Last week Governor Patrick filed a supplemental budget request with the Legislature to generate $130 million in new revenue during FY 09 to fill an alleged shortfall in funding for health care reform. Not only is this request for new money premature – a shortfall is by no means certain – but it also falls dispro-portionately on the backs of employers in Massachusetts at a time when they are reeling from record energy prices, a sluggish economy and a $500 million increase in taxes approved earlier this month. So much for the “shared responsibility” theme that was a hallmark of the original law in 2006!

The state’s FY 09 budget includes $869 million for the Commonwealth Care program, a key component of health care reform providing subsidized insurance for low-income residents. This level of funding would support 225,000 enrollees. Currently Commonwealth Care serves 174,000 Massachusetts residents, an enrollment level that has been virtually flat since February when the state began reviewing eligibility for individuals who had been on the program for at least a year. There is no evidence that enrollment is going to increase dramatically and create a funding gap by the end of this fiscal year. So there is no need to impose new financial burdens on beleaguered Massachusetts companies.

Look at the details of the recommendation from the Administration, and you realize that almost all of the new costs will be borne by the business community. Read more…

Two years into the Massachusetts health insurance mandate law and we find ourselves with a great success story on access and coverage. The law has delivered in expanding coverage and that is a very good thing. Yet, small businesses are increasingly frustrated on the long wait for relief from the never ending annual premium increases. Unfortunately their frustration is just about to boil over, first into outrage and then to surrender over two simple words—“OR” and “AND.”

Family health insurance policies for those at the bottom of the purchasing food chain are as much as $23,000 today. For small businesses, those rates are unaffordable and they have not yet seen steps to reverse the trend. What they have seen are unnecessary and unaffordable teaching hospital expansions, with recent regulatory activity to curb these new facilities coming several years too late. They are too well aware that they pay far more for the same coverage than do big purchasers, thus creating a disproportionate funding of the health care system by small businesses than by large companies or by government payers. They see group purchasing discounts for public employers, while the law actually prohibits such opportunities for them. And unfortunately the Connector still hasn’t delivered on the promise of low cost small business plans for them, focusing to date only on taxpayer subsidized plans. Read more…

A Nurse-Patient Safety bill has cleared the Senate, but substantial differences with the House version will make reaching a resolution difficult. In the Senate bill, hospitals, working with nurses would set their own nurse staffing plans. The House would have the state Department of Public Health establish and enforce nurse to patient ratios. Many lawmakers are hoping House and Senate negotiators reach a compromise that puts the contentious issue to rest. But David Schildmeier with the Massachusetts Nurses Association (MNA) says the union wants the House bill or nothing.

If they don’t have a bill that sets safe limits on patient assignment for nurses, which is what is proven will help them, then no bill is worth it because conditions will continue to deteriorate and no one will be helped.

The MNA is also angry that the Senate voted on the issue while the lead sponsor of the union’s bill, Marc Pacheco, is out of the country. Hospital leaders say they compromised in the version that passed the Senate to give the state oversight and authority to intervene if insufficient staffing creates problems in a hospital. Read more…

Then I heard the voice of the Lord saying, “Whom shall I send? And who will go for us?” And I said, “Here am I. Send me!” Isaiah 6:8

On the evening of May 27, 2008, 1700 leaders gathered at Boston University to celebrate GBIO’s tenth year anniversary. On the stage that night was Governor Deval Patrick, Speaker Salvatore DiMasi, Mayor Thomas Menino, and Mr. Jack Connors – Board Chairman for Partners Health Care. In the audience were scores of city counselors, State administration officials, and key leaders from health care, business and insurance industries. As President, I had the honor and duty of laying out a vision for the next decade that would offer a framework for meeting the public policy challenges that lay ahead, together.

In my challenge to the gathered leaders and allies, I argued that this framework is found both within the words of sacred text (noted above) and in the word we so often throw around, “Commonwealth.” Simply put, the vision we are called to embrace going forward is “shared power”, “shared responsibility” and “shared sacrifice!” Those of us who share the power to make public policy must also lead in the sharing of responsibilities and sacrifices required to sustain public policy. Nowhere is this fact more evident then in this current phase of Massachusetts’ landmark healthcare reform.
See here and here for Parts 1 and 2 of my challenge to the leaders of Massachusetts and our allies.

