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In Massachusetts, just 32 percent of enrollees in MassHealth, the state’s Medicaid program, are elders and people with disabilities, yet these groups account for 63 percent of state Medicaid expenditures. The disproportionate share of costs is due, in part, to the expensive and labor-intensive long-term care needs required by many in both demographics. This includes assistance with Activities of Daily Living and Instrumental Activities of Daily Living. The former includes help with bathing, dressing, and getting in and out of bed, while the latter also includes help with preparing meals, paying bills, and managing medication.

State demographic trends show that both populations are going to grow rapidly over the next decade. The total number of individuals with disabilities between the ages of 16 and 64 is expected to increase by 12 percent between 2004 and 2015; subsets of this population, such as those under age 24, are expected to grow by more than 20 percent. Medicaid, in this state and nationally, is the primary payer of long-term support services and yet it covers far less than the nearly 20 percent of the state’s population that at any time could be in need of this assistance.

The amount of money spent on long-term care is considerable. A November, 2007 study by the AARP Public Policy Institute estimated that approximately 700,000 to 1 million Bay State residents provided approximately $8.8 billion Read more…

Massachusetts is not only a state, but is established as a “Commonwealth.” Our first Governor of the Province of Massachusetts Bay, John Winthrop, defined what that meant in his famous “City on a Hill” sermon in 1630. In that founding document, Governor Winthrop declared it to be our duty to care for one another, to share our good fortune to meet the needs of those among us who are less fortunate, and work together to build a stronger, healthier community.

Beginning with the 2005-2006 Session, the Legislature laid the foundation for a Healthy Commonwealth with the passage of our landmark health care reform law – Chapter 58 of the Acts of 2006. In addition to expanding access to affordable health insurance, the reforms included development of a statewide infection control program, the creation of the Health Care Quality and Cost Council to set quality improvement and cost containment goals, initiation of a first-in-the-nation pediatric palliative care program, and enhancement of the state’s prevention agenda. Several other important steps such as the purchase of hypodermic needles without prescription also contributed to improving the health of the people of the Commonwealth.

By 2008, Massachusetts achieved nearly universal health coverage with an estimated 97% of her citizens with health insurance. Read more…

Cambridge Health Alliance is cutting 300 positions, closing six of 20 clinics and consolidating other services…but supporters including Representative Alice Wolf are relieved.

“The health alliance was bleeding and we were going to need a tourniquet fast. I think we’ve gotten somewhat of one. Now the challenge is to work with the community around some of these changes.”

Today the hospital announced a reorganization plan that is much less dramatic than the warning it gave the Patrick administration late last year. Then, CHA said it might have to close two hospitals and lay off as many as 1,000 workers to cope with mid-year state budget cuts and the recession. Secretary of Health and Human Services JudyAnn Bigby agreed to work with CHA to preserve what the administration considered essential services. Her office has asked the federal government to approve a funding mechanism (intergovernmental transfers…anyone want to explain this one?) worth $40 million dollars to Cambridge this year and $65 million in FY’10. Read more…

The Massachusetts unemployment rate reached 6.9 percent in December 2008, up from 5.0 percent in August and 4.3 percent the previous December. An Urban Institute study for the Kaiser Family Foundation found that each percentage point increase in the unemployment rate nationally leads to an increase of 1.1million uninsured and 1 million Medicaid enrollees. In Massachusetts, we can certainly expect that the loss of employer-based insurance that comes with layoffs will lead to increasing numbers eligible for MassHealth and Commonwealth Care. Indeed, if the Commonwealth is to maintain the high level of coverage that it has achieved since the enactment of Chapter 58, growth in these publicly subsidized programs is inevitable.

This, of course, costs money ¬– money that is scarce in the Commonwealth, as the Governor and Legislature wrestle with outsized budget deficits. But help may be coming from the federal government. Read more…

United We Stand for Public Health, a group of over 80 organizations, has re-formed to give voice to a shared urgent concern for the fate of public health in Massachusetts. We are hosting a press conference today in Nurses Hall at the Massachusetts State House to urge the Governor and legislators to protect public health in the state budget.

