Psalm 145:1-7 (The Message)
God is magnificent; he can never be praised enough. There are no boundaries to his greatness. Generation after generation stands in awe of your work; each one tells stories of your mighty acts. Your beauty and splendor have everyone talking…Your marvelous doings are headline news.

At approximately 11:00 p.m. November 4, 2008, a new hour commenced in America, as this country elected its first African-American President. On this past Sunday, in a Jubilant Service, I preached from Revelations 5:8, “And when he had taken it, the four living creatures and the twenty-four elders fell down before the Lamb. Each one had a harp and they were holding golden bowls full of incense, which are the prayers of the saints.”

The prayers referred to in this text were those of the martyrs, which remained before the Lord. In that spirit, I thought of the millions of African-Americans, and the many others on our behalf, who died over the centuries with unanswered prayers for justice, equality and vindication. So on behalf of all those who now live beyond all time and space, I thank all of you who worked to prepare America and who voted on behalf of America’s future and answered the prayers that lingered in Golden Bowls.

There is another reason why this is a magnificent hour for our nation and for our Commonwealth. The new President-Elect is committed to transforming the Massachusetts’ Health care experiment into answered prayers for 45 million Americans who this very moment are uninsured. Read more…

The Commonwealth is at a crossroads. In order to sustain the rising cost of health reform, we can pursue one of two strategies. The first would be “every payer for itself,” with Medicare, Medicaid, the Connector, and the private sector doing their bit to control spending for their chunk of the pie. The second would be the development of a more comprehensive and thoughtful approach that controls costs with an eye toward transforming our delivery system.

The latter, of course, is the strategy most likely to work over the long term. So the question is not what we should do. It’s whether we can bring to the table those who have the greatest ability to control health care costs, get them to set aside some of their self interest, and develop bold new approaches to solving the problem. The state has already shown that it can be a national leader in expanding health insurance coverage to the uninsured. In just two years, Massachusetts cut its rate of uninsured from approximately 13 percent to just three percent. Employer-sponsored health insurance is holding steady. And residents of the Commonwealth generally are happy with the effects of Chapter 58.

But we eased our way into this deal by putting more money in the system. Chapter 58 included Medicaid rate increases for providers, and Medicaid managed care plan rates have increased at about five percent annually in recent years. Payments to safety net providers continued as we moved gradually from a system of paying for the uninsured through the free care pool to an insurance-based mechanism. And for the second year of the Commonwealth Care program, the Connector negotiated a nine percent rate increase with MCOs.

The add-more-money strategy was not sustainable, particularly in the face of an economic downturn. Read more…

In the coming months, the Obama Administration and the new Congress are expected to give serious consideration to reforming the nation’s health care system and expanding coverage. Senator Kennedy is expected to play a key role in this effort, giving us a unique opportunity to apply what we have learned from the Massachusetts health reform experience to the national debate. A bit of time worn advice for federal policymakers:

Don’t reinvent the wheel. States have considerable experience providing coverage to low-income populations through their Medicaid and SCHIP programs. These programs can be scaled to grow quickly. Massachusetts has been able to successfully reduce the number of uninsured by expanding its Medicaid and SCHIP programs in both the mid-1990’s and in the most recent health reform initiative. Sensible expansion of these programs should be a key building block for federal reform.

One size does not fit all. Uninsured individuals have coverage needs that differ based on age, income, and health status. The Massachusetts Connector model recognizes this: Commonwealth Care enrollees have very little point-of-service cost sharing and pay little or no premium; Commonwealth Choice enrollees can choose among three levels of coverage. Limiting coverage options, say, to the Federal Employees Health Benefit Plan could either depress enrollment or greatly increase subsidy costs.

Health care is local. Read more…

The economic downturn and resulting decreased revenues have forced Governor Patrick into difficult decisions. The result has been significant, and often dramatic, cuts to state health programs – even those designed to serve individuals and families in the most need.

Across the country, other states are similarly feeling the pinch, and Congress has been considering options to help. One potential opportunity to lessen the impact of budget cuts on the health care system is a short-term increase in the Federal Medical Assistance Percentage, or FMAP. FMAP is the percentage that the federal government reimburses to the states for Medicaid expenses. Because Massachusetts is one of the richer states, we receive the minimum – 50%. Read more…

A top aide says Senator Ted Kennedy is trying to persuade colleagues to unite behind a single universal health care bill that will use President-elect Obama’s health plan as a blueprint. HELP Committee staff director Michael Myers says the Senator, based on past experiences, believes that the best way, maybe the only way to “get this done” is to have just one bill. He says Obama will be a unifying force. This would mean that Senator Ron Wyden, Senator Max Baucus and others would have to agree to drop or amend their plans. Myers says there is already a lot of discussion among Democrats about how to come together. Now that the election is over, talks across the aisle are expected to begin soon and will be difficult.

