In January, I forecast the Legislature’s priority to address containment of health care costs during this session. Here we are, in March, the day after the Joint Committee on Health Care Financing held a lengthy and productive hearing on bills related to just that. The Committee now begins the process of parsing the bills and redrafting what promises to be the most significant health reform legislation since Chapter 58 of the Acts of 2006. Cost-containment is no small challenge. It is, in many ways, a greater one than expanding access to coverage. But it is a similar challenge in that it requires significant investments before some of the savings can be realized. Responsibility for expanding access had to be shared, and now investing in cost-containment has to be shared as well. Read more…

This is the bullet point version of Senate President Therese Murray’s cost containment bill…as she outlined it at a State House committee hearing today. Are there any particular areas you would like to hear more about?

• Across the United States, premium increases have been between six and seven percent on average. Massachusetts, however, has seen double-digit increases for the last eight years. We need to find out why this is happening here and nowhere else.

• This growth in health care costs is out-pacing the increase in workers’ wages (3.7 percent) and the overall inflation rate (2.6 percent).

• That’s why we propose to hold public hearings for any insurance company that submits premium increases above 7 percent.

• These reviews will explore administrative costs, marketing costs, salaries, compensation packages and reserves.

• We also propose public hearings with health care providers to investigate cost-drivers and make cost-reduction recommendations.

• In short, we need more transparency if we expect to maintain the integrity of our health care system.

• This brings me to an issue that has been getting a lot of attention since we announced the second phase of health care reform….

• The proposed gift ban. Read more…

We’re beginning another occassional series of stories from Massachusetts residents who were recently, or still are, uninsured. If you want to post your story, you can comment below or send me an e-mail(marthab@bu.edu).

Thanks for reading, Martha Bebinger

John Kulig lives in Central Massachusetts. He works 2 part-time jobs as a chiropractor and as a physiology instructor. Neither job offers health insurance. John purchased insurance in time to avoid the penalty on his 2007 tax return. Here is his description of that process and his concerns looking ahead.

In October 2007 I had the opportunity to attend a weekend informational meeting sponsored by the Health Connector at the YWCA in Worcester. The most comprehensive plan, in my opinion, was the plan offered by Blue Cross and Blue Shield. But at $400.00 per month it was quite expensive and beyond my means. I also spoke with a representative from Fallon Clinic. I was surprised when she stated that my working two part-time jobs was a “life style” decision. (It isn’t – I have not been able to find full time employment.) Fallon’s plan was approximately $300.00 month and allowed me to see my current physician but there was a $2000.00 per year deductible. Read more…

THE STATE’S HIGHEST COURT HAS REJECTED A LAST DITCH EFFORT TO GUARANTEE HEALTH COVERAGE FOR ALL CITIZENS OF MASSACHUSETTS. THE SUIT WAS FILED LAST YEAR AFTER THE LEGISLATURE RECESSED WITHOUT VOTING ON A PROPOSED HEALTH CARE CONSTITUTIONAL AMENDMENT. TODAY THE SJC AGREED THAT THE LEGISLATURE WAS REQUIRED TO TAKE A VOTE…BUT THE COURT SAID IT HAS NO POWER TO ORDER THE QUESTION TO THE BALLOT. DONALD STERN, ATTORNEY FOR THE CITIZENS GROUP WORKING ON THE AMENDMENT, CALLS THE DECISION DISAPPOINTING.

We have a clear constitutional mandate, a clear violation by the legislature to vote up or down, but the court saying that there is nothing they can do about it.

SENATOR RICHARD MOORE SAYS A VOTE ON THE PROPOSED AMENDMENT DIDN’T MAKE SENSE WITH MASSACHUSETTS IN THE MIDST OF A SEPARATE EFFORT TO INSURE ALL CITIZENS. HE SAYS THE PROPOSED AMENDMENT DID HELP PUSH LAWMAKERS TO TACKLE THE ISSUE. BARBARA ANDERSON WITH CITIZENS FOR LIMITED TAXATION SAYS THE INITIATIVE PETITION PROCESS FOR CONSTITUTIONAL AMENDMENTS IS DEAD BECAUSE NO ONE WILL WORK ON A PETITION DRIVE KNOWING THAT THE LEGISLATURE DOES NOT HAVE TO FOLLOW THE RULES.

As the presidential campaign enters its next phase, the economy, health care, and the war in Iraq continue as the three big issues facing the country and driving campaign themes.

When the topic turns to access to health care, we should prepare ourselves to hear Massachusetts’ efforts for health care reform referenced as either visionary or as a cautionary tale of misguided public policy. While I continue to be unwavering in my support of health care reform, the true answer on its success is really yet to come.

In order to succeed, what we must do next is grapple with health care costs in a manner that hasn’t been done before. Massachusetts is the perfect laboratory in which to create real change.

The good news is that people are seizing the moment. Last week in this blog, Secretary of Health and Human Services Dr. JudyAnn Bigby wrote “that we must promote policies that ensure people have the right care in the right place.” I and others have said the same thing. It is my hope that the Commonwealth’s Quality and Cost Council, the Massachusetts Association of Health Plans and the provider community will leverage their common goals for the greater good. Read more…

Last week Governor Patrick and I met with Mike Leavitt, Secretary of Health and Human Services, to begin discussions on renewal of the state’s Medicaid waiver. While it may not get a lot of front-page attention, I can’t underscore the importance of the Medicaid waiver to the success of our landmark health reforms.

