Over the past two weeks, health care reform in Massachusetts received two powerful shots in the arm. The state’s Division of Health Care Finance and Policy (HCFP) recently announced that 439,000 people have enrolled in health insurance since reform, with 191,000 of those enrolling in private coverage. And, yesterday, the U.S. Census Bureau issued a report showing that the national rate of uninsurance decreased, with Massachusetts having the lowest rate of all states.

There’s more good news. HCFP’s quarterly Key Indicators also reported that care for the state’s remaining uninsured financed by the Health Safety Net – formerly known as the Uncompensated Care Pool – has decreased markedly as insurance enrollment has increased. In the first quarter of the Health Safety Net FY08, there was a 37% decrease in the number of patients using the Health Safety Net in community health centers and hospitals, compared to the same time period last year.

These newest numbers demonstrate that health care reform is working, thanks to diverse efforts to insure people — including the expansion of Medicaid, publicly subsidized insurance and the individual mandate. A diverse group of stakeholders have worked together to make these achievements possible, but we still have work to do to make sure that our progress is sustainable going forward.

Consumers, employers and government must all do their part to get Massachusetts to near-universal coverage. The overwhelming majority of employers in Massachusetts are doing the right thing, with 72% of employers offering health insurance to their employees in 2007.

There is still a small minority of employers who are not covering their employees. Read more…

At the end of August, without much fanfare, Governor Patrick signed An Act Relative to Children’s Mental Health into law, marking a major step on the path to fixing the broken children’s mental health care system in this state and enhancing access for the estimated 100,000 children who need but don’t receive mental health services.

For the first time in my 30 years of clinical practice, the state has recognized that children and families are deeply impacted by mental health problems and that many issues facing children, such as poor academic performance, have their roots in behavioral and emotional difficulties. The bill grew out of the awareness that we need to reach children early in life and we need to reach them in the places where they live and learn, especially schools. But it also grew out of the awareness that the children’s mental health system we have is not designed to do any of these things.

The legislation takes a systems approach that seeks to achieve three goals: Read more…

Almost 30 percent of the state’s dentists now accept Medicaid patients, up from 12 percent a year and a half ago. Here’s a brief explanation of why the number has grown:

Despite its goal of providing universal healthcare, Massachusetts has had trouble getting dentists to treat people insured by MassHealth, or Medicaid. But it’s now quicker and easier for dentists to enroll and submit claims since a private company began administering the state’s dental program 18 months ago. Jaime Corliss of Health Care for All says that has led to a 20 percent jump in MassHealth patients receiving dental care.

“As a result of the improvements to the system more dentists are coming onboard. There’s still some work to be done but this shows that we are making progress.”

One remaining hurdle is increasing reimbursement rates for dentists who treat MassHealth patients. The state’s reimbursement rate is about half what private insurers pay.

Regular posts will begin again on Sept. 3rd

The Massachusetts health reform law has successfully expanded access to quality insurance at affordable rates for hundreds of thousands of residents. Yet, one group has been categorically excluded from the benefits of Massachusetts health reform: university students. Since 1989, university students have been required by law to purchase health insurance under the Qualifying Student Health Insurance Program (QSHIP), Massachusetts’ first individual mandate. Students who do not have health insurance through their parents are offered a plan through their university that is a cheaper alternative to other plans on the individual market.

Many Massachusetts universities—including Tufts University, where I am a student —have excellent on-campus health services that allow students to access excellent primary and preventative care. Nevertheless, the major medical coverage under the QSHIP plans offered by most schools is outrageously poor. These plans can include annual per illness or injury coverage caps as low as $50,000, as well as $1,000 – $1500 internal benefit caps for services such as high-cost surgeries, out-patient or in-patient care, and miscellaneous expenses.

The Student Health Insurance Project (SHIP) is uniting current and former students from across Massachusetts to fight for better student health insurance. Our goal is simple: provide students who are income-eligible Massachusetts residents with the same high quality affordability insurance that other residents receive under the new subsidized Commonwealth Care plans, and require that QSHIP plans meet the Commonwealth’s minimum coverage standards set by the Connector Board. We want to ensure that Massachusetts students are no longer forced to buy sub-prime health insurance. Read more…

Amidst all the debate about the merits of the Massachusetts health reform law, it is easy to forget that its accomplishments have been nothing short of spectacular. A study authored by Sharon Long of the Urban Institute showed a fifty percent reduction in the number of residents without health insurance. Along with coverage came improved access to health care and a reduced financial burden associated with receiving care. These results were generated in just one year.

I can think of only two other state-level reforms that have had similarly dramatic effects. The first was Hawaii’s employer mandate, enacted in the mid-1970s with implementation delayed until the 1980s due to legal challenges. Under the Hawaii law, employers are required to provide health insurance coverage to their employees, but not their dependents. For more than a decade after enactment of the mandate, Hawaii had one of the lowest rates of uninsurance in the country. The second was Tenncare, implemented in 1994, which vaulted Tennessee from high levels of uninsurance typical of southern states to one of the lowest rates in the country.