A key issue is the cost of expanding health coverage. Myers says the one bill will address health care costs, but will probably not have enough savings to cover the expense of helping more Americans get health insurance. He mentions more use of electronic records and better safety and quality measures as ways to hold down rising health care costs. Ron Pollack, the director of Families USA, is worried that while these initiatives would save money over time , they will not produce the immediate savings needed to pass a bill.

Dennis Rivera, who chairs SEIU’s Healthcare efforts, supports the one bill strategy. He says competition would hurt momentum he hopes to build for action on a Universal Coverage bill in the first 100 days of the next session. Read more…

There are critical meetings underway this week at Boston Medical Center (BMC) and Cambridge Health Alliance (CHA) as the two hospital networks look for ways to make deep cuts. Roughly 16% of the state budget reductions Governor Patrick announced last month apply to these institutions. * At CHA, the 55 million is about 15% of the network’s operating budget.** BMC now anticipates $114 mil in cuts this year, which President Elaine Ullian explains here. That’s about 12.5% of BMC’s operating budget (was $900 mil last year). Both hospital networks are worried there will be more cuts in state funding this year than those announced to date.

The administration says cuts to the two safety net hospitals and their health centers are not final, but that it does not plan the additional losses BMC says it has been told to expect. Secretary JudyAnn Bigby says that her priority as she combed the health care budget was to keep enrollment in the state’s free and subsidized insurance programs open. She adds that she had been looking for more than a year for ways to improve payments to community hospitals. These cuts may appease community hospitals that have been complaining for years that additional payments to BMC and CHA are not fair.

Cambridge Health Alliance is believed to be in a more dire financial situation than Boston Medical Center. Read more…

We asked voters in and around Boston today:

1) if health care was a deciding factor in their choice for President?
2) what is their main health care concern?
3) did the candidates address it?

Here are some comments…

“I don’t want government telling me what kind of coverage I have to have or even that I have to buy health insurance. I want more choices and less government interference.”
*****
“Universal coverage is very important to me, but my real worry is cost; will I be able to afford health insurance for my family. Maybe I missed it, but I don’t think either candidate said much about costs.”
*****
“Health Care has to be affordable or there is no point in having it. Both candidates are not being realistic about how much their plans will cost.”
*****
“I’m paying too much for health insurance; it’s crazy. But I’m mostly worried right now about how to heat my house and keep food on the table.”
*****
“The health care problem is going to require an enormous amount effort to fix and the 700 billion dollar tax bailout means now that nothing will be done.”
*****
“We do not believe in national health care. It is a road to mediocrity and more bureaucracy and we have enough of that already.”
*****
“I believe everyone should have health care. I think Obama has a shot at making that happen.”

Update: The question passed by substantial margins…ranging from 66% in Natick to 82% in Amherst.

Voters in a handfull of districts across the state will see this question on their ballot:

“Shall the representative from this district be instructed (1) to support legislation that establishes health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts, and (2) to oppose any laws penalizing the uninsured for failing to obtain health insurance.”

Supporters say a “yes” vote would send the message that the state’s health coverage law is inadequate and unaffordable. The “no” side says the state’s experiment with near universal coverage is working and is the politically viable option. The issue is before voters in Dennis, Provincetown, Falmouth, Orange, Northampton, Amherst, Natick, Newton, Marshfield, West Roxbury (and part of Brookline).

Jonathan Delman uses his experience with Bi-polar disorder to help others who live with a mental illness shape meaningful research, services and treatment programs. He is one of 10 Community Health Leaders named this year by the Robert Wood Johnson Foundation. Here’s a portion of Delman’s statement:

“I am honored and humbled to receive this important award,” said Delman. “It was only 10 years ago that I was receiving Social Security Disability and Medicaid benefits. This recognition is certainly a credit to the many colleagues and family members who have supported me throughout this amazing journey. It will support my continued efforts to challenge the institutional norms of academic research, how it is conducted and how findings are utilized.” Delman is recognized by both, mental health consumers and providers. In a letter of recommendation supporting his nomination for the award, Marylou Sudders, former commissioner of mental health for the Commonwealth of Massachusetts, called Delman a “catalyst for change” with “unwavering belief and tenacity.”

Delman started Consumer Quality Initiatives (CQI), a group that asks patients with a mental illness to evaluate services they receive and help train researchers and providers. His award includes a $20,000 personal gift and $105,000 to support the work at CQI.