The Group Insurance Commission recently announced that their plan increases will once again be held to low single digits this year—about 3%. The Connector announced that rates for their subsidized plans won’t rise at all this year. All this is good news for taxpayers and premiums payers fortunate enough to buy under those plans, but what about small businesses? We understand that the average increase this year for small businesses is once again in the double digit range—about 14%.

Can somebody—the insurers, the regulators, anybody please explain what in the world is going on here? In this environment of mandated health insurance coverage; in this environment of a terrible economy with small businesses and small non-profits struggling to keep their doors open, this continued premium disparity situation is a borderline scandal.

And although some good state regulatory activity is expected to occur beginning this fall, can we really anticipate that small businesses and their employees will see any relief from that activity before spring of 2011? Read more…

We’ve heard often about the broad coalition of insurers, state legislators and providers that conceived Chapter 58. This coalition built on a history of success; Massachusetts has always been a leader among states in insurance rates, and now we are nearing 98 percent.

What we hear less often is about who got us here. Massachusetts has relied on the work of community-based outreach and enrollment workers for over 12 years. Outreach workers were fundamental in achieving the initial low un-insurance rate that made Massachusetts able to consider moving towards universal coverage. Now, the majority of the newly insured are covered by publicly funded programs; the way most people get into those programs is with the help of an outreach worker.

Outreach workers find, educate and enroll eligible people in local health centers, hospitals, schools, and organizations. Poor and middle-income families rarely have the time or the experience to effectively navigate the extremely complex coverage systems. Many have been told for years that they weren’t eligible for publicly funded health care. Read more…

BOSTON – March 28, 2009 – You know, there are times when mental illness is a laughing matter. And today — Saturday, April 28 — you can see that philosophy in play. A film festival in Boston is screening a documentary called Cracking Up that follows people with mental illness who have trained to do stand-up comedy.

Their teacher is David Granirer. He spoke this week from Vancouver, Canada, with WBUR’s health and science reporter Sacha Pfeiffer.

Listen to their conversation:

http://www.wbur.org/news/2009/83935_20090328.asp

This movie and others — all of which aim to de-stigmatize mental illness — are being screened today at a free film festival at Harvard Medical School sponsored by the Cambridge nonprofit Vinfen.

The festival begins at 10 a.m. at the Joseph B. Martin Conference Center, 77 Avenue Louis Pasteur, Boston. Cracking Up will be screened at 3:45 p.m.

For more information about the festival go to:
http://www.vinfen.org/newsroom/releases/movingimagescomedyshow.htm.

For more information about David Granirer’s stand-up comedy class go to:
http://www.standupformentalhealth.com/.

A look at recent headlines about the financial crisis raises the question, has our country lost sight of its core values? Banking and insurance executives who are partly responsible for the current economic meltdown have received billions in bonuses, yet working families are struggling to stay in their homes, obtain health insurance, send their kids to college, pay the bills and hold on to their jobs. Income for the average working person was actually less in 2007 than in 2000, when adjusted for inflation. Meanwhile, CEO pay has skyrocketed to more than 400 times the average worker’s pay. In 1973, it was only 27 times as high.

Here in Massachusetts, we have one of the greatest disparities in wealth of anywhere in the country, and for many working people it is a daily struggle to make ends meet. For instance in the hospital industry, one of our largest and wealthiest employers, over 19,337 workers and their dependents had to rely on public health insurance last year. It is clear that we need to return to our country’s founding principles of valuing hard work and respecting the dignity of working people once again. That is the heart of the Employee Free Choice Act, Read more…

For most of us, computers are a huge part of our lives — from spread sheets to BlackBerries to Facebook. But chances are your doctor and local hospital don’t operate in the digital age as much as you do.

Massachusetts is ahead of the curve, but a new study by the Harvard School of Public Health finds that most U.S. hospitals have been extremely slow to adopt computerized medical records.

Now, the federal economic stimulus bill includes about $30-billion dollars for digital medical records. To talk about how that money will be spent, we turn now to WBUR’s health and science reporter, Sacha Pfeiffer. Good morning.

SACHA PFEIFFER: Good morning.

BOB OAKES: SACHA, JUST HOW SLOW ARE U.S. HOSPITALS IN TAKING UP THIS MOVE TO ELECTRONIC RECORDS?

