A study out of Indiana University says 59% of doctors support national health insurance, up ten percentage points over the last five years. Dr. David Himmelstein, with Physicians for a National Health Program, says “doctors see a crisis, not just for uninsured patients, but for insured patients, physicians and nurses as well.” The report, in today’s Annals of Internal Medicine, is based on a survey of 2, 193 doctors. It finds that 55% of physicians support incremental reforms, which the report says includes tax incentives tied to employee coverage and insurance mandates.

Previously I’ve spotlighted the Medicaid member “churn” phenomena and have advocated for improvements to keep people who are eligible for Medicaid from getting bounced on and off coverage. The churn issue is important because it results in fragmented care, and burdens safety-net health care providers and medical homes, MMCOs, and the state with the time and effort to re-enroll these members.

As Commonwealth Care moves beyond its freshman year and into a maturing program, the same eligibility redetermination process is now being applied to its members — with disquieting results.

The redetermination process kicked off in December. At Network Health, we have subsequently seen 12,000 Commonwealth Care members involuntarily disenrolled in February and March, nearly three times the previous disenrollment rate.

To put a human face on these numbers, I can offer an unfortunately “spectacular” story of one of our Commonwealth Care members who has lost his Commonwealth Care coverage not once, but twice since his enrollment last spring. Read more…

Last week, MassInc. released a report about the state of the Commonwealth’s finances. The study’s author, Cameron Huff, raises the important point that the state budget has a “structural imbalance, with on-going spending exceeding revenues.” This is something that politicians, policy-makers and the public need to talk about; Huff’s report contributes much to the conversation. Going forward, though, we should make sure that we aren’t placing undue responsibility for increased spending on MassHealth, the state’s Medicaid program.

For his report, Huff looked at two decades of state budgets from 1987 through 2007. He finds that Medicaid “spending totaled $7.4 billion in 2006, an increase over 1987 of more than $4.5 billion, or 163 percent. This percentage growth was almost five times that of the budget as a whole. Medicaid’s share of the budget rose from 13 percent to 26 percent between 1987 and 2006. Increases in Medicaid were two-thirds of the overall growth in state spending.” Read more…

Peter MacDonald is a computer consultant who works as an independent contractor. Peter and his wife Kirsten have four children. They purchased health insurance on their own through the end of 2007. Here’s Peter’s story about why the family does not currently have coverage.

I had been buying my health insurance since May 2006. The monthly premiums then, were $650 a month for a 35 year old + Spouse and family. No prescription coverage and $25 copay. This seemed high but I could afford it. Then in December that year the premium was raised to $750 a month. Kirsten and I started paying real attention to how much we were using insurance. Over the next year we only had about 15 doctors visits between all 6 of us. In December 2007 my premium jumped to $890 a month. When I called Blue Cross Blue Shield about this I was told that there was a 20% premium increase because they were not offering the plan anymore. The reason for not offering the plan was due to the new Massachusetts Connector plan. That plan would have cost me $905 a month, the only difference was that now it included prescription coverage. At this point my wife and I decided to just put the monthly premium into a savings account just to cover health costs. Read more…

AS THE COST OF HEALTH INSURANCE PREMIUMS CONTINUE TO RISE TWO, THREE OR FOUR TIMES FASTER THAN INFLATION…LARGE EMPLOYEES ARE HOPING THAT HELPING WORKERS STAY HEALTHY WILL REVERSE THAT TREND. SO CALLED “WELLNESS PROGRAMS” OFFER GIFT CARDS OR CASH REWARDS FOR WORKERS WHO PARTICIPATE AND FURTHER REWARDS FOR THOSE WHO LOSE WEIGHT, STOP SMOKING OR LOWER THEIR CHOLESTEROL.

BEBINGER: Vivian Pera glances both ways as she descends the stone steps of one of John Hancock’s Back Bay buildings for her daily walk.

PERA: I will probably go down to Newbury St. and walk around because its really nice. Just walking, moving around, uh huh.

