Celia Wcislo, a V.P. at 1199 SEIU and a member of the Boston Public Health Commission, says Republicans are trying to frighten the public away from health reform:

I watched the debate Saturday evening in the House of Representatives, and wondered how elected officials could be from such different planets. Shortly after the vote was taken, news reporters such as TIME writer Jay Newton-Small tried to analyze the divide.

Republicans were fanning our worst fears last night. “Big brother” is watching and wanting to control your health. “Big brother” will make you pay a $250,000 fine and then send you to jail for five years. It didn’t matter that no one has been arrested or sent to jail under Massachusetts health reform — even after more than 3 years of implementation of reform. A lie is okay as long as they don’t have to prove it.

They are trying to frighten the public by saying that some “bureaucrat” will design your health plan, pick your drugs, or decide when you die. Like any of us really pick our plans or design them. (Don’t our employers chose what we can pick from?) Do any of us have a say in our prescriptions (doctors chose them, insurers substitute generics, or our own finances determine if we can afford them at all). And how many people die every year because they could not afford a treatment that could have prolonged their life? Read more…

Celia Wcislo, a V.P. at 1199 SEIU and a member of the Boston Public Health Commission, rails against doctors who place financial considerations above patients’ needs:

Maybe surgeon and New Yorker writer Atul Gawande was right when he raised questions about the differing costs of medical care around the country, starting with the example of McAllen, Texas. Maybe medical providers have more responsibility for costs than we think.

In Massachusetts, two instances of doctors putting costs and financial gain over patients’ needs have come to my attention.

The first was in a letter from a doctor to his patient on Cape Cod. It was a note discontinuing the patient from his practice because of the patient’s failure to use Quest laboratories (a for-profit company) for all tests. The physician “fired” the patient, stating: “As you are unable to honor my contractual obligations and requests, I am unable to serve as your physician.” Read more…

Recently the legislature held hearings on the need to address racial and ethnic health disparities. WBUR has covered this issue on several previous blogs.

As Boston Public Health Commissioners, we are given a a report every year on the “Health of Boston”. The 2009 version has just been released. It looks at the health of each neighborhood, rating them on the prevalence of major diseases or problems: infant mortality, Chlamydia, HIV infection, car crashes, kid’s asthma, diabetes, heart disease, and obesity. I took the ratings for eight major problems, and turned them into a map that shows the healthiest (light pink) to sickest (red) neighborhoods: Click here for an expanded view of this map.

I then used 2000 census data to break out neighborhoods based on how white/non-white the neighborhood is. This data is the most recent available data for Boston neighborhoods. Lightest green is for neighborhoods that are majority white, and the darkest green is for neighborhoods that are over 60% people of color:  Click here for an expanded map view.

Try flipping back and forth between these two maps. What you will notice is that the darkest red area (the highest level of medical problems) is nearly identical to the darkest green areas (those neighborhoods that are more than 60% communities of color). Read more…

Soon the Special Commission on Payment Reform (set up by the legislature as part of healthcare reform) will be proposing changes to how Massachusetts pays for healthcare services. Currently Massachusetts’ payment system is no different from any other state, and the entire US is having problems controlling health care costs. Our payment system pays for illness and volume, and it needs to change.

Right now, we pay doctors, providers, and pharmacies predominantly on a fee-for-service basis. That is, if they see you, they get paid. If they see you a lot, they get paid a lot. If you are in the hospital, get sent home, and then have to return for the same problem, the hospital gets paid again. We pay for volume (the more a provider sees patients, the more they get paid), and we pay when you get sick. This is the problem that needs solving. To move from paying by volume for illness, to paying fairly for prevention and wellness.

We don’t now pay well for prevention. We don’t pay doctors anything special for keeping you well, and we often don’t pay for them to check up on you at all! We don’t pay for them calling you, or talking to another doctor about you. We pay providers only when you go in to see them. Read more…

The recently signed American Recovery and Reinvestment Act will deliver necessary relief from a dismal financial situation in Massachusetts. And it can be used to restore some on the massive cuts made to health care this year, and in next year’s budget.

The Administration’s FY 2010 budget tried to protect eligibility and benefits for low-income residents. They proposed some expansion of Medicaid and CommCare with the assumption that more residents will be in economic trouble this year.

Unfortunately, they also made dramatic cuts in payments to hospitals that serve the poor, freezing rates for most other healthcare institutions and nursing homes, and cutting public health and behavioral health programs.

The rest of FY 09’s health budget was balanced by using $533M (for three quarters) of financial assistance from the Recovery Act. This week, Massachusetts will be eligible for $594M for just two of the three FY09 quarters. Read more…

The dramatic cuts in funding proposed for Cambridge Health Alliance (CHA) and Boston Medical Center (BMC) are causing an increasing stir among caregivers and the communities these key safety net hospitals serve.

