Yesterday was an important day for health care reform. In an event pulled together by Health Care for All, Governor Patrick, Speaker DiMasi, and Senate President Murray joined with representatives of the business, advocacy, provider and insurer communities to celebrate health care reform’s second birthday. What we have accomplished to date was underscored by compelling comments from Madelyn Rhenisch and Danielle Nickerson – two of the tens of thousands of people for whom the availability of health insurance through Commonwealth Care has meant better health, improved economic security and greater peace of mind. Read more…

One day after Governor Patrick filed his state budget proposal for fiscal year 2009, the Boston Globe ran a front page story highlighting the size and nature of the additional investments in health care reform included in the budget.

Following that story, there were a number of efforts to highlight information needed to understand the significance of these budget increases. I appreciate those efforts and want to reiterate some of them:

• In evaluating the costs of health reform, we should be mindful that the costs are borne not only by the state but also by the federal government.
• Anticipated Pool spending is down from pre-health care reform levels and continues to fall. It is true that this decline in Pool costs is not alone sufficient to pay for subsidized health insurance for those who previously could not afford coverage – but it does make a real and important contribution.
• Health reform is larger than Commonwealth Care. Read more…

Last Saturday, the Board of the Commonwealth Health Insurance Connector Authority held its annual retreat. The retreat was a great success, giving the Board the opportunity to review data and potential policy options concerning health care costs and their impact on the sustainability on health reform.

I want to thank the Connector staff for their efforts to foster a dialogue about some of the most challenging issues facing health reform. It’s clear that the Connector is often at the center of the health reform storm, confronting difficult policy decisions that don’t easily lend themselves to consensus – and all in the public eye. Given this fact, there are enormous demands on Connector staff for information and innovative policy ideas. They do a great job of meeting these demands, and we all appreciate their hard work and commitment to the success of health reform.

John McDonough, Executive Director of Health Care for All, observed the retreat and live blogged (is that a verb?) the discussion on the Healthy Blog website. Kudos to John for keeping pace with the discussion and making it accessible to those who couldn’t attend. Here is an “extreme cliff notes” version of some key issues highlighted at the retreat:

1. Health care cost containment is essential to the success and sustainability of health reform – and also critical to ensuring that state government has the capacity to invest in all of our state’s public priorities (please remember that investing in education, job creation and environmental protection, among other priorities, is critical to promoting good health). Read more…

Last week, the Board of the Commonwealth Health Insurance Connector Authority met for the first time since early July. The meeting was a kick-off to a busy Fall and then 2008 for the Connector, as it continues to complete initial policy and operational tasks related to health reform and commences “round two” of addressing some recurring issues.

For those who weren’t able to attend the Connector’s Board meeting, here are some of the challenges that were flagged on a draft calendar discussed at the meeting (note: these are surely not the only issues the Connector will focus on – just some of the most obvious and pressing ones).

• Commonwealth Care: the related tasks of evaluating experience under the program so far, considering program design moving forward, and negotiating new contracts with the managed care organizations which provide health insurance under this program.

• Commonwealth Choice: renewing the Seal of Approval for health plan contracts (six private health plans currently provide health insurance under this program); also, working towards allowing small businesses that contribute to health insurance to offer Commonwealth Choice plans.

• 2008 Penalties: in consultation with the Department of Revenue, reviewing the schedule of penalties in 2008 for those who can afford health insurance but fail to purchase it (as we near year two of the individual mandate, we hope to have a 2008 penalty schedule that is fair, workable and provides a meaningful incentive for those who can afford insurance to get it). Read more…

All eyes are on Massachusetts as we work to make our historic health care reform law a success, and many of them are trained on the Connector. That’s no surprise, given the challenging and controversial policy issues with which the Connector has wrestled (minimum creditable coverage, affordability), the key role played by Connector insurance programs in expanding coverage (Commonwealth Care and Commonwealth Choice), and the very public way in which the Connector makes decisions.

However, the Connector is hardly the only state player involved in implementing health reform. Our “team” includes MassHealth (expanding health coverage for children and others and leading the charge on renewing our Medicaid waiver), the Division of Insurance (implementing new health insurance rules), the Division of Health Care Finance and Policy (issuing “fair share” and “free rider” regulations and designing new eligibility rules for the Uncompensated Care Pool), and the Division of Unemployment Assistance (collecting “fair share” payments and Health Insurance Responsibility Disclosure forms from employers).

There’s also another state agency that those not familiar with Chapter 58 might least suspect to be involved with health reform, but in fact plays a critical role: our state’s Department of Revenue (DOR). DOR is vested with major responsibilities associated with implementing our new “individual mandate” requiring adults who can afford health insurance to have it. It will create and issue the tax forms through which Massachusetts residents will declare whether or not they have health insurance; work with the Connector in implementing a fair and efficient process for “hardship appeals”; and collect penalties from those who truly can afford insurance but do not have it.

DOR has already posted on its website a first draft of the tax form that Massachusetts residents will have to file early next year, declaring whether or not they had health insurance as of December 31, 2007. It will soon post a draft of the instructions that accompany this form. Commissioner Henry Dormitzer and DOR staff welcome comments and suggestions on these documents, through emails to DOR’s Forms Manager at fordp@dor.state.ma.us. Please take advantage of this opportunity to weigh in on an important part of health reform.

Leslie Kirwan
Connector board chairwoman
Secretary of Administration and Finance for Governor Deval Patrick

1. We are making the transition from establishing the rules of health care reform to putting those rules into action. So it’s critically important that we help individuals, employers and others understand new opportunities to purchase quality, affordable health insurance, as well as their respective obligations under health reform. This was underscored for me the other night, when I participated in a forum on health care issues hosted by the Commonwealth Institute. The Institute supports the efforts of women entrepreneurs and senior corporate executives to grow their businesses and careers. Along these lines, it asked Charlie Baker of Harvard Pilgrim Health Care, Jim Roosevelt of Tufts Health Plan and me to participate in a panel discussion centered on the impact of health reform on businesses. We received many great questions from the audience, a good number of which focused on the day-to-day implications of health reform for businesses.
I thought it would be instructive to list some of these questions, to highlight issues on the business community’s radar screen. Read more…

Budget season is in full swing, making the Executive Office for Administration and Finance an extremely busy place (not that it ever isn’t). In the midst of analyzing the just-released Senate Ways and Means budget, a few quick thoughts on health care:

• The main message coming out of Monday’s Blue Cross Blue Shield Foundation event examining one year of health care reform is – cost is the next frontier of reform. Read more…

Yesterday was an important day for health care reform in Massachusetts. On the first birthday of our historic health reform law, the Board of the Commonwealth Health Insurance Connector Authority (which I am privileged to Chair) unanimously approved a draft proposal to implement one of the centerpieces of our efforts to expand health insurance coverage: the “individual mandate” requiring all adults who can afford health insurance to have it. If you view health care reform as having three legs – employer responsibility, government responsibility, and individual responsibility – our vote was about putting that third leg in place. In doing so, the Board has set the stage for covering virtually everyone in the Commonwealth with health insurance that meets the highest standard in the nation. Read more…

When I was asked by Governor Patrick to become his Secretary of Administration and Finance, I was of course greatly honored – and also mindful of the major challenges that awaited me in helping to assemble the Governor’s first budget in a difficult fiscal environment.

I have to admit that, at the time, I wasn’t thinking about health care reform as a significant part of my job portfolio. But I quickly learned otherwise. Read more…