Politics

What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

Budget Victim: Inspections For Compounding Pharmacies. Really?

Remember all that outrage last year when we learned that a Framingham compounding pharmacy, the New England Compounding Center, was at the heart of national meningitis outbreak? And remember what followed: a flurry of new government oversight measures, tough public health safeguards, pledges of “Never again.”

So what happened?

Kevin Outterson, a professor at the Boston University School of Law and co-director of the Health Law Program, reports today that additional money that was supposed to be used to inspect compounding pharmacies around the state was cut to zero. At least for now.

(WBUR)

Blogging for The Incidental Economist, he reminds us why the inspections are important: “fungal meningitis from improperly compounded products killed 55 people and infected more that 600.” But apparently, in the latest state budget proposal, money for inspections has been cut, Outterson writes:

All of these products originated in Massachusetts, but all of the injuries occurred in other states. But Massachusetts felt some responsibility for the failures at NECC, as acknowledged by both Gov. Patrick and the Interim Commissioner of Public Health. The DPH enacted emergency regulations on Nov. 1, 2012 and the Governor’s special commission delivered a comprehensive set of recommendations. Both efforts informed the Governor’s proposed legislation in January 2013 and several bills pending in the Massachusetts House and Senate. Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, budget, compounding pharmacies, meningitis, public health

May 15, 2013 | 9:18 AM | Carey Goldberg

How Vermont Passed Assisted Suicide (And Can We Go There To Die?)

The Vermont State House in Montpelier (Wikimedia Commons/jonathanking)

Remember the physician-assisted-suicide referendum that came ever so close to passing last year in Massachusetts, failing in a 51-to-49 percent squeaker?

Well, where Massachusetts feared to tread, neighboring Vermont has now trodden, and the state is about to become the fourth to legalize physician-assisted suicide for terminally ill people, after Oregon, Washington and Montana. It is the first to do so through its lawmakers rather than a popular referendum or court.

The “end-of-life choices” bill rode a wild political roller-coaster before it was finally passed this Monday evening, and it’s now on its way to a supportive Gov. Peter Shumlin and expected to be signed soon.

Vermont Public Radio’s John Dillon has covered the bill all along the way, and I asked him for his insights into the political dynamics behind the action. But first, a brief note for us flatlanders: What will our neighbor to the north’s decision mean for us? Will we be able to drive with our doctors up to Brattleboro or Burlington if we’re fatally ill and want help taking control of our final days?

I sent a query to Patient Choices Vermont, the group that spearheaded the state’s “end-of-life choices” bill, and heard back from Jessica Oski of Sirotkin & Necrason, a government relations firm that has represented Patient Choices Vermont for a decade. She writes:

1. To be qualified to use the assistance of the Vermont Patient Choice at End of Life Bill, a person must be “18 years of age or older, a resident of Vermont, and under the care of a physician.” There is no specific guidance under the law as to who qualifies as a Vermont resident.

2. In order for a physician to benefit from the immunity under the law the physician must be “licensed to practice medicine under 26 V.S.A chapter 23 or 33.” In other words, licensed in Vermont.

Now for the politics. The tale I heard from VPR’s John Dillon suggests three possible lessons for the backers of physician-assisted suicide in Massachusetts: Stick with it. Compromise quickly when the right moment strikes. And you may fare better in a legislature than in a popular referendum.

The Vermont House had considered a “death with dignity” bill in 2007, John said, but it didn’t pass. Last year, a similar measure failed to pass in the state Senate. This year was different. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, assisted suicide

April 4, 2013 | 6:39 AM |

Opinion: Cambridge Backs Abortion Coverage, Feds Should Too

Roe v. Wade recently turned 40, but states around the nation are pushing back — hard — trying to greatly limit women’s access to legal abortion. On Point’s Tom Ashbrook reports that just last week: “North Dakota joined the movement, passing the toughest restrictions on abortion in the country. Abortion forbidden from as early as six weeks. No abortion for disease or deformity. A state constitutional amendment lofted that would deny abortion even in the case of rape or incest.”

