We all make assumptions, and the soundest assumptions help us move forward when forging a brand new path. They are temporary beacons and light the way for a very short distance. So, here are a few lessons learned by the Connector board Read more…

The state Division of Health Care Finance and Policy has issued draft regulations to strengthen this important piece of the health reform law. Read more…

Some of you have asked how the state will know who does and who does not have health insurance. Everyone who files taxes will be asked if they had coverage as of the end of the tax year. So if you expect to comply with the insurance requirement, you have until Dec. 31st (although you probably have to apply at least a couple of weeks before that to have a policy in place on 12/31) You will be asked to verify that you have insurance on this form (draft version) . It is called a “Schedule HC” and will be filed with your state tax return.

If you have private insurance (Blue Cross, Harvard Pilgrim, Tufts, etc.) your insurer will send you a form called a 1099-HC (Health Care) sometime early next year. Here’s a sample of that form. You will use information from the “1099-HC” to fill out the “Schedule HC.”

These are in draft versions of both forms. Instructions for filling out the “Schedule HC” are not out yet. The Department of Revenue is taking coments on the forms at this address… fordp@dor.state.ma.us.

If Massachusetts is serious about controlling rising health care costs, we’ve got to start acting that way. So far, we’re not. Some thoughts on our current predicament:

1. MA health reform critics complain Chapter 58 doesn’t control costs. They’re right. There was broad agreement on a path to expand access, not on a path to control costs. Some suggest we should not expand access until we agree on how to control costs. We only hear that complaint from folks with insurance. We disagree that the uninsured (155,000+ covered now) should have to wait for that consensus before we expand coverage.

2. Some talk about the cost crisis as though it only relates to health reform. Not so. Rising costs affect every element of society – not just those helped by health reform. David Williams at the Health Business Blog reports his business’ health premiums will rise 26.3% next year. Whether it’s a state, municipal, business, or family budget, the cost crisis affects you. Health reform is an asterisk in the bigger health cost picture.

3. One part of Chapter 58 seeks to address rising costs – the Quality and Cost Council, a 13 member body formed “to establish health care quality improvement and cost containment goals.” On June 20, the council approved its first set of annual quality and cost goals. Health Care for All published them on our blog. To our knowledge, these goals have received virtually no public discussion or comment. Read more…

Boston may be a world center of health care, but you’re going to have to start waiting a little longer to see a doctor. Maybe a lot longer. A new study from the Massachusetts Medical Society says there’s a worsening shortage of physicians here in primary care and six other specialties. Among the specialists in short supply are cardiologists, gastroenterologists, anesthesiologists, urologists, and neurosurgeons.

Click below to listen to Bob Oakes and MMS President Dr. Dale Magee discuss the shortage and the impact on the state’s effort to cover the uninsured.

Are you waiting longer to see a doctor?
What do you think the state, insurers or medical community should do?

Here we are in late July and the question is being asked with greater urgency, “Is health care reform going to be successful?” I believe the short answer is “yes.” The only folks I hear saying that it is not working are from other states, and tend to be opponents of the model agreed to by all the stakeholders in Massachusetts. I am confident that in a few years’ time, we will look back with pride on what was accomplished when we all came together to support life changing public policy. But as this is a process that is happening in real time, it will continue to evolve and be affected by both politics and the marketplace.

A perfect example of proposed legislation that could have profound implications on health care reform is Senate Bill 697, which calls for standardized coding, a numerical method used by health plans to define medical treatments for billing purposes. At first glance, this certainly appears reasonable. Who wouldn’t support a national coding system that is already used by hospitals for Medicare?

However, the reality is that this is much more complex than a quick glance would indicate, with major ramifications on payment policy and premiums. In brief, the scope of technology changes necessary would require the resource investment of tens, possibly hundreds, of millions of dollars to support either reconfiguring existing technology systems or purchasing new systems.

While Massachusetts’ not-for-profit health plans currently have the lowest administrative costs in the nation, it is no leap to assume that if S.697 passed in its current form, health care costs would increase, and ultimately undermine the goals of health care reform by raising premiums for all consumers, including those who are just now benefiting from coverage. My colleague, Eric Schultz, president and chief executive officer of Fallon Community Health Plan, told the State House News Service that the bill would “do a lot of harm in dismantling health care processes.” He was not overstating the issue.