There is a critical role for public health in the debate over cost containment and achieving health equity in the Commonwealth yet, in the mid-year 9C cuts announced the past October, the Massachusetts Department of Public Health faced one of the highest percentage cuts of any EOHHS agency and among the highest percentage cuts for any area of state government. As a result of the October cuts of close to $30 million, MDPH lost nearly 100 positions, and the department made significant cuts to core services. Given the current shortfalls and revenue projections, public health remains vulnerable. Read more…

When Senator Ted Kennedy files a highly anticipated bill that would make sure all Americans have health insurance he’ll try to cap a campaign that began, for him, in 1969. David Blumenthal worked for the Senator 30 years ago and is still an advisor.

“For the last 40 years, Ted Kennedy has, almost singlehandedly, kept the idea of universal access to health care services alive.”

Kennedy has filed a bill that would expand coverage in almost every session of the Senate. While the goal has not changed his approach has shifted over the years.

(fade up Rolling Stones)
It’s the summer of 1965. The Rolling Stones have the country’s top hit. Lyndon Baines Johnson signs a bill that, for the first time, guarantees health care for low income and older Americans.

LYNDON BAINES JOHNSON: No longer will older Americans be denied the miracles of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over the lifetime.

And a young Senator Edward Kennedy visits a new two room clinic in South Boston that will become a national model. Read more…

Health care advocates in Massachusetts are ready to celebrate the first health care victory for President Obama. Reauthorization of a children’s health insurance program known as SCHIP has cleared the House and the Senate Finance committee on Capitol Hill. Senate Republicans do not appear to have the votes for a filibuster. Health Care for All’s Matt Noyce says the bill is key part of Massachusetts’ effort to cover the uninsured.

“Massachusetts ranks first in the country on coverage for children. Only 1.2% of kids remain uninsured. So this will really work to strengthen that effort and make sure we can continue the gains we’ve had so far.”

The bill adds federal reimbursement for children of recently legal immigrants, a change that would save the state $16 million. It would increase the cigarette tax by 61 cents to pay for expanded coverage.

Every industrial nation in the world guarantees their citizens access to essential health care services except the United States. One in eight Americans — a shocking 46 million people—a majority of them in working families, do not have any health insurance. In the past there have been numerous attempts to enact health care reform by presidents of both parties — Roosevelt, Eisenhower, Nixon, Carter and Clinton. Each was met with fierce attacks by powerful stakeholders who mobilized their considerable resources to keep the financing of health care a private affair. In the first half of the twentieth century, physicians led the anti-reform coalition, fearful that government entry would mean government control of medical practice. Doctors lobbied legislators, gave campaign contributions to sympathetic candidates and organized “grassroots” protests with other like-minded groups to defeat reform. They had the support of influential allies including business organizations and insurance companies.

In the last quarter of the twentieth century it was the insurance industry that took the lead in crushing health care reform. Yet in 1965 Congress did enact Medicare, a social insurance program that guaranteed coverage for hospital care and physicians’ services to all people 65 and over. Read more…

Barack Obama is more than interested in helping right the wrongs in America’s health care system in an effective and efficient manner. To me that means some variation on an “Improved Medicare for All” (note: “Medicare for All” is not quite good enough) or what some call “single-payer.” Nevertheless, I do not believe that kind of a program is in the cards at this time. I believe we will have to settle for “improving America’s health care system in a more or less efficient and effective manner.” If so, we should make certain that that occurs in a manner that can be improved and built upon over time. Though a compromise, that’s a great advance even a somewhat effective and efficient health care system would be over where we stand today.

What are the things the president should know if he is to achieve his goal? Much can be subsumed under the heading: “Know Your History and Learn From It.” Under that heading I would include:

1. The problems with our existing system are real. And the trends are deeply troubling. Even so, there will be tremendous pressure not to address universal health insurance till we have “solved” the problem of the high and rapidly rising expenditures for health care. Read more…