Politics

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

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Mass. Seeks $80M More From Feds For Health Website

Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.

Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.

So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget.*

Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15. Continue reading

Medical Marijuana 101: Doctors, Regulators Brace For ‘Big Marijuana’

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children’s Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

“Is there anything to prevent innovative products with marijuana that will do the exact same thing?” asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

“At the heart of it,” Levy said, “the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it.” Continue reading

Buffer Zone Ruling Aftermath: Street Scene At Clinic, New Bill Filed

Outside the Planned Parenthood clinic in Boston. (Photo: B.D. Colen)

Outside the Planned Parenthood clinic in Boston on Saturday. (Photo: B.D. Colen)

The 35-foot “buffer zone” outside the Planned Parenthood clinic on Commonwealth Avenue in Boston is gone, struck down by the Supreme Court’s buffer-zone ruling last month. But a bill filed today in the Massachusetts Legislature would restore some added protections to staff and patients at the state’s reproductive health centers.

Among them, Planned Parenthood writes, is police power to issue a “dispersal order” when a group has impeded access to a facility; a prohibition on using “threat or force to intentionally injure or intimidate” someone trying to enter or leave the facility; and a “clear passage” section that bans impeding anyone trying to come or go.

An opinion piece in the Boston Globe today argues that no anti-abortion protester has ever been arrested for committing violence, and that the buffer zone “restricts and punishes not violence but expression.”

The author might want to take a look here on socialdocumentary.net at the evocative photos shot at the clinic on Saturday by B.D. Colen, a former Pulitzer Prize-winning medical reporter who teaches documentary photography at MIT. True, no physical violence. But you can imagine what it’s like to be a desperate young woman who has to navigate through dozens of protesters and “counselors” to get into the clinic.

The photo set’s “Photographer’s Statement” includes a heart-wrenching letter from a former student of Colen’s, who speaks to the emotional effects of laws and rulings that can make an agonizing time even harder. An excerpt:

“No one gives us – young and old women – enough credit about how terrifying that whole process is – with or without protestors. When they changed the laws to force a woman to look at the sonograms before they’d do the procedure, I cried. I remember being asked if I wanted to see the sonograms – I remember saying no and meaning it. I’m glad that at the time my voice was heard and my opinion was respected. What a cruel unnecessary law. What a lack of understanding that law demonstrated…

“I wish I was in Boston right now. I’d sit out there on that street after work or on my weekends.

“People think that women who have unwanted pregnancies are stupid or careless. That’s so far from the truth that I want to laugh instead of cry. I wasn’t stupid or careless – and even if I was, that shouldn’t matter. Women’s bodies are built to get pregnant. No birth control is 100% effective. I always knew my body was a fighter and stubborn as hell. Now I have concrete proof.
Continue reading

Report: Partners Merger Would Increase Costs

A report by the state’s Health Policy Commission finds allowing Partners HealthCare to merge with Hallmark Health Systems would increase health care costs on the North Shore.

The commission also has concerns about Partners’ acquisition of South Shore Hospital. The commission cannot block the merger but is passing along its concerns to Attorney General Martha Coakley, who is defending the deal.

Partners’ competitors oppose the merger.

More from the Associated Press: Continue reading

The Global View: Lessons For Mass. Health Care From Abroad

By Dr. Jonathan D. Quick
Guest contributor

A study released last week found that insurance is saving lives in Massachusetts. Expanded coverage will mean 3,000 fewer deaths over the next 10 years. We have state-of-the-art health facilities and are among the healthiest of Americans. Despite the fiasco of our failed enrollment website, the state maintains near-universal health coverage, and inspired the Affordable Care Act.

Our example is heartening not just for America, but for the many low- and middle-income countries around the world working toward universal health coverage. These countries aren’t just taking a page from our book, though — they have valuable lessons for us, too.

Dr. Jonathan Quick (Courtesy)

Dr. Jonathan Quick (Courtesy)

Here are four things Massachusetts could learn about health from developing countries:

1. Bring health care to the community level

Community health workers (CHWs) have been a staple of health systems in developing countries like Ethiopia for decades. Community members trained in basic prevention and treatment interventions, such as oral rehydration for childhood diarrhea and family planning education, are making a big difference. Although not as specialized as doctors or nurses, they work in places where those professionals either aren’t present or are overburdened. CHWs are not only cheaper to train and deploy, but they are also trusted neighbors, who don’t require the four-hour walk necessary to reach the nearest health facility.

