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


State Legislature Hears From Both Sides On Doctor-Assisted Suicide Bill

Compelling arguments on both sides of the doctor-assisted suicide debate were presented at a State House hearing Tuesday afternoon.

The Legislature’s Committee on Public Health is once again considering a bill that would allow doctors to prescribe lethal doses of medication to terminally ill patients.

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Lawmakers To Hold Hearing On Physician-Assisted Suicide Bill

State lawmakers on Beacon Hill will hear arguments Tuesday afternoon on a proposed measure to legalize physician-assisted suicide.

The bill would require a terminally ill patient — specifically, a person with an incurable illness or condition that can reasonably be expected to cause death within six months — be assessed by two doctors and a counselor before being prescribed life-ending medication. Continue reading


Romneycare, Obamacare, Now Jebcare: Candidate Bush Presents His Health Plan

Former Florida Gov. Jeb Bush acknowledges the crowd while being introduced before speaking at the National Automobile Dealers Association convention in San Francisco in January. (AP)

Former Florida Gov. Jeb Bush acknowledges the crowd while being introduced before speaking at the National Automobile Dealers Association convention in San Francisco in January. (AP)

By Fred Bever

​For what was ​expected to be a major policy speech on the thorny issue of health care reform, the event was a pretty low-key affair.

When Florida Gov. and Republican presidential candidate Jeb Bush laid out his plan for a post-Obamacare health system on Tuesday, roughly 50 people turned out, many of them associated with the venue — St. Anselm College in New Hampshire.

But at the start, Bush ​did open with a sharply partisan attack on Democratic candidates Hilary Clinton and Bernie ​​Sanders​, whom he condemned​ for their support of Obamacare and its mandates.

“For the Democrats, this is what they want, this is how they roll,” he said. “They like the power of deciding these things from up above. This is their essence and I believe the top-down driven approach is not the one for our country.”

Mandates, Bush says, stifle innovation.

Like most Republicans, Bush wants to do away with Obamacare. He objects to its mandate that all Americans carry health coverage or face a tax penalty. He’d get rid of federally-mandated plan designs. He’d give states more control over federal health care assistance programs such as Medicaid.

And while he’d reduce the value of employer health benefits that workers can write off on their income taxes, Bush would also provide a tax credit to encourage the purchase of low-cost catastrophic coverage.

“That should be the national focus,” he said. “Making sure that people have catastrophic coverage so their lives are not turned upside-down by an adverse event that could have real devastation for their family.” Continue reading

AG Says State Must Do More To Control Health Care Costs

Attorney General Maura Healey says Massachusetts will miss a self-imposed health care spending target this year. (Jesse Costa/WBUR)

Attorney General Maura Healey says Massachusetts will miss a self-imposed health care spending target this year. (Jesse Costa/WBUR)

It looks like Massachusetts will miss a self-imposed health care spending target again this year. This warning from Attorney General Maura Healey comes just a few weeks after a state agency announced that Massachusetts failed to keep spending below 3.6 percent last year, as recommended in a 2012 law.

The forecast for this year is in a report produced by Healey’s office. It finds little change in problems that have been building for years: some hospitals are paid a lot more than others, patients frequent the expensive hospitals and efforts to shift the way we pay for health care aren’t closing the price gaps.

The attorney general's report finds that some of the most expensive hospitals in the state are also the busiest, a pattern that drives up health care spending. (Courtesy Attorney General's Office)

The attorney general’s report finds that some of the most expensive hospitals in the state are also the busiest, a pattern that drives up health care spending. (Courtesy Attorney General’s Office)

“These trends, coupled with new growth in pharmacy costs and utilization of health care services, point to a likely failure to hold health care spending increases below the 3.6 percent benchmark the Commonwealth set for 2015,” according to the latest Examination of Health Care Cost Trends and Cost Drivers from the office of the Attorney General. It’s the fifth such report and the first from Healey.

For many in the health care industry, the factors driving up health care costs sound familiar. The gap between high and low cost hospitals is not new, nor is the finding that expensive hospitals care for a large share of patients. Continue reading


Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

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Thousands Ruled Ineligible For Mass. Medicaid

Tens of thousands of people have been removed from the state’s Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker’s administration obtained by The Associated Press.

The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker’s plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents.

At $15.3 billion, MassHealth is the state’s single largest budget expense.

Based on the results of the redetermination process so far, the state was on track to achieve the savings it had hoped for in the current fiscal year without cutting benefits for eligible recipients, said Secretary of Health and Human Services Marylou Sudders. Continue reading

Feds Seek Massachusetts Health Exchange Records

Federal authorities have subpoenaed records related to the Massachusetts Health Connector, including a period covering the breakdown of the health exchange’s website, The Associated Press has learned.

“The administration received a subpoena regarding the Health Connector’s difficulties dating back to 2010 and we are fully cooperating with the Department of Justice,” Elizabeth Guyton, a spokeswoman for Gov. Charlie Baker, said in a statement.

The administration said the subpoena came from the U.S. Attorney’s Office in Boston shortly after Baker took office in January. No details were immediately available, and it was not clear what information was being sought from the agency.

The U.S. Attorney’s office did not immediately return a request seeking comment.

Massachusetts’ first-in-the-nation universal health care program served as a model for President Barack Obama’s Affordable Care Act. But the state’s transition to the federal program in 2013-2014 proved disastrous, forcing the administration of former Gov. Deval Patrick to place hundreds of thousands of residents into temporary Medicaid coverage.

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Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

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Mass. VA Clinic, Hospital Wait Times Vary Widely

In a state that prides itself on access to great health care, wait times at Veterans Affairs hospitals and clinics vary widely, with some facilities in central and western Massachusetts delaying appointments at much higher rates than in the affluent east.

Nearly 9,000 medical appointments at VA facilities in Massachusetts – about 2 percent of the state’s total during the six-month period ending in February- failed to meet the department’s goal of completing medical appointments within 30 days.

That’s better than the national average of 2.8 percent, but nearly half the delays in Massachusetts occurred at only three of the state’s 20 facilities, according to government data reviewed by the Associated Press.

“We’re working to get the veterans into their appointments in a more timely manner. It’s a work in progress.”

– Dennis Ramstein, Central Western Mass. VA spokesman

The AP analysis of six months of appointment data at 940 VA hospitals and clinics nationwide found that the number of medical appointments delayed 30 to 90 days has stayed flat since Congress began pumping $16.3 billion dollars into the VA system in August. The number of appointments that take longer than 90 days to complete has nearly doubled.

Many of the delay-prone hospitals and clinics are clustered within a few hours’ drive of each other in a handful of Southern states, often in areas with a strong military presence, a partly rural population and patient growth that has outpaced the VA’s sluggish planning process.

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Hundreds Gather At Final Public Hearing On State’s Opioid Abuse Crisis

Two to three men and women in Massachusetts will die today from heroin or other opiate overdoses, according to current death rates.

“There were three times as many deaths associated with opioid overdoses last year as there were automobile accident deaths,” said Gov. Charlie Baker, speaking at the fourth and final hearing yesterday of a task force he appointed to vet the state’s drug abuse problem. “That’s really all you need to know to understand that it’s in fact a crisis.”

The task force is expected to make its recommendations on how to deal with the statewide drug crisis by next month. Ahead of that deadline, hundreds of people turned out at the State House Thursday to relate their stories of addiction and recovery.

WBUR’s Martha Bebinger joins Morning Edition with a report on what was said during Thursday’s hearing.

To hear the full report, click on the audio player above.