BEBINGER: Pera began walking about two years ago after her first screening at a program John Hancock offers workers who want to improve their health. Her insurance company, Harvard Pilgrim runs the program and paid for the nutritionist to help Pera, who is 5’1’’ lose 45 pounds. Read more…

THE RISING COST OF SUBSIDIZED HEALTH COVERAGE FOR THE UNINSURED IN MASSACHUSETTS IS PUTTING NEW PRESSURE ON SUPPORTERS OF THE STATE’S MANDATORY HEALTH INSURANCE LAW. YESTERDAY THE CONNECTOR BOARD CAST SEVERAL CRITICAL UNANIMOUS VOTES THAT RE-ASSESS “AFFORDABLE” COVERAGE. ADVOCATES FOR LOW TO MODERATE INCOME SUBSCRIBERS AGREED TO SIGNIFICANT INCREASES IN CO-PAYS AND PREMIUMS…WITH THE EXPECTATION THAT HOSPITALS, INSURANCE COMPANIES AND EMPLOYERS WILL ALSO SOON CONTRIBUTE MORE TO KEEP THE STATE’S ATTEMPT AT UNIVERSAL COVERAGE SOLVENT. Read more…

The Massachusetts Association of Underwriters (MassAHU) supports Health Care Reform and the noble goal of providing health insurance for all citizens of Massachusetts. Health insurance brokers are an integral part of the health insurance system and have become part of the Commonwealth Connector’s distribution network. However, we are concerned about the Connector’s determination to write group health insurance plans, which we fear may contribute to the unraveling of the entire health care system.

We realize that the Massachusetts Legislature worked diligently to write the enabling legislation, and we all recognize that significant progress has been made. But, the evolving role of the Connector continues to concern us. Specifically, in July, 2008, the Connector is planning to market Commonwealth Choice plans to Massachusetts employers – even employers who already have existing health insurance policies for their employees through one of the major health plans in Massachusetts including Blue Cross Blue Shield, Tufts and Harvard Pilgrim. Read more…

Capitation – a fixed, prospective payment to a health care delivery organization – was tried and then mostly rejected in the 1990s. Physicians and patients feared that it would lead to limits on choice and denial of needed care. The negative reaction to capitation was so strong that Joe Dorsey and Don Berwick recently called capitation one of health care’s “dirty words”.

Capitation earned much of its negative reputation because, as Dorsey and Berwick point out, insurance companies too often “claimed to manage care but in many cases only managed money.” Payment levels were set artificially low, and the system had little way to monitor the quality of care and watch for patterns of under-use.

We should not, however, let capitation’s failings prevent us from learning lessons from its successes. Scattered among the bad experiences of the ‘90s were innovations that resulted from capitation’s original design: aligning economic and clinical incentives to promote creativity in delivering the best care for patients. Read more…

Hopes have been high for the Commonwealth Connector as an “exchange” through which individuals could purchase health insurance on a pre-tax basis, carriers could offer more affordable products, and consumer choices would be expanded. Although more individuals now purchase on a pre-tax basis and have more affordable options than were previously available to non-group subscribers, opportunities for more choice exist.

A few recent product and pricing decisions by the Connector have narrowed rather than created options. Instead of allowing individuals to make coverage choices, the Connector has mandated that all policies must include drug coverage. Instead of encouraging product diversity, the Connector has required that alternatives to their Bronze offerings must be tiered or select network products rather than low-cost HSA plans. Most recently, the Connector asked carriers simply to cap their rates.

While these policies may be understandable in isolation, taken together they narrow options and make it more difficult to meet affordability expectations, like the 5% cap on premium increases set by the Connector for July 2008. Read more…

Happy St. Patrick’s Day. According to Thomas Cahill’s How the Irish Saved Civilization, Patrick – a former slave – was the first person in recorded history to speak categorically against all forms of human slavery. That’s for real. The snakes – well, that’s another matter.

In his honor, let’s get down to business…

The advocacy community is concerned that the Connector Board is moving toward a Thursday vote on premium increases up to 14 percent and doubling/tripling of many co-pays for Commonwealth Care enrollees.

When the late February Board meeting was cancelled to give time for a “broader” stakeholder involvement, the advocacy community submitted numerous ideas to address funding challenges. The Administration set a 30 day timeframe for consideration. Thirty days is not up, but the Connector now is moving to put the weight of financial problems on the backs of enrollees before asking any other stakeholders to participate. Read more…