CHWs are now catching on in Massachusetts and other places in the U.S. In NPR’s “A Doctor’s 9 Predictions About The ‘Obamacare Era,’” an American physician predicts “A new category of health worker will flourish: the community health worker.” Few Americans face long walks to health facilities, but many face other challenges, such as mental or physical disabilities, chronic pain, lack of transportation or difficulty navigating the health system. CHWs provide low-cost outreach that helps patients deal more effectively with these barriers.

2. Make it convenient

Another approach used in global health is accredited drug dispensing outlets. When people get sick in Tanzania, their first stop is a local drug shop. Although cheaper and more convenient than seeing a doctor, they often get the wrong drug, of poor quality, and at a high price. Through training and licensing, drug sellers are able to provide live-saving treatment for common problems like malaria and childhood diarrhea at reasonable prices. Not only has this model been successful in improving access to essential medicines, but drug sellers quickly proved they could do more to improve health: advise on HIV/AIDS prevention, check symptoms for tuberculosis, and dispense some forms of contraception.

Similarly, in the U.S. programs like CVS’s MinuteClinic and Walgreens’ Healthcare Clinic are broadening the role of pharmacy services from flu shots to screening, treatment, monitoring and other basic health services. Like the accredited drug dispensing outlets, these services are more affordable and more convenient. They are a shrewd business move by the pharmacies, but also a paradigm shift in how we provide health services.

3. Generate revenue while saving lives

Developing countries have also been figuring out how to make the most of limited resources. In Mexico, a tax on soda is providing new revenue for public health — with the added bonus of reducing consumption and improving health outcomes. Continue reading

Restraining Partners? Rampant Speculation On A Deal In The Works

What’s up with that Partners-South Shore deal?

This question has come up in every conversation about hospitals in Massachusetts for the past three to four months, at least.  It’s important because the final resolution will be a benchmark for future hospital mergers, acquisitions and partnerships in Massachusetts and beyond. And it may finally address complaints that Partners Healthcare hospitals and doctors are paid more, in some cases much more, than most of their competitors.

If you’ve (understandably) lost track, here’s a recap:

partnersPartners announced plans to acquire South Shore Hospitals in June 2012.

The state’s Health Policy Commission concluded the deal would increase costs $23-$26 million a year.

Partners countered, saying that adding South Shore to its network, currently the largest in the state, would save $27 million a year.

The commission stuck to its original findings and sent a report to Attorney General Martha Coakley.  She, along with the U.S. Department of Justice, have been looking at whether Partners exploits its size and market clout to drive up health care prices and all of our premiums.

There are lots of theories about why we haven’t heard anything since Coakley acknowledged in March that she was in talks with Partners and South Shore.  Is there an impasse?  Are federal regulators clogging up the works?  What kind of pressure is Coakley (who is also running for governor) facing? I’ve heard all kinds of theories. Feel free to add yours below.

Coakley told the South Shore Chamber of Commerce last week that she expects to complete her review of the deal in a month or two.

Working with the Department of Justice, Coakley could sue to try and block Partners from bringing South Shore into its system.

But a deal that would limit Partners clout seems more likely. So what should it include?

Here’s where my random conversations with doctors, hospital executives and patients gets really interesting. The virtual water cooler chatter includes these possible scenarios:

1. Partners can add South Shore — and that’s it.  No further expansion for, say, five years or so (the time frame varies from three to 10 years). Keep in mind, Partners has already announced plans to acquire two North Shore hospitals after the South Shore deal is done.

2. Partners can add South Shore, but it must sell off another hospital of equivalent size or scope. Continue reading

Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading

Gun Laws: A New Litmus Test For Surgeon General?

Abortion has been a litmus test for U.S. Supreme Court nominees since the hearings for Robert Bork 27 years ago. Now, some doctors are worried that anything a physician says about guns may prove perilous for nominees to be U.S. surgeon general. Will Dr. Vivek Murthy, an internist at Boston’s Brigham and Women’s Hospital, set the precedent?

Dr. Vivek Murthy, President Obama's nominee for U.S. Surgeon General, testified before the US Senate HELP committee on Feb. 4, 2014.

Dr. Vivek Murthy, President Obama’s nominee for U.S. Surgeon General, testified before the US Senate HELP committee on Feb. 4, 2014.

President Obama tapped Murthy to become the nation’s next top doctor in November. Early last month, the 36-year-old was on Capitol Hill for a confirmation hearing, where most of the questions were about the Affordable Care Act.

