Chapter 58 has been extremely effective in expanding coverage to tens of thousands of Massachusetts residents who were previously uninsured. In spite of having insurance coverage, problems remain for many. A report released this summer by the Urban Institute found that nearly one in five Massachusetts residents had medical debt. Not surprisingly, the problem was most severe among lower income residents, almost one quarter of whom had medical debt. Medical debt causes health access problems and financial insecurity for many of those who have it.
Today, The Access Project released “In Debt But Not Indifferent,” based on the experiences of nearly 200 clients that we assisted through our Medical Debt Resolution Program.
We had two goals in mind when establishing this program. The first goal is obvious: to help people resolve their unaffordable medical bills. We provided one-on-one coaching to help people appeal denied claims with insurers, submit bills to public programs, and negotiate affordable payment arrangements with providers. Our second goal was to identify patterns of problems and policies that contributed to the creation of medical debt.
The Access Project’s Medical Debt Resolution Program seeks to ensure that existing programs work properly so that medical bills are covered by the parties that should have paid them in the first place. We also work with individuals to help them establish affordable payment arrangements, so they can resolve their medical debts without destabilizing fragile family budgets or increasing personal debt.
Our work with clients between September 2006 and April 2008 revealed that a silent tragedy is taking place for many Massachusetts residents, both insured and uninsured. Read more…
For the purposes of this blog, the first thing you should know about Codman Square Health Center is that it is a good location from which to look at the effects of health reform. An area with a very large low income and working poor population, we have had as many as 49% of the 21,000 individuals we see annually among the ranks of the uninsured. This was in the year before health reform was implemented.
Health reform is a very big deal to Codman Square. The impact of it on our patients has a huge impact on our finances and therefore the level of services we’re able to provide to our community. And so we study the numbers that come out of our computers monthly to see trends. The numbers our computers give us monthly point in a number of directions.
Here are some items from our data:
• The number of uninsured is way down – from 49% of patients two years ago to 14% today. Much of that change happened during 2007 and up to March of this year. The overall number of uninsured has been stable since March, 2008. About 2/3 of the uninsured are covered by the Health Safety Net, formerly known as the Free Care Pool.
• Access to insurance seems to have translated into more use of health services. We’re seeing increased demand, about a 10% increase in visits, such that our waiting time for appointments has increased to 3-4 weeks for many services.
• Bad Debt is up over 50% from last year, which was up over the previous year.
• Patients having Commonwealth Care insurance fluctuate up and down, but overall the number is flat since January.
So what does it all mean? Most important, many more people have insurance, and the patients who have this new insurance certainly seem to appreciate it and are using it. But it is also true that it is, as has been pointed out, a “near” universal system. Read more…
During last week’s Connector hearing on the proposed changes to the Minimum Creditable Coverage (MCC) regulations, we heard a resounding message from representatives of the employer community. Employers want to be able to provide their employees with high quality health insurance benefits that meet the standards for MCC. However many employers have been stretched to their limits as they struggle to keep up with the many requirements of the Health Reform Law, including ensuring that the coverage they provide for their employees meets the MCC requirements that were passed just this last year, and that will not go into effect until January 1, 2009.
Now the Connector Board is once again looking to make changes that would add more requirements to MCC. Adding to MCC will force thousands of individuals to discard their previous plan and purchase one that the State has deemed acceptable. These plans would likely cost consumers more money. Many of these individuals are enrolled in health plans that most of us would consider pretty good coverage but may vary slightly from the list of MCC requirements. These individuals would still be considered out-of-compliance with MCC and the individual mandate and have to pay substantial tax penalties; even if they were happy with their coverage and even if their coverage complied at the time they bought it.
Making changes midstream will cause disruption within the market, as many individuals and employers have already selected their health plan for the coming year, based upon the Connector’s current MCC rules. Read more…
Much good has come from the 2006 Massachusetts health reform law, and there have been a number of calls of late to use the Massachusetts plan as a model for national reform. The praise is well-deserved. That said, if Massachusetts is used as a model for national reform, there is one element we want very clearly to change – the requirement that coverage expansions be budget neutral under the terms of a Medicaid waiver.
Massachusetts has operated its Medicaid program under a federal research and demonstration waiver since 1998. These waivers, authorized under section 1115 of the Social Security Act, allow states to deviate from the normal federal rules governing Medicaid. For example, states have used waivers to cover categories of adults and children not normally covered by the program and to increase beneficiary cost-sharing beyond the nominal amounts allowed under federal law. In exchange for increased flexibility, states must adhere to budget neutrality requirements – the program changes can not cost the federal government more than it would be spending without the waiver.
To live within budget neutrality limits while expanding insurance coverage, states like Massachusetts have pursued several strategies to produce cost savings that can be applied to coverage expansions: Read more…
Note to readers: I am a member of the board of the Connector.
One of the goals of Chapter 58 is to make health insurance more affordable for people who buy it directly from insurers. The market for people who buy their own coverage (referred to as the “individual market” or the “nongroup market”) has a troubled history of expensive premiums, limited benefits, and lack of coverage for people with preexisting health conditions. In the 1990s, Massachusetts, like many states, enacted reforms to the individual market to improve availability and affordability of coverage. These reforms included requiring carriers to sell coverage to all applicants regardless of health, adopting standardized benefit packages, and placing limits on permissible rating factors and rate variation.
Chapter 58 continued this history of reform by merging the individual and small employer markets (so that premium rates in the individual market would be based on a larger and more diverse pool of people) and encouraging the development of range of new products.
