The budget ax fell, last week, on the Quality and Cost Council — the other half of Ch. 58’s Health Care Reform Law. Charged with creating a web-site to provide consumers with comparative price and quality information, and led by a board consisting of an admixture of state health care agency heads, A and F, the Inspector General, representatives of the Attorney General and the Auditor, prominent providers, payers health policy experts, and buyers, and the Council has taken significant steps toward addressing its mandate. This, despite a bare bones budget and a minimalist staff, augmented by staff from DHCFP and others. The complex claims data operation authorized by Ch. 58 did take place, a web site developer did put together the web site structure, consultants have vetted the statistical booby traps involved in presenting data, and a contractor has been selected to map out how the Council and the Commonwealth might use all these data to begin to deal with ever-rising costs. And then came the budget crunch. Making cuts in program is never easy and critics can say that cost cutting strategies should have been the last thing cut, not the first. And for the staff who are losing their jobs, it is probably cold comfort that they go, with the respect and gratitude of the council members who know how hard they have worked and how far they have come. But the need to do something about rising costs does not go away with their departure, Read more…

One week before the country chooses a new President…we want to know…how would the Obama or McCain health plans affect you? You can see a side by side comparison of their plans here. Some broad questions are:

1) Do you want to be able to shop for health insurance plans anywhere in the country?

2) Are you worried about whether your employer would drop coverage if the tax benefit for buying through the workplace disappears?

3) Do you agree with a mandate for children or adults or both?

4) What if any fine should employers who don’t offer coverage have to pay?

We’d love to hear your responses throughout the week. We’ll try to answer any questions you have in a live chat at noon today.

“We’ve given each other some hard lessons lately,
But we ain’t learnin.’
We’re the same sad story, that’s a fact;
One step up and two steps back.”
Bruce Springsteen – 1997

These are among the words of the title song of a Bruce Springsteen album a decade ago talking about blue-collar woes, lost loves, found loves that didn’t pan out, and lives chafing against the status quo. They could just as easily be the theme song for those of us working to advance health reform during an economic recession.

Massachusetts’ landmark health reform law passed in 2006 has, according to the Connector Authority’s October 2008 report, achieved an unparalleled 97% health insurance coverage. About half of that coverage is privately paid by employers and workers, and the rest is paid by taxpayers either completely or with some individual financial participation. The Commonwealth is on the verge of providing virtually universal health coverage, and the individual stories of lives saved are truly heartwarming!

Surely, no one can again ask if it’s possible to achieve universal health coverage. But now we must ask, for how long? Read more…

Over 430,000 Massachusetts residents are newly insured since the health reform legislation was signed into law in 2006. One mostly unnoticed aspect of this story is that the percentage of employers offering health coverage to their employees has been steady at around 70%, not declined, as was feared. In total, 159,000 of the newly insured have obtained coverage via their employer, far more than anyone anticipated. This is a major incremental contribution from business (estimated at as much as $750 million in new employer contributions) to the funding of health care in Massachusetts, money that potentially saves state government from paying additional subsidies for low-income workers. A catastrophic downturn in the economy will put this progress to a serious test. If Massachusetts health reform survives the next few years it should be able to survive anything.

There are a limited number of ways to cut outlays for health care. The simplest is to cut payment rates. That’s started already with the 9C cuts and will undoubtedly continue. This approach has limits as government rates are already below costs for many providers, leading to cost shifting into commercial premiums. The next lever is to make eligibility standards for state programs more restrictive and begin to drop patients from coverage. While this is technically feasible, it is virtually impossible to contemplate as a first line measure given all the recent focus on improving access and extending eligibility.

A final set of options centers on policy initiatives. Read more…

America’s medical schools may be among the few winners from the current economic downtown. When the jobs on Wall Street dry up, we can expect would-be investment bankers to flock to medical school. This may be good news, particularly with recent media attention on the Massachusetts Medical Society report predicting that the doctor shortage will only get worse over time.

There are a broad range of opinions about whether the doctor shortage is as described, and how to solve complaints about health care access. The Association of American Medical Colleges has called on medical schools to increase their enrollment by 30%. They have also urged Medicare to lift the cap on Graduate Medical Education funding to support expansion of the workforce. This will be very expensive and may not actually solve the shortage.

More doctors doesn’t necessarily mean better access to care. Adding more dermatologists may decrease the waiting time for botulinum toxin treatments from eight days to six but have no impact on the nearly 30-day wait period to have a changing mole examined. And adding more cardiologists may lead to more angioplasties without decreasing the wait time for consultations for managing individuals with congestive heart failure.

