SOME MEMBERS OF THE STATE’S HEALTH INSURANCE CONNECTOR BOARD SAY PENALTIES FOR FAILURE TO HAVE MANDATORY COVERAGE ARE INCONSISTENT, AND IN SOME CASES TOO LOW. MOST OF THE BOARD AGREES WITH PROPOSED FINES THAT WOULD BE CAPPED AT 912-DOLLARS THIS YEAR. BUT M-I-T ECONOMIST JON GRUBER SAYS THAT’S ONLY ABOUT 20-PERCENT OF WHAT IT WOULD COST AN OLDER PERSON TO BUY INSURANCE.

“The law has a mandate and our job is to implement that mandate and I fear that if these penalties get too low the mandate won’t work.”

OTHER BOARD MEMBERS SAY THIS YEAR’S PENALITIES ARE ALREADY HIGHER THAN LAST YEAR AND ARE REASONABLE.

FOR THE COMPLETE OUTLINE OF PENALTIES FOR 2008, WHICH VARY BASED ON INCOME, CLICK HERE.

This is a cross-posting from the Health Care for All blog. Check out the stories of 3 Massachusetts women hurt by our health care system. The stories are posted on You Tube. HCFA director John McDonough says “to our knowledge, this is the first time, anyone has attempted to use You Tube as a way to connect with the broad public about the issues of patient safety and medical errors.” The videos will also be shown at a State House hearing tomorrow (1/10) on two “Consumer Health Care Quality” bills.

THE MASSACHUSETTS PUBLIC HEALTH COUNCIL HAS APPROVED REGULATIONS ALLOWING PHARMACIES, OTHER RETAIL OUTLETS AND HEALTH CARE FACILITIES TO OPEN SO-CALLED “QUICK” CLINICS, THAT TREAT COMMON AILMENTS…IN STORES.

CRITICS QUESTION THE QUALITY OF CARE.

MICHAEL HOWE, CEO OF THE CVS AFFILIATED “MINUTECLINIC”, DEFENDS THE CONCEPT, SAYING THE STATE’S HEALTH CARE MANDATE HAS CREATED AN INFLUX OF NEW PATIENTS WHO ARE STRAINING HOSPITALS AND HEALTH CENTERS.

“You have a number of new patients that are looking to establish relationships with primary care physicians, and the limited service clinics will be part of expanding the capacity of primary care throughout the Commonwealth.”

HOWE HOPES TO HAVE 25 OR SO IN-STORE CLINICS UP AND RUNNING BY THE END OF THE YEAR.

The state’s Health Care Quality and Cost Council faces a challenge that is bigger than the Big Dig. After all, that project took 20 years to spend 15 billion dollars. The state spends that much in health care about every four months. If our health care access legislation is to succeed, the Council must find a way to bring one sixth of the state’s economy, the state’s largest industry, under control.

At the first meeting of the Council in the New Year on January 2, Dr. Don Berwick, president and CEO of the Institute of Healthcare Improvement and an elected member of the nation’s prestigious Institute of Medicine, provided just the right analogy when he compared our health care system to a “commons” – the space at the center of colonial towns where folks would bring their livestock to graze. If everyone acted only in their self-interest, the land would soon be overgrazed and all would lose. The challenge, he said, was to find a way to inspire those involved to view their duty as not only a personal gain, but also as a contribution to the good of the community. One needed to only look at those attending the meeting – consultants and those advocating for various constituencies – to know that this would be a hard sell. But we ignore him at our own peril. Read more…

Senator Hillary Clinton offered some brief comments on the MA health care law today while speaking to voters in New Hampshire about her plan to let Americans buy into the Congressional health plan.

Click on the player to listen to her remarks: can listen here

I’ve also gone to the great trouble of transcribing her comments:

“I’ve watched what’s happened in Massachusetts. And Massachusetts went at it a slightly different way and they had a lot of new bureaucracy that they created to keep track of people. And they don’t have the buying power that the federal government has; but I think it’s very commendable that they are trying because we’ll all learn things from that. But the federal government is in a much stronger position to build on this Congressional plan and I think it’ll be cost effective, produce better results, higher quality and get everybody covered.”

