The medical care system is not easy to understand. There are hundreds of different payers for care given to individuals – insurance companies, government, unions – all with different rules for paying and limits on what they’ll pay for. They have different methods for determining what is reasonable for them to pay for visits, lab tests, procedures, surgeries, etc., and they have different expectations on what will be written off by the provider or paid for by the patient. For those without insurance in Massachusetts, there was, and still is for some, the so-called “free care pool” for those who are poor enough to qualify for it, and there are significant out-of-pocket expenses for those above that level of income. There are also out-of-pocket expenses for most insured people, in the form of copayments, deductibles and non-covered services. Read more…

We Swiss have the reputation of being slow: indeed it took us a century to accept – in 1996 – the double principles of universal coverage and mandatory individual health insurance. The goals of the Swiss reforms sound familiar to Massachusetts: cover everyone, make insurance more affordable for low and moderate income people through subsidies, and control health care costs. Also familiar are resistances and stormy debates that this reform brought about in our country. Read more…

OK – so you bid for the task of trying to sell health insurance to people who don’t have it and don’t think they can afford it but will be, for the first time in this country, required to have it. Where do you turn? The Red Sox, or at least their home turf. The Connector has scheduled a press conference to next Tuesday at Fenway Park to roll out its marketing campaign for unsubsidized health care plans for the uninsured. As my boss said, if you’re trying to reach young healthy males who say, “health insurance, who needs it?”, Fenway Park is the place to be. The ads are not expected to feature Red Sox players.

Does it come as a surprise to anyone that just as the reform is ready to be implemented, some of those that benefit by putting more health care dollars in the system are starting to once again bash the employers that don’t happen to be taxpayer or insurance premium funded? Read more…

The following is a copy of a letter the Connector is sending to 193,000 for profit and not for profit corporations in Massachusetts. The letter explains what they have to do to comply with Chapter 58, the state’s health care law. Read more…

Budget season is in full swing, making the Executive Office for Administration and Finance an extremely busy place (not that it ever isn’t). In the midst of analyzing the just-released Senate Ways and Means budget, a few quick thoughts on health care:

• The main message coming out of Monday’s Blue Cross Blue Shield Foundation event examining one year of health care reform is – cost is the next frontier of reform. Read more…

Gather round ye young and old, and I’ll tell you a grand tale
It’s been at least a score since the story began, but it never does get stale

I can see you all are tired, and I know it’s getting late
So, let me skip the boring stuff and go straight to ‘ole Chapter 58

‘Tis true it’s a little scary, hold your children fast and near
But if you listen ‘til the story’s end, I promise you won’t feel fear

There’s a little bit for everyone, young and old alike
Yes, there’s even something here for your little tyke
Read more…

As recently reported by Alice Dembner in The Boston Globe, the Commonwealth needs to focus its attention on collecting business penalties from corporations who do not currently offer affordable health insurance to their employees.

The good news is that over 70% of Massachusetts residents get their coverage from employer sponsored health plans. The bad news: There are still several hundred thousand workers and their families that remain uninsured today.

The top dozen employers who employ more than 50 people and fail to cover a large part of their workforce are shocking. Read more…

The Blue Cross Blue Shield of Massachusetts Foundation released this report today, “The 2006 Massachusetts Health Care Reform Law: Progress and Challenges after One Year of Implementation.” It’s a good reference if you are losing track of what’s been done to date and what’s ahead.

The State Children’s Health Insurance Program (SCHIP) was created by Congress in 1997 to provide coverage to children whose family income was too high to qualify for their state’s Medicaid program. In Massachusetts, SCHIP is part of MassHealth, covering about one-fifth of the 460,000 children enrolled. Nationwide, SCHIP covers about 6 million children, many of whom would otherwise be uninsured. Some states have also received permission to used SCHIP funds to cover parents and pregnant women (Massachusetts is in this latter group).

Here is an issue brief describing the past, present and potential future of SCHIP in Massachusetts. SCHIP is a critical part of the Commonwealth’s coverage expansion strategy because of its relationship to MassHealth and, by extension, the health care reform law. This year, SCHIP has been an important policy focus in Washington, and legislative action in the coming months will have significant repercussions in Massachusetts.

One immediate issue is the funding of SCHIP in the current fiscal year. Unlike Medicaid, SCHIP is not an open-ended entitlement. Read more…