Politics

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

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Coakley: Mental Health Care Is Next Great Mass. Challenge

Attorney General Martha Coakley

Attorney General Martha Coakley

As WBUR’s Martha Bebinger reported, Massachusetts attorney general (and gubernatorial candidate) Martha Coakley is calling for the state to build “a behavioral health system for the 21st century.” Coakley spoke this morning to the Massachusetts Association of Health Plans. She recalled her brother, Edward, who began to struggle with depression at 17 and committed suicide at 33. We asked her office for the prepared text of her speech; it is excerpted below.

“…Which brings us to the third great challenge that I would like to pose to everyone today – improving access to quality behavior health care for everyone who needs it.

This is no small challenge.

There are millions of families dealing with the effects of mental illness across our country.

According to the National Institute on Mental Health, one in four adults suffers from a mental disorder in any given year. It’s probably higher.

And in a time when soldiers have returned from two separate wars, studies have shown that 20% of returning Iraq and Afghanistan veterans report symptoms of PTSD or major depression. It’s also most likely higher.

On Veterans Day, I learned that there are 22 suicides a day by veterans.

Some of you may know that my family dealt with the impact of mental illness.

My younger brother Edward was a brilliant person – he was smart, funny, a great pianist. He also suffered from depression, onset around 17 or so.

He struggled with it for much of his adult life, and my family struggled with how to help him.

When he was 33 years old, he committed suicide.

My parents had died just 1 and 3 years earlier. It was difficult for me and my sisters.

It is why I know first-hand – as many of you do – that behavior health care is as vital to the treatment of many patients as physical health care. Continue reading

In Defense Of Health Care Law, Obama Cites Mass. Success

President Obama spoke at Faneuil Hall about the federal health care law. (Charles Dharapak/AP)

President Obama spoke at Faneuil Hall Wednesday about the federal health care law. (Charles Dharapak/AP)

President Obama’s visit to Boston Wednesday was a carefully orchestrated effort to revive momentum for the Affordable Care Act. The president took the stage at Faneuil Hall, the same place where former Gov. Mitt Romney signed the Massachusetts health coverage law in 2006.

Romney was not invited. Instead, Faneuil Hall was packed with hand-picked supporters of Obamacare. The president congratulated those who supported the 2006 law for making Massachusetts the state with the lowest rate of uninsured people in the country.

“And it’s because you guys had a proven model that we built the Affordable Care Act on this template of proven bipartisan success,” Obama said. “Your law was the model for the nation’s law.”

But rolling out the model nationwide has been rocky. Some governors are refusing to participate. The U.S. House of Representatives has voted to repeal the national law again and again. And the federal website, where Americans are supposed to be able to shop for insurance, is a mess.

“There’s no denying it,” the president said, “right now the website is too slow. Too many people have gotten stuck and I am not happy about it. And neither are a lot of Americans who need health care. And they’re trying to figure out how they can sign up as quickly as possible. So there’s no excuse for it. And I take full responsibility for making sure it gets fixed ASAP.”

Obama looked to Massachusetts for relief. Continue reading

Single-Payer Rumblings In Mass. Legislature

The Massachusetts State House (Wikimedia Commons)

The Massachusetts State House

The dominant story about Obamacare right now is the technical debacle of the Healthcare.gov Website, but you’ll also find an occasional bit of this sub-theme among the punditry: The flaws of Obamacare will push the country further toward a single-payer system like Canada’s. (Exhibit #1 from The Los Angeles Times: Health Law’s Ailments Can Be Cured By Single-Payer System.)

So it’s a particularly interesting moment to see a report by Matt Murphy of the State House News Service that begins like this:

SINGLE-PAYER DEBATED AS POSSIBLE NEXT STEP IN HEALTH REFORM

STATE HOUSE, BOSTON, OCT. 22, 2013…. Massachusetts might not be ready to adopt a single-payer health care system but advocates on Tuesday, including a number of progressive lawmakers, suggested it might only be a matter of time.

Sen. Jamie Eldridge, an Acton Democrat, testified before the Joint Committee on Health Care Financing in favor of two bills he has filed this session to implement a universal Medicare plan in Massachusetts (S 515), or to take the more incremental step of creating a public health insurance option (S 514) to give consumers a taste.

“As much as we’ve made great advances here in Massachusetts and covered nearly all people, there are still some deep flaws in our health care system,” Eldridge said. “A single-payer model is a more efficient system, better health care options and something employers prefer because they no longer have to provide health care.”

Asked if he thought either proposal had a chance of winning approval, Eldridge said, “No. I don’t. I think what’s happening now is single-payer advocates are engaging the business community.”

Also: Continue reading

Dr. Tim Johnson’s Obamacare Podcast: The ‘Unbelievable Bumble’

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

Dr. Timothy Johnson, retired Medical Editor for ABC News, in the WBUR studios. (Jesse Costa/WBUR)

As president, you know things are really getting bad when every humor outlet from The New Yorker’s Andy Borowitz (“Snowden Offers To Fix Healthcare.gov“) to The Onion (“New Improved Obamacare Program Released On 35 Floppy Disks“) is mocking your program’s failures.

President Obama himself expressed his frustration today over the widespread technical glitches besetting people trying to sign up for health insurance under Obamacare, saying that “nobody is madder than me,” NPR reports.

Here, in his latest podcast on health reform, Dr. Timothy Johnson, retired medical editor for ABC News, takes on what he calls “the very rocky start to the centerpiece of the Affordable Care Act: the insurance exchanges.” He and his guests discuss the technical SNAFUs that are marking the launch of the exchanges and dissect their causes. He begins with a New York Times article today that says federal health authorities simply did not have the expertise to do the job of setting up the technological infrastructure needed for Obamacare. He asks, “Question #1, are they right, these reporters? And question #2, can it be fixed?”