But here in Massachusetts — Cambridge, to be specific — we’re in our own little blue-state bubble of tolerance and reproductive rights for women (amen). Here, two local abortion-rights advocates report on a recent city council vote on the issue.

By Diane Roseman and Megan Smith
Guest Contributors

There is one part of the abortion story that tends to get less attention: the part about federal restrictions that prevent many women from exercising their constitutional right to an abortion.

The Hyde Amendment, originally passed by Congress only a handful of years after Roe v. Wade, withholds federal healthcare assistance funds for abortion. This means that millions of women who qualify for Medicaid, as well as federal employees, military service members, veterans and Peace Corps volunteers who receive their insurance from the federal government, are unable to use their insurance to cover the costs of an abortion.

Diane Roseman

Massachusetts is one of seventeen states that uses its own Medicaid funds to cover abortion care for women who qualify for them. But even here, many women, such as federal employees, are still faced with the realities of these restrictions.

Recently, the nonprofit Eastern Massachusetts Abortion Fund, which provides resources to people unable to cover the full cost of their abortions, provided financial support to a Boston woman who works for the federal government and is already the mother of a four year old. She had become pregnant and could not continue the pregnancy, and was shocked when she found out that her health insurance did not cover abortion.

On Monday, April 1st, the Cambridge City Council — bucking the trend of many states that are limiting abortion rights — passed a resolution sponsored by Representative Marjorie Decker (largely symbolic) opposing federal and state restrictions on abortion funding. Continue reading →

FILED UNDER: Personal Health, Politics

April 2, 2013 | 10:37 AM | Rachel Zimmerman

Trapped Lives: Chilling Photos Of Mentally Ill Prisoners

(x1klima/flickr)

There’s got to be a better solution.

That’s my takeaway after viewing “Trapped,” a chilling series of photographs by Jenn Ackerman (posted on Slate) that documents the daily injustices of some extremely troubled mentally ill prisoners at the Kentucky State Reformatory.

The pictures underscore the institution’s crass attempts to keep the inmates safe and also protect the corrections officers who manage them. Some examples:

–One inmate is cuffed to his cell and made to wear a “spit mask” used “to prevent him from spitting at the doctors and correctional officers.”

–Another prisoner “stares out of the cell he remains in for 23 hours a day.”

– A correctional officer wearing rubber gloves “comforts an inmate during one of his psychotic episodes” by sticking her fingers through a little slot into his cell. Continue reading →

FILED UNDER: Personal Health, Politics, mental illness, prison system

March 29, 2013 | 11:14 AM | John Auerbach

Commentary: Mayor Menino, Out-Front Leader On Public Health

By John Auerbach
Guest Contributor

In the early 1990’s, at the height of the AIDS epidemic, there was a shortage of courage among many political leaders. That was why I was surprised when I heard that a little-known city councilor from Hyde Park was taking a public stance that needle exchange should be considered as a way to slow the spread of HIV. Needle exchange was (and still is in many circles) too controversial for most elected officials to support, in spite of the substantial body of evidence that it was effective. When I heard he was from Hyde Park, not a neighborhood that had felt the full impact of the epidemic, I wondered, “Who is this guy?”

John Auerbach

That guy, it turned out, was Tom Menino. And in classic Menino style, he wasn’t taking the position he took because it was politically popular to do so. It wasn’t. He was taking the position because he thought it was the right thing to do.

It was several more years before I actually met him. I heard he was looking for someone to head up the newly created Boston Public Health Commission. I wasn’t interested in the job. I thought that the task was too overwhelming – pulling together 50 or more relatively small programs into a single department at a time when resources were limited and most of the attention was focused on supporting the success of the nascent Boston Medical Center. But I remembered the story of his courage in the AIDS epidemic, and I wanted to thank him. Continue reading →

FILED UNDER: Medicine/Science, Politics, aids, pubic health, Tom Menino

March 27, 2013 | 11:37 AM | Carey Goldberg

Actuaries: ObamaCare Will Hike Claims Cost 32 Percent (But Not In Mass.)