So far, the only data I’ve seen about how these reforms have affected the individual market is one PowerPoint slide that compares the cost and comprehensiveness of coverage for a 37-year-old before and after reform. The slide shows that this 37-year-old can now get much better coverage for half the cost (a deductible of $2000 vs. $5,000, drug coverage, preventive and emergency care before the deductible, and a monthly premium of $175 vs. $335 before reform). Impressive progress indeed.
But after seeing this PowerPoint slide yet again at a conference out-of-state, and presented yet again by a national health policy person who had no connection to Massachusetts, I decided it was time to add at a few more data points to the discussion about the individual market reforms in Chapter 58. Read more…
As the punch, counter-punch continued on the presidential campaign trail yesterday, health care advisers to Senator Barack Obama and Senator John McCain stuck to the issues at a Harvard School of Public Health forum. David Cutler (Obama) and Gail Wilensky (McCain) laid out their candidates’ plans and took a few questions.
An Overview
There is some agreement from each camp about the importance of electronic health records, tying what we pay hospitals and doctors to the quality of their work and medical malpractice reform.
Cutler and Wilensky disagree on how to cover the uninsured and how important that issue would be. Cutler says, for Obama, health care is no. 2 behind Iraq. Wilensky would not say if getting coverage for everyone is one of McCain’s goals. She said Iraq, other national security issues and the economy are McCain’s top priorities. But she stressed that he is only Republican for some time with a serious health plan.
The two advisers each say the other candidate is not putting up enough money to fund his health care plan. Cutler says McCain can’t stick with or expand the Bush tax cuts AND balance the budget without major cuts in health care programs. Wilensky says Obama is pledging to spend the same money from reversing some of those tax cuts for a number of major initiatives. Read more…
The cost of health insurance in Massachusetts is expected rise at almost twice the inflation rate once again this year.
The state’s major health plans predict premium hikes in the neighborhood of 10 percent.
The increases vary but many employers say they’ll still be difficult to absorb. WBUR’s Martha Bebinger reports.
BEBINGER: The state’s largest insurer, Blue Cross Blue Shield says premiums for most of its customers will rise 8 to 11%, a few points more for small businesses. Senior Vice President for Sales Tim O’Brien says those increases are slightly lower than the projections at this time last year
TIM O’BRIEN: We’re seeing a 1-2% reduction in the rate of increase and I think any employer that you talk to would view that as good news but none-the-less we need to focus on all the programs we’re doing to improve the affordability of health care.
BEBINGER: O’Brien says employers who are trimming that 1-2% from the price of health insurance are doing that by asking employees to pay higher deductibles or co-payments, and by adopting programs that help workers improve their health. Jim Klocke, Senior Vice President at the Greater Boston Chamber of Commerce, says few employers will take next year’s rates as good news.
JIM KLOCKE: Anytime you get a double digit increase in a major business cost, it give you headaches, it causes you problems. It’s a problem not just that costs are high, but that they keep growing at a high rate.
JON HURST: It’s very discouraging; the promise of health care reform clearly has not been felt by small businesses.
The Connector staff spent much of their summer making technical changes and clarifications to the Minimum Creditable Coverage (MCC) regulations. Many of the proposed changes make important and beneficial changes: clarifying that coverage under out-of-state plans can satisfy the individual mandate and that Veterans Administration coverage satisfies the mandate, and ensuring that High Deductible Health Plans provide adequate coverage of basic health care needs to be deemed “creditable” by the state. However, one of the issues that the ACT!! Coalition will highlight in our testimony at today’s hearing is far from technical and it’s impact could be devastating.
From the start, the regulations have required that, to be considered creditable, a health plan must cover a “broad range of medical benefits.” With revisions to the regulations, the Connector has made clear that some of those services are “core services,” which cannot be limited by annual benefit caps or limited to an indemnity fee schedule. Cost-sharing for these services also must count toward the out-of-pocket cap. The core services are physician care, inpatient acute hospital care, day surgery and diagnostic tests.
The other “broad range” services, emergency services, maternity and newborn care, mental health services, prescription drugs and radiation and chemotherapy, can be subject to limitations on how much the plan will pay for the service in a given day or year and the cost-sharing need not count toward a plan’s out-of-pocket cap. Read more…
The opposition to asking more of those businesses who still aren’t paying their “fair share” of employee health insurance, to contribute to the costs of health care is, indeed, puzzling. More than 90% of Massachusetts businesses are, and have been, providing health care coverage to their employees. It isn’t fair for them to be asked to continue subsidizing the other businesses – including some competitors – who fail to do their part. Yet, in opposing reasonable “Fair Share” contribution rules, leading business organizations appear to be undercutting the positive efforts of many of their own major members.
If a small portion of businesses continue to get away with shifting the cost of their uninsured workers to others – including the substantial portion of businesses who help cover the uninsured through the Safety Net Care assessments, as well as paying for their own employees, how will Massachusetts support universal coverage? The businesses that already pay the Safety Net Care assessments got a hint when the state approved recently a supplemental budget that provided “one-time” increases to those assessments. Let’s remember that the “fair share” contributions were considered a more reasonable solution to funding health reform than an across-the-board payroll tax. Read more…
There is no deal yet between the state and federal government on a multi-billion dollar Medicaid spending plan. Today the state asked for another two week extension of the agreement that was to expire June 30th. Governor Deval Patrick said last week that state and federal negotiators are close to reaching a deal. This Medicaid waiver is a critical part of funding the state’s health coverage law and many parts of the health care system. Even a small decrease would be difficult to absorb when the state already expects a one billion dollar budget shortfall this year.