Significant effort (both time and money) has gone into educating people about health insurance, and we have made much positive progress in enrolling formerly uninsured residents in meaningful coverage. However, at the same time, it’s quite ironic that we aren’t taking some simple and readily available steps to support people in maintaining needed coverage.

Recent rule changes for both MassHealth and Commonwealth Care are of particular concern. These changes seem likely to undercut the success of health reform by causing coverage lapses due to involuntary disenrollments (i.e., being terminated from the program).

The new rules reduce the amount of time MassHealth members have to respond to their eligibility redetermination notification. With the redetermination period cut from 60 days to 45, the odds of members losing coverage is much higher. Many MassHealth members face significant challenges with communication, transportation, housing, and resources. As we know from our plan’s experience, these types of challenges lead directly to increases in disenrollment. These new rules are intentionally designed to save the state money by reducing program size, even though the state is well aware that the majority of those who are adversely impacted are eligible for these public programs.

Ironically, the vast majority of people who are involuntarily disenrolled will re-enroll at some point in the near future, most within a few months. The “churn” of these members results in a sizable time, administrative, and financial burden associated with the re-enrollment of eligible members, a burden that is shouldered more and more by safety net organizations. Read more…

A SINGLE SHEET OF PAPER, WIDELY DISTRIBUTED IN OREGON AND 15 OTHER STATES, ALLOWS PATIENTS NEARING THE END OF LIFE TO MAKE CLEAR CHOICES ABOUT WHAT KIND OF MEDICAL CARE THEY WANT TO RECEIVE. UNLIKE FORMS USED MASSACHUSETTS, THIS IS A SET OF MEDICAL ORDERS, SIGNED BY A DOCTOR. HEALTH PLANNERS IN MASSACHUSETTS WOULD LIKE TO IMPORT THE IDEA, SO THAT PATIENTS GET ONLY THE LAST ATTEMPT INTERVENTIONS THEY WANT. AS WBUR’S MARTHA BEBINGER REPORTS…THE PROGRAM COULD HELP CONTROL HEALTH CARE COSTS.

VIDEO: I remember sitting with my arm around my mother after my father died and we were talking gently about him (fade under)

BEBINGER: In this video reenactment a woman has just watched her father pass away in a nursing home when an EMS crew bursts into the room. Read more…

Log on this Thursday, from 1:00 to 2:00 pm with your questions about how the health insurance law works and how it applies to you. This is a one hour, live, “how to” guide. All adults in Massachusetts who do not have coverage by 12/31 will be hit with a $219 tax penalty (unless they qualify for a waiver)***. The people answering questions understand the mechanics: who is elligible for which type of coverage, who is exempt, and how to secure a waiver from the insurance mandate.

If you want to post questions in advance, add them as a comment below. We will put them up during the hour and you can check back later for the answer. Please give us your name when you submit you submit a question.

Here are some links that might be helpful in advance:

You can compare insurance options and prices on The Connector’s website.

Information about who is eligible for an exemption from the insurance mandate is here.

This is the tax form on which you will be asked to verify that you have health insurance.

***(a revised version of this sentence) “All adults in Massachusetts who do not have coverage by 12/31 will be hit with a $219 tax penalty, unless they cannot afford insurance (pursuant to the state’s affordability table) or they can afford insurance (pursuant to the state’s affordability table), but qualify for a waiver because they experienced a financial hardship in 2007.”

As many recent blog entries have pointed out, the issue for Massachusetts health reform going forward is cost. If health insurance premiums increase too much next year, the state will not be able to provide the same level of subsidies to low-income people, while the cost of non-subsidized plans may become unaffordable for many with middle incomes. The state will then be faced with difficult decisions about whether to reduce subsidies, reduce benefit levels, or raise taxes to make coverage available.

Chapter 58, the Massachusetts health reform initiative, is based on the concept of shared responsibility. Individuals contribute by paying premiums for health insurance, a heavy financial burden for many. The government, and thus taxpayers, contribute by underwriting subsidies to help low-income people obtain insurance. Businesses contribute by having to offer insurance to employees or pay an assessment; they will also face increased costs as more of their employees opt to take up coverage to meet the mandate requirement. Providers will also contribute as they are left with costs the Health Safety Net no longer covers – for example, the costs of care for low-income people who are terminated from Commonwealth Care plans because they can no longer afford the premiums.