Yesterday’s lead Globe editorial states the challenge in clear terms, Read more…

The House adopts much of the Senate’s bill…including annual hearings on what’s driving rising medical and insurance costs, uniform codes for insurance billing and a “Medical Home” pilot project focused on patients with chronic diseases. There is a loan repayment program for primary care doctors and grant money to help physicians set up electronic health records(EHRs) (Representative Patricia Walrath says the House would allocate 15 million while the Senate set aside 25 million. There is 25 mil in the budget, and it’s not clear how the House would spend the 10 mil balance). EHRs would be required for hospital, community health center and physician licensing as of 2015. Walrath worked with a small group of colleagues on a key difference. The House would not ban gifts from pharmaceutical sales reps to docs…but instead requires that companies…

Either set up their own code of conduct or accept Pharm’s code of conduct. There was a great deal of discussion on the issue and this was, I won’t say consensus of the group, but this is what came out.

Walrath says she hopes the House moves closer to the Senate on the gift ban question during House/Senate negotiations on the bill. Read more…

Pity the poor cigarette smoker.

When it comes to raising revenue to pay for health care reform, the public is ready, willing, and (thanks to a law just passed by the legislature and signed by the governor) able to whack tobacco users with another tax. A public opinion poll conducted earlier this month by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation finds strong public support (57 percent) for increasing the cigarette tax to raise money to fund budget shortfalls related to the health reform law.

This isn’t necessarily surprising. What is surprising is that despite months of what can only be described as negatively-tinged media coverage of the health reform law (stories on million dollar-plus cost overruns and bureaucratic glitches in enrollment to name just two examples), the public nonetheless strongly supports the state’s landmark health reform law.

More than two-thirds of those polled (69 percent) for The Massachusetts Health Reform Survey support the two-year-old law. Read more…

The state’s health care regulators deserve credit for tackling the problem of the explosive expansion of teaching hospitals into local communities.

Unbridled expansion hurts community hospitals and raises health care costs, not just by creating duplicative services but also by replacing services once delivered by local providers. When that happens, those services often increase in cost by 20 to 30 percent – without a corresponding improvement in the quality of care. When a teaching hospital moves to the suburbs, its rates do too.

As part of health care reform, the Legislature created a sensible framework for establishing new health insurance mandates, which are health care services the state requires health plans to provide. Before any new mandate can be put in place, state regulators must perform an analysis to calculate and assess its effect on health care costs.

A similar test should be applied to proposed hospital expansions. Before approving any expansion, regulators should ask:

How is quality of care improved?
How is access improved?
How will the cost of care change? Read more…

Back in October, Nancy Turnbull wrote about my case and about how my QSHIP plan had left me in tremendous debt; not to mention the burden of navigating a health system wrought with complications in addition to health insurance issues. Today I write to update my story and propose a solution, so such health insurance problems might be avoided in the future.

In brief summary, I was able to purchase a Commonwealth Choice plan which covered me despite my pre-existing cancer diagnosis (amazing!). While some might say the $5,000/year plan was out of reach for many, the cost was much less than the $250,000 debt I would have accumulated otherwise. I had amassed $45,000 in debt in just a few short weeks because my university plan benefits were depleted after one MRI and one CT scan. After negotiating with my insurance company and obtaining a flat 18% discount, which lowered my debt to $37,000, I was accepted into the Health Safety Net (HSN), which essential covered all but the physician’s bills. It is here important to note that I was lucky to have been treated at a facility approved by the HSN (or the HSN would not have been able to cover me). I was also lucky that the providing hospital had an agreement to waive the remaining physician’s bills to ensure continuation of care.

I consider myself VERY lucky to live in a State that offered me coverage despite my illness, and what this demonstrates to me is the possibility for improved choices for students. Read more…

Now that the dust has settled on the Democratic Presidential primary, those of us who are fixated on politics and health policy have begun to focus on the next major frontier — the potential for some sort of significant health care reform at the national level following the November election. There’s no question that the country is poised to make history on health reform. The public is clamoring for change and the candidates are listening.

Both of the presumptive presidential nominees, Barack Obama and John McCain, have articulated proposals for major changes in the health care system if they are elected. While their plans differ in significant ways, they each have the one thing in common that we must carefully monitor: the potential for a major impact on the success of the Massachusetts health reform plan.

Obama proposes an expansion of Medicaid and SCHIP, and a system of income-based subsidies for those who do not qualify for public coverage. Read more…

Two Boston hospitals are in the top ten list of America’s Best Hospitals out today from U.S. News & World Report. Massachusetts General Hospital is ranked 5th and Brigham and Women’s is in the 8th spot on the annual review. There is a separate list for hospitals that focus on children…and Children’s Hospital Boston is 2nd in the General Pediatrics category. Beth Israel Deaconness Medical Center is the focus of this column from the editor of the US News rankings. The list is controversial because some industry leaders say it relies too heavily on reputation. Medicare’s “Hospital Compare” website is a good place to check how well hospitals treat common problems including heart failure, pneumonia and surgery to remove a gallbladder.