Source: The Society of Actuaries’ report, “Cost of the Future Newly Insured under the Affordable Care Act.” (Posted with the society’s permission.)

The Associated Press, delving courageously into actuarial data, reports here:

Insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama’s overhaul, the nation’s leading group of financial risk analysts has estimated.

That’s likely to increase premiums for at least some Americans buying individual plans. The report by the Society of Actuaries could turn into a big headache for the Obama administration at a time when many parts of the country remain skeptical about the Affordable Care Act.

…Medical claims costs are the main driver of health insurance premiums. A study by the Society of Actuaries estimates the new federal health care law will raise claims costs nationally by an average of 32 percent per person in the individual health insurance market by 2017. That’s partly due to sicker people joining the pool. The study finds wide disparities among states. The estimates assume every state will expand its Medicaid program.

Naturally, my curiosity turned provincially to Massachusetts. The full Society of Actuaries report is here, including this gorgeous infographic breaking down the data by state. I’m happy to report that New England states are looking good: Vermont and Massachusetts can expect claims costs on individual policies to decrease by over 12 percent and Rhode Island by more than 6 percent. New York can expect a whopping drop of nearly 14 percent. Compare that to poor Wisconsin and Ohio, expecting an increase of over 80 percent.

The AP piece also features some refutations from the Obama administration, including: Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, federal health reform, health insurance, health insurance premiums, obamacare

March 21, 2013 | 11:57 AM | Martha Bebinger

Berwick Weighs In On Dispute Over Medical Quality Standards

Medicare’s Pioneer ACOs are arguably leading the most important experiment under the Affordable Care Act.

Back in 2011, just before Medicare named the 32 providers who would test new ways to deliver care with better quality and lower costs, Don Berwick, then the leader of the Centers for Medicare and Medicaid Services (CMS) said, “for Medicare, coordinated care represents the most promising path toward financial sustainability and away from alternatives that shift costs onto patients, providers, and private purchasers,” in this New England Journal of Medicine article.

Don Berwick, former head of Medicare and Medicaid, steps in to mediate a dispute over hospital quality measures.

Don Berwick, former head of Medicare and Medicaid, offers advice on hospital quality measures.

So when Berwick (who is also seriously considering a run for governor of Massachusetts) said last week that he’s advising some Pioneer ACOs in their dispute with CMS about how to measure quality, my ears perked up. Today, he clarified that he’s only spoken to one ACO executive who called to ask for his advice. Berwick points out he can’t, in accordance with federal ethics rules, get involved in direct negotiations.

Berwick says it’s important to “stay on the high road with respect to the purposes here. The idea of ACOs is important and it (quality) is an important component in the whole move toward integrated care. So let’s not throw the baby out here.”

Berwick, who is also busy helping Britian’s National Health Service recover from an “enormous illness”, offers the Pioneer ACOs some guidance.

“As you work through solutions, stay on the high road. And then, try to get to a platform where the discussion is not, will we play or not, but can we work this through at a technical level.” Continue reading →

FILED UNDER: Insurance, Politics, donald berwick, hospitals, practicing medicine, quality

March 19, 2013 | 8:31 AM | Rachel Zimmerman

Affordable Care Act At 3: A Snapshot In Massachusetts

Just to be perfectly clear, this is the Obama administration’s update on health reform since the Affordable Care Act became law three years ago. Still, it’s worth noting the ACA’s sweep and wide-ranging impact.

Changes include the number of young adults covered under their parents’ health plans (3.1 million nationwide and 21,000 in Massachusetts as of Dec. 2011), new no-co-pay preventive care for women (approximately 47 million women, including 1,212,350 in Massachusetts, have guaranteed access to additional preventive services without cost-sharing) and the removal of lifetime limits on insurance (2,520,000 people in Massachusetts, including 975,000 women and 633,000 children).

