Mandated by the Massachusetts Health Reform Law, the Quality and Cost Council is underway. In my first blog, let me advance several suggestions for the Council’s focus. First and foremost the Council should recognize that any attempt to significantly reduce actual healthcare spending could lead to a backlash from some users of health care and provider groups.. Nevertheless, we must find a way to reduce the long-term growth rate of health care spending or our health system could slowly but steadily deteriorate. I will discuss my short-list of ideas to lower spending in future blogs.

As a first step, however, the Council should establish as its goal the reduction of the growth rate in spending to levels that mirror the growth in the state’s economy—3 to 4 percent. Read more…

Harvard Pilgrim Health Care regularly convenes an Ethics Advisory Group (EAG), made up of health care consumers, employer customers, health care providers, academics, and others, who volunteer their time to help us evaluate business problems that test our values framework. The Group’s advice on how to approach business challenges ranging from high-deductible products to joint ventures to protection of member privacy and confidentiality has been invaluable to Harvard Pilgrim staff and leadership.

On April 5th the EAG tackled the question of what values framework would be most appropriate to help Harvard Pilgrim meet the challenge of Massachusetts Health Reform. A key focus of the discussion was on the values most relevant to striking a balance between affordability and coverage.

In its deliberations the EAG strongly endorsed the goals of Health Reform but had several concerns. Read more…

“Enlarge your house; build an addition. Spread out your home, and spare no expense! For you will soon be bursting at the seams. Your descendants will occupy other nations and resettle the ruined cities..” Isaiah 54:2-3 (New Living Translation)

What a beautiful text for talking about this strategic moment in the unfolding history of Massachusetts Health Care Reform. The historic Bill has been passed, requiring significant commitments from state government, employers and individual citizens of our Commonwealth. A fair affordability schedule for our state’s new individual mandate law has been agreed upon. The forces of the Connector Board, community based organizations like GBIO, and some from the private sector have aligned on mark and are now set to go! The trumpet has been blown and the news has spread all across the Commonwealth, “Enlarge the house of healthcare coverage. In fact, build an addition. Spread out your home and spare no expense!” Expectation is high, questions regarding the complexity of the Individual Mandate, affordablility schedules, 125 pre tax accounts, waivers, Silver plans, Bronze plans abound! But we, those who have accepted the charge of outreach and enrollment, are ready. Wait! Shocker of shocks. The funds needed to do effective outreach and enrollment (part of the government’s commitment) have suddenly been cut by both the Governor and the House FY08 budgets! In fact, these funds have been cut over 75%. Of the 35 organizations funded across the commonwealth to help residents understand, apply and enroll, most will lose their funding on June 30, just as health care reform kicks into high gear on July 1! It is as though the administration and the House has said, “The hard work of crafting reform is finally over. Thank God!” Then they turned to those of us committed to doing the equally hard work of outreach and enrollment and said, “I am sure you have a magic wand! Just wave it and the rest of the uninsured will come running into the house with all of their questions magically answered!” “As for us,” the government seems to be saying, ” we must be spared from the expense of such insignificant activities”.

Well, we have no magic wands! Read more…

Federal tax laws may be among the most boring topics in the world – except to tax lawyers, tax delinquents, tax dodgers, and CFOs – but this is one case where the smart consumer and the savvy employer have interests in common and both will be well served if they take advantage of one provision of the new Health Care Reform Act. The law provides that employers must allow employees to buy their health coverage with pre-tax payroll deductions. These are sometimes called cafeteria plans, or “Section 125″ plans, because they are governed by Section 125 of the Federal Tax Code.

The whole point is that the federal government actually helps both you and your employer. Your employer saves FICA, State, and Federal Income Taxes and, for all but very small companies, escapes a penalty called a “free rider” surcharge. You save money on your personal income taxes, because this provision allows you to lower the amount of your taxable income by using pre-tax dollars to pay your health care premiums.

One example: on a typical $70,000 income, you could save $1,140 in taxes by funneling your health care premium through your employer’s Section 125 Plan. So what should you do to make sure you get this tax benefit? Read more…

(Connector Director Jon Kingsdale offers more details on some the questions from callers to the WBUR show last Friday.)

For uninsured residents in Massachusetts, looking for health insurance just got a whole lot better … and easier.

It’s better because they now have new, more affordable health plans to choose from. Six of the state’s leading health insurance companies now offer a variety of new, high quality, affordable health plans. All of these plans include preventative care, protection in case of medical emergency, and a range of other benefits.