PFEIFFER: Well, the researchers surveyed about 3,000 hospitals around the country to find out how many of them are using electronic records, or E-records. And they found that fewer than 8 percent of all hospitals are using even a basic system. Read more…

Thought #1

The Globe today has a story about an “offer” from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, the two largest health insurer trade groups, to give up risk rating—the practice of varying premium rates by health status. Massachusetts did this back in 1990 for small employers and in 1996 for individuals. So, ho hum for our state. But the story did remind me that I’d been meaning to suggest that Massachusetts should think about abandoning the major discriminatory rating practice we do still allow, and that’s age rating. Our insurance laws permit health plans to charge older people as much as twice the premium rate as younger people for the same product. The classic argument in favor of age-rating has been that it’s necessary to have lower rates for younger people in order to convince them to purchase insurance. But this argument isn’t so convincing in Massachusetts any longer because of the state’s individual mandate, which requires most adults, including younger people, to purchase insurance. The ability of health plans to age-rate also creates a troubling inequity in the state’s affordability schedule at the highest income levels, where the schedule requires people to purchase insurance regardless of the cost. This requirement, combined with age rating, means that an older person with exactly the same income as a younger person might be required to pay as much as twice the amount—and therefore twice the percent of income—to comply with the mandate.

I can just hear the teeth gnashing about the suggestion of doing away with age-rating, Read more…

Health and Human Services Secretary JudyAnn Bigby will be part of a webcast panel today talking about “The Effect of the Economic Downturn on the Health of Communities of Color.”

Here’s the notice:

On Wednesday, March 25, from 1 p.m. to 2 p.m. ET, the Kaiser Family Foundation will hold a live, interactive webcast to examine the economic downturn’s impact on health care in communities of color as part of its Today’s Topics In Health Disparities series. Rising unemployment has left many families uninsured and increasingly strained family finances are prompting some Americans to cut back on medications and forgo preventive care. Read more…

For the past few years, nursing has been one of the hottest fields in Massachusetts. A statewide nurse shortage spurred many people to enroll in nursing schools, where attendance is now booming. And in May, hundreds of local nursing students will graduate and begin to look for jobs.

But many new nurses, and even some experienced ones, are finding that the job pipeline is drying up. WBUR’s health and science reporter Sacha Pfeiffer explains why the hiring landscape for Massachusetts nurses has taken a turn for the worse.

You might think Rachel Weinstein would be feeling optimistic about her chances for employment. She’s a senior at the school of nursing at Boston College, and after she graduates this spring she’d like to work in intensive care at a big Boston hospital. She’s submitted a few applications, but her hopes for landing a position are pretty low.

RACHEL WEINSTEIN: “Some of my friends in the business school are like, ‘Oh, I’m not going to be able to find a job, but you’re in health care, you’re in nursing, you’re fine.’ And that’s really not the case at the moment.”

Weinstein has that gloomy outlook because of what she’s been told by recruiters and other students.

RACHEL WEINSTEIN: “I’m hearing that the job market’s terrible right now and hospitals aren’t going to be hiring new grads this year and that it’s just a very competitive market right now.”

A tight job market for nurses? But the state’s nursing industry has been starving for new recruits in recent years. Nursing schools have been churning out graduates as fast as possible, and hospitals were aggressively recruiting new nurses. Some hospitals were even paying nurses signing bonuses. But Lisa Zankman says that was then, and this is now.

LISA ZANKMAN: “We are not hiring entry-level nurses right now, and we’re actually not hiring all that many nurses at all right now.”)]

Zankman is senior vice president of human resources at Beth Israel Deaconess Medical Center, which expects to have a $20 million loss this year. Read more…

Massachusetts is one of only six states that don’t tax alcohol at retail stores. While alcohol is cheap here, the costs of substance abuse are staggering. And everyone pays – even people who don’t drink at all.

One of among several proposals to raise revenues before the Legislature, the plan to eliminate the sales tax exemption on alcohol sold at package stores and some grocery stores makes sense economically and from a public health perspective. For the estimated one-third of people who don’t drink, it would cost nothing.

State officials estimate it would raise about $92 million. It’s a small price, considering that more than 2,000 deaths and 60,000 hospitalizations are linked to substance abuse and addiction. The cost to the courts, criminal justice and corrections systems total in the billions of dollars. We just cannot afford the cost of addiction any longer. Read more…

In a front page story in the New York Times this week, reporter Kevin Sack suggested that the Commonwealth is facing “a day of reckoning.” We must confront our health cost problem, the article suggested, with the same vision and leadership that led us to embrace the challenge of coverage reform three years ago.

As contributors to this blog have written, there is little debate that the cost problem is urgent and threatens the sustainability of our pioneering coverage law. And most experts point to the same root causes of our rising spending: the growing incidence of chronic disease, the rapid introduction and spread of new medical technology, and the explicit incentives and expectations in our system that more care equates to better care – which can lead to unnecessary and even harmful treatment.

Conventional wisdom suggests that the consensus then breaks down: we might agree on the sources of the cost problem, but we will never agree on solutions. Some argue that it just too complicated and that competing interest groups are unwilling to compromise. We forget however, that this same skepticism plagued our early debate on coverage. Read more…