Hawaii and Tennessee have lost their places of leadership in health insurance coverage. The Hawaii mandate is frozen in time due to federal law, making modifications that are more appropriate to the 21st century impossible. Tenncare has been dismantled and the number of uninsured in the state has grown.

Others draw the lesson from these two states and others that state-based reform is doomed to fail. While I would be the first to say that there are limits to what states can accomplish, it seems more valuable to seek to learn from the lessons of Hawaii and Tennessee. Read more…

The end of July may have marked the end of the Legislature’s formal sessions for 2007-2008, but it did not mark the end of our work for the year. In this and other public forums, discussion and analysis of the health reform law enacted in 2006 continues, as it should. The Legislature and the Patrick Administration have ongoing responsibilities and duties to health reform, and that work continues, too. The blueprint established by Chapter 58 is being followed and built upon by the Legislature, most recently through Chapter 305 of the Acts of 2008, “An Act to Promote Cost Containment, Transparency, and Efficiency in the Delivery of Quality Health Care.”

Chapter 305 makes good on the promise for sustainable health reform, by establishing policy priorities for containing health care costs, increasing transparency of what we get for our well spent health care dollars, and improving quality and creating efficiencies in our health care delivery system.

The new law puts in place provisions for a statewide system of secure and accurate electronic medical records, and a special commission on payment reform charged with making recommendations to the Legislature for incentives and payments to providers that encourage delivery of appropriate and coordinated care, with improved patient outcomes.

The new law also provides incentives for new medical school graduates to practice primary care here, where they are trained. Read more…

Social science experiments show that we humans, absent conscious contemplation, gravitate toward a reflexive belief that the world is just. Psychologists call it the “Just World” hypothesis, or theory, and have demonstrated its pervasive influence. The “just world” theory attempts to explain this powerful human bias and its connection to the moral judgments we make in response to another’s misfortune. In the “Just World”, bad things only happen to bad people and good things only happen to good people. So, be good and you will be safe. Perhaps we need to believe the world is just to avoid that other menace of human psychology – cognitive dissonance. What shall we do if being good is no insurance against misfortune? What kind of world do we inhabit that bad things happen to good people and good things are given to bad people? A corollary of the “Just World” theory, however, is more insidious: — If bad things happen to you, you must be a bad person; if good things happen to you, you must be a good person. I worry that this easy logic of the psyche may often undermine support for community solutions to suffering and collective responsibility for risk. Combined with our national history and cultural bias toward individualism and personal responsibility, it may make for a self-centered brew indeed.

In a blink, we delineate between the “deserving” and the “undeserving” poor. Do we now believe in the deserving and the undeserving sick? Sickness is brought on by poor lifestyle choices, right? Good health behavior – healthy “lifestyles” – will avoid it. If I am healthy – live healthy – why should I pay for the sick? If you get sick, you must have made bad choices. Make good choices and you will be healthy. Be good and you will be safe… Read more…

Word leaked out this week that Massachusetts’ negotiations with the Bush administration over renewing the state’s Medicaid waiver – the agreement under which the federal government provides matching funds for our Medicaid program as well as the new health law – are not going swimmingly. With federal officials seeking to slash some $2 billion worth of health spending from the state’s proposed budget, the already fiscally troubled health reform experiment in Massachusetts may be on even more tenuous ground in the coming years.

However, historians of health reform will receive this news with a distinct sense of déjà vu. The Massachusetts reform law, passed in 2006, is often described as a ‘first-in-the-nation’ effort, and is billed as a universal or near-universal measure. Upon passage, the New York Times claimed that “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Then Senate President Robert Travaglini claimed that “the biggest victory is for the people of Massachusetts, who will now have equal access to the most renowned healthcare in the world.” These were significant promises to Massachusetts residents, and significant promises for the nation. Fast forward just one year later and the math behind the promise of universal health care is looking fuzzy. Read more…

The administration’s decision to revise the employer “fair share” formula is breathtakingly shortsighted for a host of reasons. They’re fighting the wrong battle against the wrong enemy at the wrong time, and, in the process, endangering the broad coalition that has been critical to the success of health reform.

Contrary to the claims of advocates, the current fair share regulations reflect the carefully crafted compromise that broke the logjam and led to passage of the landmark legislation in 2006. The administration’s rationale for blowing open this hard-earned agreement is that employers aren’t paying their fair share. Let’s look at the facts.

It’s true that people with state-subsidized insurance are paying higher out-of-pocket costs this year – up to $25 million in the aggregate – but the increased price tag for the business community is far more. Not only are Massachusetts employers paying an additional $500 million to cover 85,000 previously uninsured employees and their dependents, but the $35 million being transferred from the Medical Security Trust is paid by employers, and $100 million of the $300 million in new corporate taxes will fund state health-care spending.

The ultimate irony is that the state’s increased assessments on employers, insurers, and providers may be covering a “shortfall” that does not exist. Read more…