It just got easier, because the state’s Health Connector has created a new website and a call center — one-stop shopping–where people can find all the information they need about the available plans, and the one that is right for them. Think about it – one place where people can compare plans, coverage options and benefits. Like Travelocity or Expedia – only for health care – buying insurance just got a whole lot easier and faster.

Try it – log on to www.MAhealthconnector.org or call 1-877-MA-ENROLL and you can find information on all the plans being offered by Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan and Tufts Health Plan.
Read more…

OK, I should say, there’s more to health reform than Chapter 58, but this headline seemed catchier. So what else is there?

We know cost control is the elephant in the room – and we keep our fingers crossed that the Quality/Cost Council will make some magic happen real soon.

We know racial and ethnic health disparities are lessened significantly when almost everyone has insurance coverage, and we know that eliminating disparities requires more than coverage – the Legislature’s Public Health Committee will be holding a public hearing on omnibus disparities legislation sponsored by Rep. Byron Rushing and others on May 16 (H2234).

We know eliminating medical errors and improving quality is essential to prevent injury and death as well as to reduce waste. HCFA’s Consumer Quality Council has a suggestion in the form of S1277 and H2226 sponsored by Sen. Dick Moore and Rep. Denise Provost.

This week, health reform means focusing on fixing the mental health system for children in Massachusetts. Read more…

A.I.M. and the Massachusetts employer community are proud to be at the forefront of the state’s landmark health care reform program. We are pleased that its implementation is proceeding reasonably smoothly, and that it has already achieved a significant part of its intended purpose of reducing the number of the uninsured. There will continue to be challenges, both for individuals and employers, particularly beginning on July 1st, when both of the new employer responsibilities become effective.

The progress we are making, however, only re-emphasizes the imperative need to address the cost issues that were largely bypassed in framing the reform act. Health insurance costs have been the number-one issue for employers for years; more recently they emerged as a major problem for municipal governments; with the individual mandate looming, we are now hearing complaints about high costs even from health care and social service advocates who long ignored or depreciated our concerns. The board of the Commonwealth Heath Insurance Connector Authority, on which I serve, has struggled to devise “affordable” health plans to extend coverage without undue financial burden. A.I.M. will continue its work by convening the state’s leading employers around cost containment issues – but we hope to do so as part of a broad public deliberation in which all parties and interests participate.

Richard Lord is President and CEO of Associated Industries of Massachusetts

Last week the New York Times ran a story with the headline “As Health Plan Falters, Maine Explores Changes.” The story described the gap between the high hopes for Maine’s Dirigo health plan (“Dirigo,” the state’s motto, means “I lead”) and the more modest realities. No one wants to hear that their efforts are “faltering”—indeed I don’t believe that is a fair characterization of what is happening in Maine—but perceptions are important and must be attended to.

One of the great strengths of the Massachusetts reform is its aggressive implementation timeline. Slow implementation schedules cause participants in the effort to lose their sense of urgency. Difficult issues can be are postponed. Positions can harden and delay becomes a negotiating tactic. The public and those on the edges of the reform coalition move on to the next issue, leaving only a core of committed folks to carry the burden of all the work that needs to be done. And, as Massachusetts learned well in the 1990s, implementation delayed can ultimately end in repeal of the reforms.

Of course rapid implementation has its risks as well. Read more…

WBUR is live today from 3:00 – 4:00 with a show about the state’s universal health coverage law. We will focus on the latest insurance options for residents who will have to buy plans without state subsidies.

Are the plans worth the cost?
Will you sign up?
How do you feel about mandatory health insurance?

We will also hear an update on what the law requires from businesses.

Call us at 1-800-423-8255.

If we want to comment in advance, or during the show, jump in…we’ll be checking the blog.

It is increasingly clear that to really improve our nation’s health status requires more attention to chronic illness, prevention and wellness. Providing routine acute care is not sufficient. And for health care reform to succeed in Massachusetts, we need more of that comprehensive primary care. Access to routine primary care is already an issue in Massachusetts so, if health reform is to meet expectations, this problem needs to be solved.

Finding a primary care physician (PCP) who is accepting new patients these days is a challenge. Even when a PCP is located, the average waiting time for a new patient appointment is nearly five weeks. And it’s not just a local problem. The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.” The culprits: growing demand for primary care, and fewer physicians selecting careers in primary care.

The supply side of the problem is a complicated one. Read more…