The singular measure of the success of Massachusetts health reform, defined as universal coverage, should be whether we achieve health equity for all residents of the Commonwealth. The challenge is whether we can eliminate the persistent disparities in health and health care experienced by significant segments of the state’s population.

One step toward achieving that goal was realized when the Massachusetts State Legislature passed legislation that authorized the creation of a new statewide Office of Health Equity to lead efforts within the Executive Office of Health and Human Services and across the other Secretariats to coordinate efforts that would lead to the elimination of disparities in health in Massachusetts. The statewide coalition of advocates representing over 70 groups and organizations comprising the Disparities Action Network (DAN) who worked with this as their chief policy agenda and pushed it thorough the legislature sincerely thank Representative Rushing and Senator Wilkerson for their leadership on getting this initiative through the State budget process and as Co-Chairs of the Health Disparities Council established under Chapter 58. Read more…

The U.S. Centers for Disease Control says 16.4% of adults in Massachusetts smoked last year, the fourth lowest rate in the country. That’s an 8% drop in one year and is the largest decrease in more than a decade. Public Health Commissioner John Auerbach explains the sudden decline.

We attribute it to two things. The first is that Governor Patrick and the legislature restored money to the public health budget (for tobacco control). In addition to that health care reform was a very positive influence on tobacco use.

The state says that as uninsured residents enrolled in health plans, they connected with primary care doctors who helped them quit smoking. The Department of Public Health will continue to offer free nicotine replacement patches through the end of August. DPH says a one dollar per pack increase in the tobacco tax is also moving residents to reduce or stop smoking. It’s not clear yet how this decline will translate into lower cigarette tax revenues for the state. Health Care for All says the cigarette tax revenue projections are based on this smoking rate. Here’s a brief look at “Who Smokes?“

On Tuesday, July 22nd the Massachusetts State Senate unanimously passed S-2819 “An Act to Improve, Promote and Protect the Oral Health of the Commonwealth. Now, with two days left in the legislative year, the bill is awaiting consideration in the House of Representatives.

Why is this legislation so important? If enacted, S2819 would permit registered dental hygienists, who practice in public health settings such as schools, Head Start programs, nursing homes, etc., to provide preventive oral health services to underserved, MassHealth recipients without the supervision of a dentist. In addition, the bill would establish registration and career laddering for dental assistants and enhance the oral health infrastructure in Massachusetts. Read more…

Update 7-30 – The Governor’s package clears the Senate.

The House has approved a supplemental budget that adopts most of Governor Patrick’s $130 million in charges to help fund coverage for the uninsured. In the House version:

- Health insurers would pay $33 million from reserves, a one time assessment

- Hospitals would pay a one time increase of $20 million in their contribution to the Safety Net Trust Fund (formerly the Free Care pool). This is $8 million less than the hospital charge proposed by Governor Patrick. The House says teaching hospitals should continue to receive this 8 million for the training and reimbursement of specialists.

- The state would shift up to $35 million from the Medical Security Trust Fund (MSTF) into the General Fund, if needed, for coverage of the uninsured. The MSTF is a fund, drawn from employer fees, to cover health care for unemployed workers.

- The House does not include an additional $33 million from fines on employers who don’t offer employee health coverage that is part of Governor Patrick’s proposal. The Patrick administration plans to raise that money through a regulatory change. The change would require that employers (with 11 or more workers) provide coverage for 25% of their employees AND pay 33% of premium costs. The current regs say that a company can cover 25% of its workforce OR pay 33%.

The House and Senate are not expected to oppose the change. Read more…

8-21-2008 – Statement from Network Health:

“Unfortunately, Network Health has determined that a recent a survey of former Network Health Commonwealth Care members, which was administered by a third party, was not conducted in a statistically valid manner.

Network Health remains committed to working with MassHealth and the Commonwealth Connector on the continued successful implementation of the state’s historic health reform law.”

7-29-2008 – Original Post:

As you know from my previous posts, the “churn” of still-eligible MassHealth and Commonwealth Care members on and off their coverage is a topic of great interest and concern of mine. I focus on it because it’s antithetical to what our commonwealth has embraced in creating the health reform law and mandating insurance coverage for all Massachusetts residents. And, not only does churn self-perpetuate the problem of the uninsured in Massachusetts, I also believe that it creates lost opportunities for care management and critical gaps in care, and is a waste of time, energy, and money for the state, for members, for health care providers, for health plans, and for taxpayers. In the words of one recently disenrolled Commonwealth Care member, “If the state is going to insist that you have health insurance, they should make it easier to keep it.”

The goal of reform efforts is continuous insurance coverage of nearly all Massachusetts residents. Yet, in a recent survey we conducted of nearly 400 recently disenrolled Network Health Commonwealth Care members, more than 40 percent told us they do not have health insurance since losing Commonwealth Care (!!). Of that 40 percent without coverage, nearly 20 percent said they did not know why they lost their Commonwealth Care coverage. As one survey respondent said, “I am very interested in knowing why I was cut from the plan. I never got a reason.” Read more…

A letter to the editor about Senator Obama’s health care proposals in last Friday’s New York Times concludes, “There is no question that we spend a lot of money on health care in this country. Let’s not rule out the possibility that we are getting our money’s worth.” Sadly, it seems clear that the U.S. health care system overall is in fact not delivering value for our dollars, when compared with other countries or the highest performing states. This is the inescapable conclusion of the latest “National Scorecard on U.S. Health System Performance,” just published by The Commonwealth Fund.