These cuts have local and national implications. With cuts looming, and with no apparent plan in place to ensure access and care, patients and caregivers in the communities where minority and low-income neighbors are served by BMC and CHA are feeling increasingly alarmed by a proposal which would be devastating for their community hospitals. Community, labor, and religious groups are taking measure of the impact the proposed cuts would have to essential care for minority and low-income neighborhoods. And advocates, safety net providers, and policymakers across the country are watching to see if Massachusetts can develop a plan to ensure the continued viability of its safety net system in the face of the dramatic changes wrought by health reform and the current economic and budget crisis.

A plan is essential because Massachusetts cannot afford to lose the vital services provided by BMC and CHA.

Consider:

CHA provides 150,000 visits annually for patients with behavioral or substance abuse problems. CHA provides 10% of all the state’s mental health inpatient stays, and 14% of all Medicaid mental health and substance abuse care. With the cuts proposed to CHA this year alone, it is possible that 10% of all the acute care psychiatric beds in Massachusetts could be closed. Read more…

Business leaders have recently expressed frustration and anger at the proposed changes by the Division of Healthcare Finance and Policy (DHCFP) on the Fair Share requirements under Massachusetts healthcare reform.

Previously, the regulation in place said that to avoid a penalty, employers must offer to pay 33% of the premium or 25% of full-time employees must buy the insurance their employer offers. That meant employers could avoid responsibility and the penalty, even if employees pay up to 67% of the premiums, or if their workforce is mostly part-time.

Employers meeting either of these two tests faced no penalty under the law. This arrangement was negotiated between business representatives and the Romney administration, with the understanding that many employers would not have to pay the penalty.

Everyone is being asked to pay more for the cost of successfully insuring more than 170,000 Massachusetts residents. If you buy cigarettes, you will pay $1 more per pack in state taxes. If you are on CommCare, you could pay 10% higher in premiums, and higher co-pays for doctor visits. Providers will pay $20M more to cover health costs, and insurers will pay $33M more.

Consumers and advocates have consistently asked that everyone share in the cost of reform. Read more…

The initial data from the Department of Revenue found that, so far, about 62,000 uninsured residents (2% of tax filers) would not be penalized for being uninsured because
there was no affordable insurance available to them. When the full DOR data is received, that number may grow slightly higher.

I would predict that a large number of these folks are people who are offered employer-sponsored insurance, but at rates that are unaffordable to them. Over a year ago, the Connector predicted that there could be 60,000 people who would not be penalized because insurance was unaffordable.

At the last Connector Board meeting, the Connector set up policy workgroups to begin tackling hard issues, including how to help workers who are low income, but can’t afford the insurance they are offered at work. We want to help them obtain coverage, but we also want their employer’s money to help fund that insurance.

The Massachusetts Health Reform law was built to maintain employer-sponsored insurance, so that costs would not be shifted from employers onto state taxpayers. Read more…

Connector Board member and former First Deputy Commissioner of Insurance, Nancy Turnbull has written often about how health insurance companies are doing under Massachusetts’ healthcare reform.

In a nutshell, they have done well, very well indeed. 2007 data shows hefty profits for the state’s “non-profit” health insurance companies. More importantly, the data shows these companies are well positioned to contribute more towards the rising costs of healthcare reform. Over the last five years, the major health insurers in the state have earned more than $2 billion in profits, and at year-end 2007 had combined reserves of nearly $3 billion. The majority of profits and surplus have been accrued by BCBS, the state’s largest health plan, but most other carriers have done well also.

Since 2006, close to 100,000 people have privately bought health plans (which based on an average annual premium of $3,000-$4.000 a year means an estimated $ $300-$400 million in new revenue). Read more…

“Row harder.” That’s what some are saying to poor and sick consumers who they want to hit with large co-pay and premium increases, intended to cover financial gaps faced by the Connector due to successful enrollment efforts.

Locally and nationally, rough fiscal waters are ahead for healthcare. Threats by the federal government to further decimate funding for children’s healthcare and Medicaid loom like a black cloud over our state’s noble first-in-the-country healthcare experiment.

The time is now for new, big ideas about how Massachusetts keeps healthcare reform on course. Consumers, taxpayers, and the state are doing their share of the rowing. It’s time for businesses, insurers, and hospitals to grab an oar.

A recent Boston Globe editorial asked, “If people on limited incomes must pay more, why not employers?” It’s an important question at the right time. It should also be applied to insurers and hospitals. The $295 fee employers who fail to offer affordable insurance must pay is a paltry sum, in light of what is now being asked of Connector insurance enrollees, the state, and taxpayers. If consumer rates go up, so should assessments for negligent businesses. The state should also revise the anemic regulations that determine which employers are obligated to pay assessments. Read more…