It wasn’t that long ago when hospitals and health plans were brought together by the Massachusetts Health Data Consortium to discuss the technical solutions necessary for the Health Insurance Portability and Accountability Act of 1996. The outcome of that collaboration is simplified administrative processes, which translate into reduced costs for health plans, providers, and members.

But there is always room for improvement. To that end, it is my recommendation, which has the support of the Massachusetts Association of Health Plans, that hospitals and health plans reconvene with the Massachusetts Health Data Consortium to find common ground on this complicated and expensive, though well-intentioned bill. No one wants to see the gains we’ve recently achieved with health care reform become once again out of reach.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan

Many of us have worried that an unintended consequence of health care reform would be the isolation of undocumented immigrants as the only people left uninsured and without access to health care in Massachusetts. So far, the regulations being discussed by EOHHS appear to allow for a safety net of health care access at community health centers for low income people who are not eligible for Commonwealth Care.

Even so, we are hearing from outreach workers in the community that many undocumented immigrants are laying low, hiding, not revealing their addresses. At least one Spanish radio station has apparently been featuring several stories of immigration officials separating families. Listeners are led to believe that the community health centers are obligated under law to report any undocumented patients to immigration officials.

We need to find as many ways as we can to put the word out that community health centers are NOT obligated to report undocumented patients to immigration authorities. On the contrary, HIPAA regulations actually prohibit us from giving information about our patients to anyone without their permission. (Who knew how handy this would turn out to be?)

It is important that we find a way to make sure everyone feels safe accessing basic health and human services in their community.

Lori Abrams Berry
Executive Director, Lynn Community Health Center

It’s Summer, the perfect time for the first ever test on the state’s health coverage law. Take your time…you have one week to get us your answers. Email them to: marthab@bu.edu. We’ll send you back your score. The answers will be posted next Tuesday. There will be some exciting prizes which we will post with the answers.

If You Build It, Will They Come?

• Which health plan has the most Commonwealth Care members?

• What percent of the people who have enrolled in Commonwealth Care so far are required to pay a premium?

• What percent of the estimated number of uninsured people with incomes less the poverty level have enrolled in Commonwealth Care?

• How much funding for health reform outreach and enrollment is included in the FY08 budget?

• How many other states have passed comprehensive health coverage reform laws since Chapter 58 was enacted in April 2006?

Shared Responsibility

• How much in total Medicaid rate increases are providers scheduled to receive in fiscal years 2007-2009 under the provisions of Chapter 58?

• How much money does that state estimate it would collect in FY 2007 from employers that dif not make a “fair and reasonable” contribution to health insurance?

• If every adult who was uninsured in Massachusetts when Chapter 58 was enacted were to become insured year-round, at a monthly premium of $175 per month, approximately how much additional revenue would health insurers receive annually?

• If every person who is eligible for Commonwealth Care were to enroll, approximately how much money will be left in the Health Safety Net Trust Fund?

• Why is June 30, 2008 a critical date for Massachusetts health reform?

Coverage and Costs

• Suppose you are a resident of Boston (who’s older than 26), you aren’t eligible for employer-sponsored health insurance, Medicaid or Commonwealth Care, and you’re looking for health insurance to comply with the individual mandate. If you consider only products sold by four health insurers (Blue Cross Blue Shield, Harvard Pilgrim, Neighborhood Health Plan and Tufts Health Plan), how many different products would you need to review to ensure that you’ve exercised fully your newly-granted right of greater choice?

• If you live in Boston and get a job working for the Commonwealth of Massachusetts, how many different health insurance options would you have?

• What’s the approximate average monthly premium contribution paid by a worker in Massachusetts who has employer-based health insurance?

• What’s the lowest monthly premium available to a 27-year-old hospital worker in Massachusetts who lives in Boston and buys a Commonwealth Choice product?

• Assume this person is not eligible for Medicaid, Commonwealth Care or employer-sponsored insurance, and does have to comply with the individual mandate. If there is no increase in Commonwealth Choice premiums in 2008, what penalty will this person have to pay if he or she does not purchase insurance in 2008?

• What would the penalty be if this person were 60-years old instead of 27?

