oral and general health of the adult population. Please support Rep. Scibak’s amendment to restore coverage for periodontal services for adult MassHealth enrollees (adding language and $10 million to line item 4000-0700).

Plan for Full Restoration of MassHealth Adult Dental Benefits

More than 1 million people, including 149,000 seniors and 245,000 people with disabilities, are without access to dental care beyond cleanings, fillings, extractions, and full dentures. Without access to appropriate dental care, many people living with chronic illnesses such as diabetes or hypertension see their conditions worsen. Those with oral health issues that may have been easily resolved with a simple procedure may require far more invasive and costly treatments. Please support Rep. Pignatelli’s amendment directing EOHHS to develop a plan to fully restore dental benefits for adult MassHealth enrollees (adding language to line item 4000-0700).

March 10, 2017

"Dentists still drill and fill teeth and physicians still look at the body from the tonsils south."

Julie Beck from The Atlantic just wrote an article that highlights the importance of dentists working alongside physicians. Read the article here.
At Health Care For All, our Oral Health Integration Project (OHIP) promotes the health of all Massachusetts residents by building a broad-based coalition advocating for the integration of dental and medical care. 
Our current objectives are to include oral health and dental services as a requirement of new state standards for Medicaid and commercial Accountable Care Organizations (ACOs). Given ACOs’ focus on whole-person health, the inclusion of oral health is critical to fully realize the potential of integrated care. For more information on OHIP, click here.
November 30, 2016

Tom Price tears a page from the health care bill during a press conference. (Win McNamee/Getty Images)

The announcement by President-Elect Trump to nominate Rep. Tom Price as federal Secretary of Health and Human Services is chilling. As the Vox headline put it, "By picking Tom Price to lead HHS, Trump shows he’s absolutely serious about dismantling Obamacare." Price introduced a draconian version of an ACA replacement plan, even much less generous than the stingy plan sponsored by Speaker Paul Ryan. The centerpiece is the elimination of income-based help for the purchase of insurance. In an ironic flip of priorities, the Price plan provides more help to younger, healthier and richer people, at the expense of older, sicker and poorer Americans, who would get much less assistance. The plan also sets up deep cuts in Medicaid funding (explained here), which would necessitate slashing coverage and benefits for the 1.9 million low-income Bay Staters who depend on MassHealth for their medical care.  

But here in Massachusetts, there's a broad consensus in opposition to cuts which would hurt our best-in-the-nation record of expanding coverage and virtually eliminating uninsurance. Today's Globe included statements from the heads of the Biotechnology Council (“I’d hate to see us go back to a day where so many people are uninsured or can’t get insurance because of preexisting conditions”) and the state Health and Hospital Association ("Fundamentally, it’s like a sweater with threads, if you pull a few out, you gotta repair that somehow") opposing any changes to the ACA.

Governor Charlie Baker is with us, too. He was very clear about his approach

"Massachusetts had a universal plan in place before the Affordable Care Act. It's important to the people of Massachusetts that we can continue to be committed to that," Baker told reporters Nov. 16 after returning from a Republican Governors Association meetings in Florida.

"I think it's going to be incumbent on all of us that the people of Massachusetts continue to be covered," Baker said.

We will be looking to Governor Baker to rally other Republican Governors, as 15 other of his Republican colleagues have also implemented the Medicaid expansion authorized by the ACA.

Health Care For All is committed to once again bringing together a broad coalition to resist any efforts to reduce access to affordable coverage in Massachusetts. In 2006, under Governor Romney, we organized the health care, business, labor, senior, children's, religious and citizen activist communities to support our health reform campaign, which showed the way for the rest of the country. Our bi-partisan effort was focused on results, not politics. We are determined to continue that fight. Please join with us. Use this link to add your name to our effort.

                                                                                                                                                          -- Brian Rosman

November 13, 2016

President-Elect Trump's Health Care Site GraphicThe election of Donald Trump, running on a platform of complete repeal of the Affordable Care Act, puts at risk the coverage of some 22 million people who rely on the law for their health insurance. Patients who depend on the law for their coverage are fearing the worst. So, on the day after the election, more than 100,000 Americans rushed to sign up for coverage, the largest number ever during this year’s open enrollment.  

But what about us, in Massachusetts? Our 2006 “RomneyCare” reforms predate the ACA. Our own reform law resulted in the reduction in our uninsured rate from around 11% in 2006 to about 6% in 2010. Implementation of the ACA further expanded coverage, and today our uninsurance rate is about 3%. And our law has broad political support, including Republican Governor Baker. So now Fortune Magazine is recommending that people upset about Trump's election move to Massachusetts, rather than Canada.  

The short answer is that we can’t yet know the impact of policy changes to be enacted by Trump and the Republican Congress. Already, there are some signs of retreat, as Trump indicates support for keeping pre-existing conditions protections. The Washington Post reported that, “In the long run, waffling on repeal will probably be less painful than causing a health-care catastrophe” (see this smart analysis on The Conversation for background). For example, the President-elect’s new official government website health care page has different policies than the campaign’s. 

But our pre-ACA state reforms did not exist in vacuum. They depended on federal fiscal and policy support for their operation, provided through the MassHealth Medicaid waiver. Implementation of the ACA in Massachusetts allowed for substantial improvements in coverage, and state financial savings. Vicky Pulos, an attorney at the Massachusetts Law Reform Institute, provides some perspective and a warning about what could happen:

In MA over 300,000 adults are enrolled in MassHealth and an additional 180,000 in Connector Care under provisions of the ACA.

If the Medicaid expansion and federal tax credits and subsidies in the ACA are repealed, it won't happen overnight. We still have the bones of our 2006 state health reform law on the books, but prior to the ACA we insured far fewer people at a far greater net state cost. Retaining coverage will require all hands on deck.

Meanwhile last Friday, MassHealth received approval from CMS (the federal Medicaid agency) for amendment and extension of its 1115 demonstration (the waiver) to 2022. Approval allows MassHealth to move ahead with plans for Accountable Care Organizations that will change the way providers are organized and paid. The goals are to reduce state spending and provide more coordinated care. Approval also secures billions in additional federal funds over 5 years.

It's far too early to speculate how a new federal administration may affect the waiver. However, approval does not insulate MassHealth from future changes in federal law or policy or a new administration taking a different view of whether the waiver serves the public interest.

HCFA and our Affordable Care Today (ACT!!) Coalition will launch a broad, aggressive campaign to oppose any reduction in affordable coverage in Massachusetts. We urge you to join us, now. Sign up using this form to stay informed about Massachusetts health reform, and how you can add your voice in support of keeping good health care affordable in Massachusetts.

                                                                                                                     -- Brian Rosman 
 

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