A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Health Care Market

Charlie Baker on the Post-Reform Health Insurance Market

Most health reform attention has been focussed on the subsidized insurance products launching in October (under 100%fpl) and in January (100-300%fpl). There's another big enchilada -- the new market to emerge next spring will be for folks with incomes over 300%fpl (over about $30K for an individual). Little discussion of how this new market will change (e.g.: 7/1/07 the small group and nongroup/individual insurance markets will merge). Underlying all of this is, of course, the looming individual mandate. This week's Boston Business Journal includes an interview with Harvard Pilgrim CEO... Read more »

Prescription Advantage Open Enrollment: 9/15 to 11/15

Prescription Advantage, the Commonwealth's pharmacy assistance program for eligible seniors and disabled individuals, begins its open enrollment period on September 15th and runs until November 15th. Applications and application assistance are available from Prescription Advantage by calling 1-800-AGE-INFO. Click here for the official PA website. Thanks to the legislators -- Senate and House -- who have worked hard to keep this program alive and thriving. Read more »

Comparing Health and Auto Insurance Individual Mandates

While we don’t agree at all with their political bent, there’s a fascinating brief written by Greg Scandlen for the National Center for Policy Analysis comparing individual mandates for health insurance with individual mandates for auto insurance. It should be helpful grist for the mill when we get down and dirty on individual mandate implementation. Click here for the full brief. Some food for thought: All but three states mandate automobile insurance, but 14.6 percent of America’s drivers remained uninsured in 2004, according to the Insurance Research Council. No state mandates health... Read more »

Year 7 of Double Digit Premium Hikes: Are We Ready to Change Directions Yet?

Jeff Krasner in today's Globe does his typically excellent work detailing how health insurance premiums will be rising at double digit rates in 2007 for the 7th consecutive year. A little history: In the mid-1970s, in response to unacceptably high rates of health insurance premium inflation, Massachusetts and other states adopted a host of hard hitting regulatory interventions to reduce the rate of growth in premium costs. Most failed to do the job. Hospital rate regulation worked for about a decade, then the state lost the political will to maintain it, ultimately deregulating in 1991 in... Read more »

Dept. of Delicious Ironies: Romney Signs New Mandated Benefit into Law

On Thursday, Gov. Romney signed into law House Bill 5256, now Chapter 292 of the Acts of 2006: An Act providing Health Care Coverage for Certain Prosthetic Devices. This legislation was sponsored by the MA Society of Orthotics and Prosthetics and is a brand new health insurance mandated benefit. We think the new law is good and Gov. Romney and the Legislature did the right thing in approving it. (see details below.) We can't help noting the extent to which Gov. Romney and Lt. Gov. Healey constantly rail against "mandated benefits" and did everything they could in the health reform debate... Read more »

Health Reform Mysteries: The Merger Commission Meets

The activities of the Small Group/Nongroup Market Merger Commission have been flying even lower on the radar than we thought. Turns out the Commission had an “open” meeting on Thursday observed by a only handful of insurance industry reps and attended by six of the nine commission members. We were given no notice despite repeated inquirites to the Division of Insurance on it. (We’re told neither Sen. Wilkerson or Rep. Mariano were there and that Secretary Trimarco assigned a designee, who was not there either.) Also turns out the membership isn’t quite what we thought either. Here is the... Read more »

Small Group/Non-Group Insurance Market Merger Flying Under the Radar

Believe it or not, there’s more going on with health reform than Commonwealth Care premiums and benefits. Other aspects have been moving ahead without noticed. One such item is the merger of the non-group (individual) and small group insurance markets, due to take effect July 1, 2007. Chapter 58 mandates the merger of these markets to make insurance private market coverage more affordable for people who buy insurance on their own. (Blue Cross Blue Shield estimates post-merger nongroup premiums may drop by as much as 25%.) The merger didn’t pass without controversy. Some insurers worry... Read more »

RealBenefits Wins First-Ever MacArthur Award to Non-Profits

The John D. and Catherine T. MacArthur Foundation today awarded RealBenefits (a technology company started by HCFA’s partner, Community Catalyst) one of its first-ever MacArthur awards recognizing small non-profit organizations with a proven track record of creativity and effectiveness. The Foundation is awarding $500,000 to RealBenefits for its ability to change "social services as usual." Read more »

Prescription Access Litigation Project Scores Win Against "Average Wholesale Prices"

Our friends at Community Catalyst's Prescription Access Litigation Project had a big win this past week on a federal lawsuit attacking the use of "average wholesale prices" by pharmaceutical companies. On August 10, 2006, a settlement agreement for $70 million was reached between GlaxoSmithKline and the Plaintiffs. In a trial set for November 2006, Plaintiffs will continue the case against Bristol Myers Squibb, AstraZeneca, Johnson & Johnson and Schering-Plough. See details below: The "Average Wholesale Price” or AWP has long been the pricing benchmark for almost all prescription drug... Read more »

Connector Watch August 3rd - Marathon Meetings

Having gotten most of the set-up procedures and get to know you formalities out of the way, the Connector Board is now down the it’s real work, and it’s really hard work. The full board met for 3 ½ hours, followed by a 3 hour meeting of the affordability subcommittee. Yes, this is no business for half-hearted dabblers. Here’s a summary of both meetings for those who couldn’t free up their whole Thursday to be there. Full Board Meeting: There were no official board votes today, but some procedures were agreed to, some decision were made informally and a general consensus surfaced around other... Read more »


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