Here, again, according to an administration news release, is a rundown of some of the ACA-related funds flowing into the state:

Obama signs national health care reform law

Massachusetts has received $180,067,775 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges.–$1,000,000 in Planning Grants: This grant provides Massachusetts the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed.

–Early Innovator Grants: These grants are being used to help a group of “Early Innovator” states design and implement the information technology (IT) infrastructure needed to operate Affordable Insurance Exchanges. Early Innovator States have committed to ensuring that the technology they develop is reusable and transferable to other States. Connecticut, Maine, Massachusetts, Rhode Island, and Vermont participated in a multi-state consortium led by the University of Massachusetts Medical School, and received over $241 million in Early Innovator grants to develop model Marketplace information technology (IT) systems.

–$134,581,413 in Exchange Establishment Grants: These grants are helping States continue their work to implement key provisions of the Affordable Care Act. Continue reading →

FILED UNDER: Insurance, Money, Politics

March 12, 2013 | 10:15 AM | Josh Archambault

Commentary: A Not-So-Rosy View Of Mass. Health Reform

By Josh Archambault
Guest Contributor

Hundreds of healthcare journalists will be attending the Association of Health Care Journalists’ (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict “extreme premium increases” for many small businesses under Obamacare.

In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision.

Josh Archambault of the Pioneer Institute (Courtesy of JA)

The small business community has been paying more for health insurance since the commonwealth’s 2006 reform merged sicker individuals into the same risk pool. The legislature has also added to costs by passing 12 additional mandated benefits since then, a cost borne completely by small companies and individuals.

Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years. That translates into employers and consumers in Massachusetts paying $213 million in 2014 and $3 billion more over the next decade.

Conference speakers will be sure to mention that the Connector was created to help small companies obtain competitively priced insurance, and other states will experience this benefit in the exchanges required under the federal law. Only one problem, the rhetoric doesn’t match reality in Massachusetts. Continue reading →

FILED UNDER: Insurance, Money, Politics, ACA, cost, health reform, The Connector

March 8, 2013 | 12:48 PM | Rachel Zimmerman

Gruber Responds To Economix Critique Of Health Reform

Massachusetts health reform in general and its advocates in particular were the target of a pretty harsh critique yesterday in The New York Times’ blog, Economix.

The post, by University of Chicago Economics Professor Casey Mulligan, argued, among other things, that the U.S labor market is “in for a shock” when health reform takes full effect despite how “smoothly” things may have appeared when Massachusetts carried out its own health reforms starting in 2006. Mulligan writes:

Beginning next year, millions of Americans will be eligible for generous subsidies in the form of cash assistance to pay for their health insurance premiums and out-of-pocket health expenses pursuant to the Affordable Care Act. The subsidies will sharply reduce the financial reward to working because they will be phased out with household income.

Jonathan Gruber of MIT

Mulligan then goes on to trash MIT economics professor Jon Gruber, a key adviser on both state and national health reform, for his defense of the Bay State’s reform efforts:

When it comes to quantifying the new federal law’s penalty on employment, Professor Gruber and Health and Human Services are incorrect to take comfort in the Massachusetts experience since 2006. As I explained last week, the federal law’s employer penalty is more than tenfold the Massachusetts penalty. In other words, if the Massachusetts penalties pushed down workers’ wages by 16 cents an hour, the federal penalties would push them down $1.67.

Professor Gruber is also incorrect that the federal law is introducing less generous subsidies than the Massachusetts law did. Federal subsidies will be available for people laid off from their jobs, but the new Commonwealth Care subsidies in Massachusetts are not, because Commonwealth Care excludes people eligible for the Medical Security Program (a longstanding program providing health benefits to Massachusetts people receiving cash unemployment benefits).

I asked Gruber to respond to Mulligan’s critique. Here, unedited, is what he sent over via email:

Problems with Mulligan argument:

1) He cites as supporting evidence a 1994 article that referred to a completely different policy

2) He ignores the fact that the disincentives to income increase in MA are massively larger than in the federal program. Continue reading →