Massachusetts’ first Medicaid waiver was approved in 1995, took effect in 1997, and allowed our state to expand Medicaid to many low-and moderate-income residents who had not previously had coverage. The waiver was renewed in 2001, with relatively few changes. When the waiver was up for renewal in 2005, at the same time Massachusetts was getting serious about health reform, the Bush Administration threatened to take away much of the funding that had allowed us to successfully expand Medicaid.

After very difficult negotiations, we were able to retain strong federal support through the waiver, but with the stipulation that we move enact health reform in Massachusetts. It seemed that the Administration didn’t realize how serious we were in Massachusetts to see health care reform become a reality. Read more…

Even when there was no reason for hope, Abraham kept hoping— Romans 4:18a (New Living Translation)

Recently, the word” hope” has been batted around on the national stage like a new tennis ball in a Wimbledon Grand Slam Tennis Competition. But in a few weeks, Massachusetts will celebrate a powerful undisputable symbol of “hope” – the second year anniversary of Chapter 58. Two years ago, those who had hoped, prayed and worked for quality universal healthcare, even when there seem to be no reason to hope, rejoiced over our new healthcare law. Two years later, this new, experimental law is itself a “hope” – an “endangered hope” – yet to be fully realized in an environment of escalating medical cost, deteriorating economic realities, and an expanding index of human greed.

Last week, this “endangered hope” was almost mortally wounded when the Connector considered loading onto the backs of the poor, sick and most vulnerable indefensible hikes in premiums, co-pays and out-of-pocket maximums, while ignoring insurers, employers and hospitals as possible solutions to the growing financial challenge of funding this reform. Dangerous!

Thankfully, the Connector delayed its vote until later this month. Read more…

Just over a month ago, Governor Patrick unveiled his budget for Fiscal Year 2009, which makes targeted investments in health care reform and primary care initiatives, as well as education; public safety; job creation; and partnerships with cities and towns.

Health care reform will not succeed with insurance reforms alone, and investing in health care reform and primary care are key priorities for the Patrick Administration. We must promote policies that ensure that people have the right care in the right place. Massachusetts must receive the best value from health care expenditures, while ensuring health care is safe, timely, efficient, effective, equitable and patient-centered.

We continue to support the goal of near-universal coverage, and the first year of this innovative program has been a success. More than 300,000 people who were uninsured now have health coverage. Yet even beyond continuing to support expanded coverage through Commonwealth Care and MassHealth, there is other important work to do. We need to focus more attention on health care costs and improved access to primary care services for all people in Massachusetts. Several initiatives in the Governor’s budget reflect these goals. Read more…

In the last legislative session (2005-2006), Massachusetts launched a comprehensive, historic effort to extend affordable, high quality health insurance through a public-private partnership featuring shared responsibility among individuals, employers, and government. We increased access to private market coverage as well. As we continue to implement Health Reform – we have more than 300,000 previously uninsured who now have health insurance.

Our new Commonwealth Care and Commonwealth Choice insurance products, as well as our expanded Medicaid coverage that are the cornerstone of health care reform are subject, however, to many of the same economic pressures experienced by the more than 90% of our residents and employers who have had health insurance all the along. Rising health costs are not sustainable for anyone – our newly insured through health reform or the larger population who have been insured.

The federal government (CMS) has projected rising costs nationally, and we are seeing rising costs in our state health insurance programs as well. Health care spending, according to CMS, continues to outpace overall economic growth and general inflation by more than 6% in both cases, and the share of health care spending of our gross domestic product is growing beyond the current 16%.

We’ve learned that just cutting spending can significantly harm quality, shift burdens to others, and harms our state’s economy which depends so heavily on health care, so arbitrary cuts in services, salaries, equipment, etc. is not the answer. Read more…

THERE IS A LOT OF TALK ABOUT THE NEED TO CONTROL HEALTH CARE SPENDING ACROSS THE COUNTRY…BUT PARTICULARLY HERE IN MASSACHUSETTS WHERE THE COST OF COVERING THE UNINSURED IS THREATENING THE PLAN ITSELF.

There has to be climate change, otherwise our health care reform will implode under the costs.

THAT’S SENATE PRESIDENT THERESE MURRAY WHO FILED HER HEALTH CARE CLIMATE CHANGE BILL YESTERDAY. IT IS A BROAD PACKAGE THAT INCLUDES NEW REQUIREMENTS, MORE STATE SPENDING, GREATER SCRUTINY OF HEALTH CARE COSTS…AND THE HOPE THAT SPIRALING HEALTH COSTS WILL START TO UNWIND.

BEBINGER: Senate President Therese Murray is worried about spending on the state’s health coverage law…and she calls this bill health reform phase 2. It aims to control health care spending for and by everyone.

MURRAY: Health care costs have become the no. 1 issue facing our economy. These costs are not only squeezing our state finances, but they are also making it increasingly difficult for young people for families and businesses large and small and municipalities to make ends meet.

BEBINGER: Murray explains her bill as many parts that as a whole will reign in costs and improve the quality of health care in Massachusetts. She’d tackle a shortage of primary care doctors with expanded tuition incentives, loan forgiveness programs affordable housing options and by recognizing nurse practitioners and physician assistants as primary care providers. Murray would require that all insurers create uniform codes and billing to cut down on administrative costs. Read more…