Health Care Reform has revealed many related and intertwining issues that affect those who don’t fit into mainstream job patterns.

In the past on this blog, I’ve talked about the concerns of artists with
“Combination Income Sources,” and how the 2004 Independent Contractor Law Change will hurt them and the creative economy. Now, I’d like to focus on those people who don’t fit into preexisting notions the State uses to define employment “norms.”

For instance, many artists who live on Cape Cod work seasonally, but the Cape’s “season” no longer fits into the State’s related definition. Massachusetts says “A seasonal employee is one who works for a designated seasonal employer for a duration of not more than 16 weeks
during the seasonal period.” In reality, the Cape’s season is now 20 weeks, not 16. Read more…

…ask what they think about socialized medicine.

Here’s the press release…

Poll Finds Americans Split by Political Party Over Whether Socialized Medicine

Seventy percent of Republicans think socialized medicine would make things worse and 70% of Democrats think it would make things better

During the course of the presidential nomination campaign, some candidates’ health care plans have been described as ‘socialized medicine’. Historically, the phrase socialized medicine has been used to attack health reform proposals in the U.S. However, a new poll by the Harvard Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive finds that Americans are split on whether a socialized medical system would be better or worse than the current system. Read more…

Overall, Health Reform has had a positive impact on the Lynn Community Health Center and our patients:

 The Lynn Community Health Center enrolled over 9,000 previously uninsured patients in Commonwealth Care and MassHealth in 2007
 More Lynn residents than ever have access to affordable health insurance
 Our newly insured patients now have coverage for specialty care and ambulance services – critically needed services that previously were deferred, resulting in negative health outcomes, or if received, caused significant medical debt and hardship
 Due to positive changes in reimbursement by the Health Safety Net, our dental clinic has broken even for the first time since we opened in 2001

These are significant and tangible positive outcomes!

And of course, there are also some concerns:

 Affordability – The most important part of our state’s effort to provide health care to everyone in the commonwealth is to make sure that coverage is affordable. We are beginning to see signs of serious financial stress among our patients. Read more…

TEMPERS ARE FLARING AS THE CONNECTOR STAFF PROPOSES HIGHER PREMIUMS AND CO-PAYS FOR RESIDENTS WHO QUALIFY FOR COMMONWEALTH CARE. HEALTH INSURERS ARE EXPECTED TO HOLD PREMIUM INCREASES FOR COMMONWEALTH CHOICE (THE NONSUBSIDIZED PLANS) TO AROUND 5%. BUT PREMIUMS FOR SUBSIDIZED COVERAGE WOULD RISE $5-$15 OR ABOUT 14% (see the last page). GREATER BOSTON INTERFAITH ORGANIZATION PRESIDENT HURMON HAMILTON SAYS THAT’S TOO MUCH FOR LOW TO MODERATE INCOME RESIDENTS.

To raise their premium, what I call the misery index by 14%, while holding the cost for those who have more resources at 5% is morally unacceptable.

SOME CONNECTOR BOARD MEMBERS SAY THEY WILL TRY TO TRIM PROPOSED INCREASES IN SUBSIDIZED PREMIUMS AND CO-PAYS. BUT THE CONNECTOR IS STRUGGLING TO BALANCE WHAT IS AFFORDABLE FOR THE STATE AGAINST WHAT INDIVIDUALS ARE REQUIRED TO SPEND ON COVERAGE.

Frequent visitors to this space have read all of the gloomy predictions recently about health reform. Both the media and health care pundits in Massachusetts (and even around the nation) have started to ring the death knell on reform and are crying that the sky is falling.

But wait a minute.

Now is not the time to lose focus of what it is we that we set out to accomplish nearly two years ago. Did anyone really think that there would be no challenges along the way? No obstacles to success? Of course not.