In a previous blog entry, I asked whatever happened to community rating for insurance. For those of you who don’t know, community rating was the system in place for most medical insurance companies in which most people had similar insurance premiums, because the risk was shared among the entire population of insured people.

Community rating has all but disappeared in the private insurance market, but what is still somewhat surprising to me is that the Commonwealth of Massachusetts also abandoned community rating in setting up the insurance system for Commonwealth Care and Commonwealth Choice insurance plans.

This decision allowed the governor to state last year that it was possible for an individual to get medical insurance for $170 per month. The fine print, however, was that this was the insurance premium for a 38 year old man, and the $170 doesn’t include the cost of deductibles and co-payments.

What it also doesn’t say is that the effort to keep the cost down for 38 year olds results in extremely high rates for those in riskier categories, meaning anyone over 38. Just how expensive, you ask?

A class from UMass Boston Nursing School recently visited me to discuss community health. One of the students happened to have with her a previous assignment, which was to find out what kind of insurance was available for an uninsured person in the new health care system. She used information for a 58 year old single female from Fall River, working as a nurse’s aide and making $32,000 per year, which is above the annual income that would qualify her for subsidized insurance. The options were eye opening. Read more…

If our experience at Fallon Community Health Plan is any indication, the Commonwealth Health Insurance Connector can start saving people as much as 13 percent on their health insurance premiums.

The reason lies with what we call “limited and higher performing” provider networks.

By now, it’s no secret that increasing health care costs pose a long-term threat to the state’s new health reform law. High costs are especially a problem for individuals, families and small businesses who are mandated to purchase health insurance under the new law but do not qualify for subsidized care.

The Connector is offering insurance to this group through a program called Commonwealth Choice, which provides four options based largely on the level of deductibles and co-pays: Gold, Silver, Bronze and Young Adult.

For the past six years, Fallon Community Health Plan has been offering two HMO products — Select Care, a broad network that offers access to the vast majority of providers in the state, and Direct Care, which offers a network of community-based providers. While limited, the Direct Care network must meet high standards for quality. The savings over Select Care is 10-13 percent — and the savings are driven by the use of the network, not any difference in benefits. Read more…

A common criticism of the U.S. healthcare system is that we spend too much on treating sickness and not enough on staying healthy. The idea is that a greater emphasis on wellness and prevention will lead to a healthier population and cost less than our current system.

There are huge benefits to having a healthier population – improved quality of life, increased productivity, and longer life expectancy to name three. There also are immediate financial returns to better health, particularly for the private sector. The Milken Institute , an economic think tank, estimates that more than 109 million Americans have at least one chronic disease for which the cost – measured in terms of the total impact on the economy – is $1.3 trillion annually. Of that, $277 billion is spent on direct treatment. The remaining 80 percent is lost economic productivity. Even a modest improvement in health would make a major difference to the Medicaid program, employers’ healthcare costs, and workforce productivity.

What would it take to accomplish this? According to the Milken study, 40 million cases of chronic illness could be delayed through lower rates of obesity, continued reductions in smoking, a decline in alcohol consumption, increased physical activity, bringing cholesterol rates down to their 2000 levels, improved air quality, a gradual decline in illicit drug use, and a modest improvement in early intervention and treatment. Read more…

approved-goal-1-01-02-08.pdfIn June, the Health Care Quality and Cost Council set the goal of holding health care cost increases to no more than the annual growth in the Gross Domestic Product by 2012. Today, the council approved a list of strategies to control rising costs. Council members acknowledge it will be difficult to move ahead in many of the suggested areas…setting health insurance rates, limiting hospital expansions and returning to managed care. Council chair, Health and Human Services Secretary JudyAnn Bigby, says work on some of the strategies will begin now. Other parts of the plan will have to wait until the board has funds to hire independent experts who would help design specific recommendations.

A study co-authored by regular contributor, Dr. David Himmelstein, finds that well off patients with health insurance are more likely to receive free prescription samples than are low income uninsured patients. The study is in this month’s issue of the American Journal of Public Health.