While debate continues on some aspects of our state’s health reform law, one issue inspires consensus: the need to control health costs in Massachusetts. The logic is simple: the law is based on creating subsidized and unsubsidized insurance coverage for the state’s uninsured. But if health care spending in Massachusetts continues to grow at about 10 percent each year, these new insurance products will quickly become unaffordable (for some they are unaffordable today). Sustaining our law requires directly facing the problem of health costs.

Dolores Mitchell and Bruce Bullen both discussed this issue, focusing on whether the public is ready to make cost-conscious choices in a more transparent system, and whether such choices will encourage providers to moderate their costs. These options must be pursued, but the most promising route to controlling costs is by making care better. Read more…

Since this blog began, articles have appeared on affordability, eligibility, what businesses must do, insurers’ and policymakers’ perspectives, physician shortages, and congratulatory pieces on how far we’ve come to lead the nation in health care access for all citizens.

There’s been little written, however, on how this health care revolution will address one of our state’s most pressing problems: health care disparities. Read more…

A series of four regional small business seminars on the new health care law wrapped up last week in Haverhill, an instructive outreach effort co-sponsored by the Retailers Association of Massachusetts, the National Federation of Independent Business, numerous local chambers of commerce, Senator Steven A. Baddour and the Commonwealth Connector Authority. I would like to thank Jon Kingsdale and his outstanding staff, as well as the Division of Health Care Finance and Policy, the Division of Insurance, the Division of Unemployment Assistance and our corporate sponsor, Verizon, for their participation in this important educational effort.

This was the second round of seminars building on an earlier effort last fall by our organizations to attempt to reach out to very small employers in the small group market (50 & under.) Hundreds of small businesses were educated as to their responsibilities and options under the law. Approximately half of the attendees were very small employers with fewer than 11 full time equivalent employees – exempted from the mandates – but still impacted by the reactions of and the rising premiums for their employees. Attendees left well educated, yet still very nervous as to when the double digit increases to their premiums will end and concerned about how much their costs will rise this summer and fall as more and more of their employees opt into their small group plans.

As much as we educate our own members, I am still struck by the large number of small businesses across the Commonwealth that likely remain in the dark as to their new responsibilities on insurance offerings, Section 125’s, state reporting and the soon to be felt demands of employees. With July 1 less than two weeks away, the lack of education on the law to thousands of small employers raises the question on whether penalties for employers – like those for individuals – need to be delayed or mitigated. Read more…

There is a quiet buzz emerging from some Commonwealth Care members and member advocates about Commonwealth Care members being locked into specific health plans. (As a general rule, upon enrollment and subsequent eligibility redetermination, Commonwealth Care members have 60 days to change health plans, and then remain members of their plan for one year.)

Certainly, the concept of a lock-in is not unique to the Commonwealth Care program; an annual lock-in is the norm for every person involved in employer-sponsored insurance. The imperative of the lock-in is to create a stable population with reasonable plan tenure. This is a fundamental concept of insurance and affords continuity of engagement with a health plan’s services.

Behind the buzz about the lock-in lurks a larger issue. Read more…

1. We are making the transition from establishing the rules of health care reform to putting those rules into action. So it’s critically important that we help individuals, employers and others understand new opportunities to purchase quality, affordable health insurance, as well as their respective obligations under health reform. This was underscored for me the other night, when I participated in a forum on health care issues hosted by the Commonwealth Institute. The Institute supports the efforts of women entrepreneurs and senior corporate executives to grow their businesses and careers. Along these lines, it asked Charlie Baker of Harvard Pilgrim Health Care, Jim Roosevelt of Tufts Health Plan and me to participate in a panel discussion centered on the impact of health reform on businesses. We received many great questions from the audience, a good number of which focused on the day-to-day implications of health reform for businesses.
I thought it would be instructive to list some of these questions, to highlight issues on the business community’s radar screen. Read more…

In her posting on June 5th,Dolores Mitchell argues convincingly that rising healthcare costs pose a danger to the ultimate success of Chapter 58. In fact, despite the many innovative provisions of Chapter 58 and the efforts of the Connector Board to reduce health plan premiums there is little in the law that addresses healthcare provider costs.

About the question of whether or not the new Health Care Quality and Cost Council, chaired by the state Secretary of Health and Human Services, can help control provider cost increases, Dolores is not sure. She asks instead that purchasers “stiffen their resolve and insist on better rates, even to the point of dropping some providers or charging higher co-pays for selecting them.”

Unfortunately, these approaches have been and are being used with lukewarm market response. Read more…

The Connector Authority is heralding the “Young Adults Plans” (health insurance plans available through the Connector for 19-26 year-olds) as an affordable insurance option for young people. Advocates are questioning the adequacy of these plans. Who’s right?

The plans are cheap – in price and value. Young Adult Plans (YAPs) have extremely slimmed down benefit packages. Most alarming – they may contain annual benefit caps. Emergency regulations released by the Division of Insurance on April 17 allow YAPs to limit coverage to $50,000 per year, leaving insured young adults with zero coverage for catastrophic health care needs.

Seem to us this defeats the purpose of insurance. Read more…

Michael Moore’s latest film is coming to a theater near you by the end of month and is expected to energize debate about how to fix health care in the US.

Here’s how one group that supports a single, national health plan hopes to capitalize on the film’s release.

And here is some analysis of the film and Moore from the Toronto Star.

We look forward to your reviews, or links to reviews you think are worth reading.

Having health insurance is unquestionably better than not for providing a pathway to health care, so the more than 100,000 people newly insured since last July by MassHealth and Commonwealth Care are already better off in that regard. But how much better off? How good is the access, and the care, they are receiving? Read more…

Washington State is among the latest of our sister states to take great strides in expanding access to health care. They earmarked money to cover more children, allowed small employers to purchase coverage at a government-negotiated price and let parents cover dependents up to age 25. Officials in that state are reasonably confident that they can cover all children by 2010 and all residents by 2012.

It’s certainly encouraging to see so many states take hope from what we are achieving in Massachusetts. They are recognizing, as we did earlier, that the problems of caring for the uninsured and the burden they place on the rest of the system have become acute. We can’t wait for the federal government to develop a national plan. Read more…