For those who have started to lose hope that reform can succeed, there is some very encouraging news. Today, for the first time, Massachusetts hospitals are releasing a report analyzing the impact that reform, the virtual gateway, and other coverage initiatives have had on free care demand. The report, and the data included within the report, offer a startling glimpse at how well reform is working. Consider this: during the past three years, we have witnessed a 28 percent increase in coverage through Medicaid and Connector products. What has happened to free care demand during the exact same three-year period? An identical 28 percent decrease. Yes, one of the central tenets of reform, that we can move people out of the pool and into insurance, appears to be very sound. Read more…

Over the years, I’ve come to realize that very few people really understand the health care system, and this includes legislators and members of congress who vote on changes to this system. It also includes our presidential candidates, and I’ve watched the presidential primary process with amazement at both the lack of understanding and the plans that have emerged to “fix” health care.

The democratic debate for the final two candidates comes down to whether you believe in an “individual mandate,” i.e., requiring individuals to purchase health insurance if they don’t have it through their employer, or if they’re self employed. Clinton’s plan calls for one; Obama’s doesn’t.

In our Massachusetts system, I’ve had a problem with the “individual mandate” in health reform since the legislature dropped a “business mandate” (i.e., requiring businesses to provide health insurance) provision before passing the law. This, combined with the state adopting a methodology for determining insurance rates that punishes you as you get older, can result in the state enforcing a rule that will cause bankruptcy or severe financial hardship for many residents. Read more…

This is a slide show the Lynn Community Health Center staff uses to help navigate the new health care law.

| View | Upload your own

Two Congressmen, James Langevin (D-RI) and Chris Shays (R-CT) plan to file a bill tomorrow they call the first bi-partisan universal health care plan to come from the US House of Representatives. It would:

1) create a new agency modeled on the federal employee health care benefits program
2) let anyone buy one of the plans offered by this new agency
3) pay 72% of premiums – with sliding scale subsidies to cover the balance for low income Americans
4) use funds from a payroll tax to cover expenses
5) require that everyone have health insurance

The bill adopts the “everyone must share the responsibility for health coverage” theme that we’ve heard so often in Massachusetts.

Here’s a link to the bill.

Steve Bailey of the Boston Globe is at his best when dissecting where business and politics intersect. His column Wednesday was 99% on target on the cost challenges the state is facing on the new health care law. The projected costs he cited from Alice Dembner’s article a few days earlier are indeed staggering. And his conclusion that the next step of reform–seeking to rein in those costs–may be harder to pass than the access measure in the face of the political power of the health care industry is all too true.

But I take exception to one point that Steve made, that the “business community was largely left off the hook.” This is an inaccurate notion that some in the access, mandated benefits and health care provider communities would like to perpetuate. That conclusion is certainly not what I am hearing from our 3000 small business members! Insurance premiums continue their double digit annual climb; take up rates with employees are obviously going up due to the individual mandate, further raising the employer’s premium costs; and compliance requirements and thresholds, such as defining full-time as 35 hours rather than 40, or requiring prescription drugs and lower deductibles, further escalate costs and limit alternatives.

Small businesses in Massachusetts are struggling in this economy, and basic operating costs like rising health insurance and energy bills are slashing or eliminating profitability. Read more…

Last week the news leaked out from the Patrick administration that public spending for the health reform plan in the coming fiscal year will be about $400 million over the original projections. This follows a $146 million cost overrun in the current year.

Why are such miscalculations the norm? Are the costs of health reform unknowable? Or did politicians (and the media) listen only to the “experts” who told them what they wanted to hear?

As I wrote here several months ago, the Census Bureau has been saying for years that there were far more uninsured in Massachusetts than state leaders cared to admit. But politicians and the economists who advised them stuck to their guns. It turns out the Census Bureau was right. The result is that many more people are eligible for the subsidized coverage than the legislature or governor planned for. And, by the way, the demand for free care from safety-net hospitals and clinics is not dropping as fast as projected, again a result of undercounting the uninsured and ignoring the large number of immigrants who are mostly ineligible for insurance under the reform. Read more…