The regional supply of physicians varies widely. Read more…

As the nation’s economy falters, Massachusetts may be better positioned than other states to avoid the predicted rise in the ranks of the uninsured. A study published by Health Affairs today says employer support for the state’s health coverage law remains strong and few companies are dropping coverage. The findings are based on a survey conducted last Spring well before recent economic turmoil that typically triggers less coverage and higher costs for those who retain the benefit. But the study’s author, Jon Gabel, says individual and employee requirements may undo that pattern in Massachusetts.

The fair share requirements and the individual mandate provides an incentive for many employers to continue offering coverage when economic conditions may suggest that under normal circumstances they would drop coverage.

But employer groups warn that if this is long term recession companies may have to cut coverage to stay in business.

How is our faltering economy likely to affect the Commonwealth’s recent gains in health care access and coverage? The most direct effect will be a probable decline in employer-sponsored health insurance: since most people get their health coverage through an employer, a drop in employment would mean a loss of coverage. (I should note here that, thus far, major metropolitan areas in Massachusetts have dodged the job losses befalling much of the rest of the country.) This trend would be offset somewhat by the fact that Massachusetts has in place a very strong coverage safety net – MassHealth and Commonwealth Care. These programs, authorized by the federal government under the Commonwealth’s Medicaid demonstration waiver, are designed to be countercyclical – enrollment should rise when economic conditions decline. Governor Patrick’s recent budget cuts maintain eligibility and benefit levels in MassHealth and CommCare, though the increased enrollment that likely will result from contraction in the private sector would put further pressure on the State budget.

Even if the number of uninsured does not grow significantly, though, the number of underinsured might. A real phenomenon with no precise definition, “underinsurance” basically describes a circumstance in which health insurance does not adequately protect a person from prohibitive, potentially catastrophic medical expenses. Read more…

In the presidential campaign, the candidates take strikingly different approaches to covering uninsured residents. Senator John McCain says it is government’s responsibility to help Americans get affordable health coverage. Senator Barack Obama says health care is a right that government must help protect.

Their different strategies are getting a lot of attention in Massachusetts, where the state is investing billions of dollars to provide near universal insurance. WBUR’s Martha Bebinger looks at how the McCain and Obama health plans would affect that Bay State law.

Text of the story:

There are a lot of similarities between Senator Obama’s plan to cover the uninsured and the Massachusetts health coverage law. He would make insurance mandatory for children. In Massachusetts it is required for adults but not children. Obama would fine large employers who don’t offer coverage. Remember the Commonwealth’s $295 per worker fine? He would expand free coverage and offer subsidies to moderate income individuals and families, something Massachusetts is already doing. And Obama would create a clearinghouse for residents who don’t get insurance through their employer, something like the Connector in Massachusetts. The approaches are so close that seemingly small differences in fines, or who is eligible for what, might cause trouble here. But Connector director Jon Kingsdale isn’t worried about that level of detail right now.

JON KINGSDALE: There’s nothing I’ve seen in Obama’s plan that would give Massachusetts a real problem adjusting and certainly, having the level of federal commitment that he’s talked about having would be helpful. And you cannot really do this without substantial federal financial participation

BEBINGER: Senator McCain talks about helping states in a more limited way, Read more…

Increases in health insurance premiums have become an annual story and despite our awareness of what drives them (rising medical costs largely beyond the control of health plans), the intensity of the debate surrounding their cause continues to increase.

But is there a way to reduce some of the sting of rising premiums? Through a combination of very simple strategies with larger lessons for health care, Fallon Community Health Plan has been able to hold down and, in some cases, reduce 2009 premiums for our Medicare members — despite rising health care costs.

We offer coverage to Medicare beneficiaries through 12 different Medicare Advantage plans, each with slightly modified benefits to best fit individual health status and financial risk tolerances. For 2009, we reduced premiums for four of those plans, from 10 to 42 percent. The others are remaining level.

The real story here is how we were able to do it. Regular readers of Commonhealth know that I’m perhaps the state’s biggest advocate for limited, high-performing networks. And they are the primary reason we’ve been able to reduce or hold premiums flat for our Medicare Advantage members. Read more…

Today, the Boston Globe has a story about how cost remains a significant barrier to health care. The data in the story comes from a joint survey project the Blue Cross Blue Shield of Massachusetts Foundation embarked upon with the Globe.

In the coming months, as we have an opportunity to mine the data from the survey, the Foundation will release policy briefs examining other barriers to health and health care as experienced by low- to moderate-income residents of the Commonwealth. Topic areas will include regional disparities, emergency room usage, and access to community resources for health.

While the state’s health reform law gave hundreds of thousands of residents something many thought they’d never have — an insurance card — we all know that a card in your wallet is no guarantee of access to health and our health care system. Other salient factors include whether or not you have a primary care provider. Whether you can schedule appointments in a timely manner; whether you have access to good nutrition; and whether you live in a safe neighborhood.

These are important questions that deserve close study and scrutiny. Read more…