• What is the annual permissible limit on covered medical expenses in a Young Adult Policy?

• Suppose you are a young adult living in Boston who purchases the least expensive Young Adult Plan sold through the Connector. You have a bad car accident and incur hospital costs of $70,000. How much more will your out-of pocket expenses be than if you had purchased the most comprehensive policy available to you?

Who Said It?

• “I don’t like calling it [the Massachusetts reform law] universal coverage. That smacks of Hillarycare.”
• “Half-jokingly” refers to insurers as ‘sleazeballs and bloodsuckers’.”
• “My status symbol is my brown felt hat from Botswana.”
• “Section 125 is not sexy.”
• “The real measure of success is not just access to health insurance. It’s not even access to health care. What we want is improved health.”

Not Just Health Coverage

• How many state entities were affected or created by Chapter 58?
• Name three specific goals proposed for FY 2008 by the Health Care Quality and Cost Council.

• What company is coordinating the new statewide infection prevention and control program?

• What was the overall Massachusetts ranking in the recent Commonwealth Fund “State Scorecard on Health Systems Performance”?

• Where did Massachusetts rank in the category “Avoidable Hospital Use and Costs”?

Pot Pourri

• Name 5 of the top 20 employers in Massachusetts that have 50 or more employees using public health assistance programs.

• Approximately what percent of non-US citizens living in Massachusetts have no health insurance?

• Which Red Sox players are featured in the Connector’s “I’ve Got It” TV ad?

• Name two of the tag lines in the health reform advertising series “Because…”

• What WBUR Commhealth blog entry has generated the most reader comments?

Finale: for Extra Credit

• Submit a health reform haiku (in 5-7-5 format)

“Jesus sat down opposite the place where the offerings were put and watched the crowd putting their money into the temple treasury. Many rich people threw in large amounts. But a poor widow came and put in two very small copper coins, worth only a fraction of a penny. Calling his disciples to him, Jesus said, “I tell you the truth, this poor widow has put more into the treasury than all the others.” Mark 12:41-43 (New International Version)

Through the lense of this powerful text, what can we observe about the current contributions being tossed into the treasury set aside to fund healthcare reform?

GBIO leaders, who have been knocking on doors this summer letting people know about the new healthcare law, have begun to discover an answer.

In our work we have encountered three kinds of people at the door.

(1) Those who are insured through their employer, through MassHealth or are new Commonwealth Care enrollees.

(2) Those who are uninsured, most of whom will qualify for Commonwealth Care.

(3) Those whose employers offer them coverage, but it is too expensive, and remain uninsured.

This last group of people is the most difficult, because we have absolutely nothing to offer them.
Read more…

Everyone involved in the health care reform effort in Massachusetts should be proud. In just a little over a year, we have reduced the number of uninsured residents in the state by more than one-third and we are continuing to make progress each month. Policy makers nationwide are watching Massachusetts closely to determine if this is a model for reform in other states or at a national level or whether, at the very least, some components of our reform law could be replicated elsewhere.

As other bloggers have suggested, however, we certainly cannot ignore the very real threat to the success of our program in Massachusetts unless we seriously address the issues related to rising health care costs. After almost a decade of double digit cost increases we are beginning to see some slight slowdown in premium increases, but they are still growing at more than double the rate of regular inflation. Under health care reform, our state government has assumed a significant new burden that is not sustainable unless we tackle this very complex issue.

Since July of 2006, more than 50,000 people have signed up for the state’s Medicaid program which had over one million enrollees already – almost one of every six Massachusetts residents participates in this program. Since last October, over 92,000 individuals who earn less than 300% of the federal poverty level have signed up for heavily subsidized health insurance in a new state program called Commonwealth Care. It is great that all of these people now have access to health coverage. However, this also places very serious pressures on the state’s finances. We must immediately focus our collective attention on steps that can be taken to bring the costs of health care under control.

Of course none of this is going to be easy. But then again, two years ago very few people would have predicted that virtually all of the interest groups in Massachusetts – business, labor, advocates, insurers, providers, and government – would be able to reach a compromise to expand health care coverage to almost all our citizens. These same groups must now pledge to work together in a similar manner to ensure that the great progress we have made will continue in future years.

Richard C. Lord, President and CEO
Associated Industries of Massachusetts