Murthy is a strong supporter of the federal law and founded a national organization originally called Doctors for Obama, now Doctors for America. His group also urged Congress to pass stricter gun laws after the Sandy Hook Elementary shootings. That was a point of concern during the hearing for Sen. Lamar Alexander, a Republican from Tennessee.

“You said, in your advocacy for passage of gun control, last year, that you’re ‘tired of politicians playing politics with guns, putting lives at risk because they’re scared of the NRA,’ ” Alexander said and then continued with a question: “To what extent do you intend to use the surgeon general’s office as a bully pulpit for gun control?”

“Thank you, Sen. Alexander,” Murthy said, adjusting his microphone. “To start, I do not intend to use the surgeon general’s office as a bully pulpit for gun control. That is not going to be my priority. As we spoke about, my priority and focus is going to be on obesity prevention.”

Murthy cleared the Senate Health, Education, Labor and Pensions Committee with a vote of 13 to 9. Then, in late February, Chris Cox, director of the NRA’s Institute for Legislative Action, delivered a letter to Senate leaders opposing Murthy’s nomination.

Cox told Fox News that “Mr. Murthy’s not just a gun control supporter, he’s a gun control activist. And it’s clear that his agenda is to treat a constitutional freedom like a disease.”

Members of the National Rifle Association began calling their senators and the group said a vote for Murthy would be considered a vote against the NRA.

Continue reading

Mass. To Drop Contractor Behind Flawed Health Insurance Website

Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website.

The site was supposed to be up last October, offering one-stop health insurance shopping for anyone in Massachusetts. But six months later, only a few functions work but have glitches, and a few are not usable at all.

Sarah Iselin, a special assistant to Gov. Deval Patrick hired to oversee the fixing of the website, has been working with a team of outside contractors from Optum to determine if the CGI project can be fixed.

“That assessment made clear that based on past performance and our current needs, parting ways with CGI is the right course for the commonwealth moving forward,” Iselin said Monday.

In a statement, CGI said it will “work with the Commonwealth to ensure a smooth transition to the next phase of exchange deployment, allowing for the best use of system capabilities already in place.”

Iselin and her team told the Health Connector board they are reviewing two possible remedies: hiring a new vendor to build on working parts of the current site or buying website elements from other insurance exchange sites. Iselin cautions that buying elements will be difficult because Massachusetts has many unique insurance rules, including 263 different factors that determine who is eligible for what type of coverage.

Continue reading

House Moderates Stance On Medical Marijuana Dispensaries

The Massachusetts House has backed away from a call for the state to start over in its review of medical marijuana dispensary applications. But House leaders are recommending that the Department of Public Health (DPH) stop and make some changes before continuing what they say is a flawed process.

In a letter released Thursday, Rep. Jeffrey Sanchez, the House chairman of the Joint Committee on Public Health, listed three recommendations:

1) Go back and verify all the information submitted by every applicant who scored 137 or more points. This would add eight groups to the list of 20 that were cleared for provisional status.

2) In the future, verify information submitted before selecting applicants for provisional licenses.

3) Close loopholes that might let “non eligible persons” maintain an interest in a dispensary.

“We want to make sure that we are responsible to this voter-approved law that was passed and that we’re able to identify any problems relative to who these folks are,” Sanchez said.

Before Sanchez sent the letter, House Speaker Robert DeLeo told the Greater Boston Chamber of Commerce that he doesn’t understand why DPH checked some information, but not all the paperwork, before narrowing the list of applicants.

“My problem,” DeLeo said, “is I would have preferred that you [DPH] do all vetting upfront before any decisions are made.”

DPH issued a statement saying it will continue to work with the Legislature and will consider the recommendations in an effort “to ensure a thorough and transparent licensing process.”

But the department and the House are overlooking the main objection raised by those who were not selected: the way applications were scored.

“Much more needs to be done to a process that’s revealing itself to be flawed and inadequate in every respect,” said Joshua Resnek, spokesman for the Centers for Alternative Medicine, whose application to open a dispensary in East Boston was rejected.

Resnek and his group have asked DPH to recalculate their score. Several other groups who were rejected have filed suit against the state.

While some applicants are fighting to overturn the application process, others with provisional approval have millions invested in leases, planned renovations and growing facilities where they anticipated planting marijuana next month.

With all this wrangling, patients are left wondering if they will, as the state has said, be able to purchase marijuana at a legal dispensary sometime this summer.