It seems fair to ask whether another major stakeholder in health care reform – health insurance companies – should also share the pain. State Senate President Therese Murray recently raised this issue. In an address to the Greater Boston Chamber of Commerce she pointed out that that some insurance companies have reserves almost as large as state reserves that are used for purposes other than health care. Senator Murray said, “Why not re-invest this money to bring down costs and add access for health care and research?”

In this regard, legislators, policy makers, and others may be interested to know about a Pennsylvania initiative. Read more…

Employers throughout the Commonwealth continue to feel the burden of rising health care costs. People often assume that the reason costs are going up has to do with provider expenses such as medical technology, supplies and salaries. But there are more factors involved in Massachusetts’ escalating health care costs than increasing labor and equipment costs.

Over the last 20 plus years, the state’s biggest provider has become increasingly able to control the rates it receives from payers. It now receives rates that are 30-40% higher than other Massachusetts providers for the same procedures and the same (or better) patient outcomes.

This payment disparity leads to serious repercussions for other Massachusetts healthcare providers, particularly those in the community. It is a factor in the razor thin margins experienced by most hospitals, impeding needed investment in new medical technology and other capital expenditures for the benefit of patients. It also impacts the hiring and retention of physicians, when the state’s largest system offers physicians a 30% premium over other providers. Read more…

Tomorrow,the Massachusetts Supreme Judicial Court will hear oral arguments in a citizen suit involving the Health Care Constitutional Amendment.

The suit asks a basic question that goes to the heart of what it means to live in a constitutional democracy. When the Legislature ignores the constitution and violates the voters’ rights can the Court provide a meaningful remedy?

The future of the Health Care Amendment depends on the answer. But, more importantly, so does the future of the initiative amendment process and the balance of power between the legislative and judicial branches of our state government. . The initiative process can be controversial. But it is one of the core checks and balances of governmental power, Massachusetts-style.

Until 1917, only the legislature could put a constitutional amendment before the voters. Read more…

We know that, to-date, more than 200,000 newly eligible Massachusetts residents are receiving health insurance under Chapter 58 out of about 460,000 the state said were uninsured when the reform law passed in 2006. That’s great news and as I have said on these pages before, hospitals have been working very hard to help sign up people.

We also know that, to-date, according to data reported to the Massachusetts Hospital Association, free care utilization has gone down by less than 10 percent statewide – and many hospitals are actually seeing an increase in free care costs. Hospital bad debt – care the hospitals are not reimbursed for – is up about 4 percent.

So, one would think that with all these folks signing up, care is improving and the cost is being redistributed from the Free Care Pool, the State’s safety net for the uninsured, to the fee for service model as people seek care. This supposition is one of the underpinnings of health reform.

But what is actually happening? Are there more people than we originally thought who are uninsured? Have more become uninsured over the two years since the law was enacted? Read more…

Last Saturday, the Board of the Commonwealth Health Insurance Connector Authority held its annual retreat. The retreat was a great success, giving the Board the opportunity to review data and potential policy options concerning health care costs and their impact on the sustainability on health reform.

I want to thank the Connector staff for their efforts to foster a dialogue about some of the most challenging issues facing health reform. It’s clear that the Connector is often at the center of the health reform storm, confronting difficult policy decisions that don’t easily lend themselves to consensus – and all in the public eye. Given this fact, there are enormous demands on Connector staff for information and innovative policy ideas. They do a great job of meeting these demands, and we all appreciate their hard work and commitment to the success of health reform.

John McDonough, Executive Director of Health Care for All, observed the retreat and live blogged (is that a verb?) the discussion on the Healthy Blog website. Kudos to John for keeping pace with the discussion and making it accessible to those who couldn’t attend. Here is an “extreme cliff notes” version of some key issues highlighted at the retreat:

1. Health care cost containment is essential to the success and sustainability of health reform – and also critical to ensuring that state government has the capacity to invest in all of our state’s public priorities (please remember that investing in education, job creation and environmental protection, among other priorities, is critical to promoting good health). Read more…