The report scores the U.S. health system on 37 indicators in five areas: healthy lives (measures of mortality, life expectancy and limitations on activity); quality (effectiveness, coordination, safety and patient-centeredness of care); access (coverage and affordability); efficiency (administrative and clinical waste, inappropriate care or setting, readmissions); and equity (racial and ethnic disparities across select measures). Overall, the U.S. scores a 65 compared with a benchmark score of 100 and shows no improvement since the Fund published its first scorecard in 2006. Across the specific indicators, only 35 percent of them showed improvement from the 2006 report to 2008, while scores relative to benchmarks fell for 41 percent of the measures. It’s a discouraging assessment. As the authors put it: “The U.S. health system continues to exhibit suboptimal performance relative to what is achievable and to the resources invested.”

How do we improve? Read more…

“Not quite there yet” is the word from state and federal Medicaid officials. They will continue negotiations on a multi-billion dollar Medicaid Waiver for another two weeks…the third extension since the waiver expired on July 1st. The waiver is critical for funding of the state’s health coverage law. Patrick administration officials said earlier this week that their federal counterparts have not identified any particular items in the contract that are a problem and continue to support the law. This latest extension means that state legislators will end formal sessions without knowing if the state faces a shortfall in funding the law beyond the $350 million or so (Masshealth + Commonwealth Care) outlined in a filing to lenders this Spring.

A mental health parity bill has cleared the Senate after passing the House. Senate sponsor, Steven Tolman, says he hopes it will put an end to calls he gets from substance abusers who are trying to stop…but hit limits on coverage for treatment.

That is unconscienable. We have ripped down the barriers to get services so they are available for those in need.

The Senate version adds eating disorders, substance abuse, autism and post traumatic stress disorder to the list of medical conditions for which members can get unlimited benefits…but keeps some caps on therapy and other services. The House bill lifts those caps. Business groups and health insurers lobbied against the House version. But Massachusetts Association of Health Plans President, Marylou Buyse, does not object to the Senate bill.

We think the Senate took a measured approach. It gives people with serious mental illness the care they need. And gives everyone else generous but reasonable limits.

The House Sponsor, Ruth Balser, says she will move to accept the Senate version to make sure that something gets done before the legislature ends formal sessions on July 31st. Balser says, while the Senate bill does not create full mental health parity, it is still an important step forward.

In all of the commentary written here and elsewhere on how to control health care costs, little attention has been given to the potential contributions that could be made by physicians – those at the center of the health care system.

But maybe the idea is beginning to catch on.

Two separate articles on the same day in two of the nation’s most respected publications have highlighted the role of the physician in containing health care costs.

Alan Sager and Deborah Socolar of Boston University, writing in The Boston Globe, boldly state that “doctors’ decisions essentially control almost 90 percent of health care spending…yet cost controls have ignored, marginalized, or sought to manipulate doctors instead of working with them.”

The pair, arguing that “a financial, legal, and clinical peace treaty between payers and doctors” is required to develop a health care system that covers everyone and eliminates waste, offered one approach: develop “small clusters of primary care doctors and other professionals that live within budgets, accepting capitation payments calibrated to patients’ health. Raising primary care doctors’ incomes by half would sharply increase their supply and their time to listen to patients and coordinate care.” [Italics added.]

Separately, in the business pages of The New York Times, economist Milt Freudenheim wrote about experiments around the country by federal and state governments and insurers to cut health costs by paying doctors more. Read more…

Two years ago, the MA Healthcare Reform Law went into effect with the admirable goal of insuring the uninsured – and it asks everyone to participate – the government, insurers, providers, employers and individuals.

Is it working?

According to the latest press release by the Commonwealth Connector – the government authority responsible for administering the new law – there are 340,000 newly insure MA residents, giving the Commonwealth one of the lowest uninsured rates across the nation – and some say a universal healthcare model for the rest of the country.

What’s wrong?

With all the newly insured people coming into the system so rapidly, we are having trouble finding enough doctors to treat them and – we are having trouble finding the money to pay for it. In fact, some estimates show that the new law is under-funded by as much as $150-$200 million.

What does the Governor propose?

Last week, Governor Patrick issued a proposal asking businesses, insurers and hospitals to contribute about $100 million to fund the shortfall – and according to some new polls, consumers are supportive of his idea because they think “others” need to step up and pay “their share” – suggesting that recent increases in co-payments and deductibles prove consumers are already doing “their part.”

What are the specifics for the Governor’s proposal?

The Governor proposes raising $100 million in three ways:

1. Changing the “or” test for employers to “and” ($33 million) – if employers fail, they must pay a $295 annual assessment for each employer
 Specifically: employers with more than 10 employees must pay at least 33% of worker’s premiums within their first 90 days “or” have at least 25% of their worker’s covered by an employer plan
2. Tax health insurance company reserves ($33 million) – these monies are used to pay claims and a certain amount must be kept on hand by each insurer to make sure those claims can be paid
3. Tax hospitals ($28 million)

What’s wrong with this plan?

The problem with the Governor’s plan is it’s a HIDDEN TAX on consumers – and it doesn’t fix a thing! Why? Read more…