Listen to the podcast above to hear some answers (and to hear guest Dr. Gail Wilensky, a high health official under the first President Bush, refer to Obamacare’s technical failings as “an unbelievable bumble” — what a fun phrase, rolling so nicely off the tongue!) And here’s one useful tip: For those who have trouble on healthcare.gov, the Kaiser Family Foundation is offering a simple calculator of health insurance subsidies on its website, www.kff.org.

Readers, reactions? Please share below. And catch Dr. Johnson’s inaugural podcast here.

What Makes Berwick Run: Spurned Medicare Chief Seeks To Lead Massachusetts

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Don Berwick — pediatrician, health care improvement guru, Anglophile, Obamacare booster — has a really, really great bedside manner. He leans in; he listens. He’s deeply thoughtful about seemingly intractable problems (Medicaid expansion, for instance, or the way doctors get paid) without being alarming. In short, he’s the guy you want in the exam room when your kid falls off the jungle gym.

And if you live in Massachusetts, he wants to be your governor.

The last time you probably heard about Berwick, a Democrat, he was being lambasted by certain (Republican) members of the U.S. Senate who vowed to block his confirmation as President Barack Obama’s designated Administrator of the Centers for Medicare and Medicaid Services. Berwick served as the head of CMS for 17 months, and then, with regret but little discernible bitterness, he returned home to Newton, Mass., and decided to run for governor. (Before heading CMS Berwick served as the director of the Institute for Healthcare Improvement, a nonprofit in Cambridge.)

We spoke with Berwick mostly about health care on his way to more far-ranging interview on Radio Boston. In a 30-minute discussion, Berwick talked about the “majestic” Affordable Care Act and compared re-inventing health care to throwing a hat over a very tall wall and climbing over to retrieve it. Here, edited, is some of our (very long) interview:

So, overall, how is your campaign going?

I’m thrilled by how things are going. Of course, people are interested in health care, it’s a very big issue for our country and our state. We have to get this right. I keep saying the truth, which is that the eyes of the country are on Massachusetts. We’re, what, five years ahead of the country in broadening coverage. Health care is a human right in the state now, and you can’t say that in any other state, and that’s what began in 2006. So we’re kind of pioneers for the country. Now, in order to make that possible, we have to reform health care.

Health care has to meet people’s needs better, at lower cost, without harming anyone, but by making health care better, that’s the best way to improve, to contain costs. That’s the journey we’re on, since the cost containment enterprise is now started, and everyone’s watching, everyone’s watching. Continue reading

Lingering Health Law Questions Jon Stewart Wants Answered

By Georgia Feuer
Guest Contributor

Last week Jon Stewart hosted Secretary of Health and Human Services Kathleen Sebelius on The Daily Show. During the interview, he kept returning to the same question: Why was the piece of the Affordable Care Act that requires businesses to provide health insurance delayed for one year, but the piece requiring individuals to obtain health insurance (the “individual mandate”) was not delayed?

In her answer, Sebelius mentioned that there are subsidies and tax credits available to individuals starting in 2014 and also that the so-called “employer mandate” affects a very small number of businesses. The employer mandate only applies to businesses with 50 or more employees. Only 5% of businesses have 50 or more employees, and most of these companies already offer insurance.

Screen shot 2013-10-14 at 1.11.38 PMBut Jon Stewart was not satisfied with her answer, and that is because she did not give the whole answer. The real reason why the individual mandate cannot be delayed is that it is too crucial to the success of health care reform. To understand why, let’s suppose that getting health insurance was, in fact, voluntary. Then the people who would be most motivated to purchase health insurance are those who are sick. Continue reading

What Obamacare Is Really About, From One Who Knows

healthyamerica
I hate Obamacare. That is not a political statement; it’s a journalistic one. The complex, 800-plus-page law is an explanatory nightmare, and every time I think I really understand it, my clarity slips away.

So I’m always grateful when John McDonough weighs in. A professor at the Harvard School of Public Health and author of a definitive account of the law – Inside National Health Reform — he’s a leading (and openly partisan) Obamacare expert. His new piece – Obamacare 101: Promises, Pitfalls and Predictions —  is the first in a new series run by WBUR’s opinion page, Cognoscenti. Called Policy for a Healthy America, it will look at “the challenges and opportunities facing the U.S. health care system.”

Among the future questions the series will address: Why is tackling the nation’s obesity problem so difficult? How is technology changing health care delivery? Is a single-payer system the answer?

Here’s a bit from today’s piece by John McDonough:

The biggest changes will transform people’s ability to buy health insurance. An insurance concept known as “guaranteed issue,” set to take effect on the first of the year, bans the practice of “medical underwriting” and the imposition of pre-existing conditionexclusions. The individual responsibility provision, called the individual mandate, will impose a new tax penalty on individuals who do not buy health insurance and who can afford to do so. Continue reading

Looking Back: What Really Happened At The Start Of Mass. Health Reform

A lot of Obamacare supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion.

But back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried.

Here’s why:

2006 Romneycare handshake

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state’s universal health coverage law at Faneuil Hall in Boston. (AP File)

1) It looked like the state had, by a lot, underestimated the number of people who would be eligible for free and subsidized coverage. (In 2006, the estimate was 140,000. By April 2008, the estimate rose to 225,000, based on early sign-ups. Enrollment plateaued at 177,000 in 2009.)

2) A dramatic increase in first enrollment put a strain on doctors and health care services at every level.

3) Patients, many of whom had not had insurance for years, had a lot of problems they hadn’t taken care of and were seeking more tests, surgery and other treatment that drove up costs.

4) State budget watchers started to panic. The governor’s office kept going back to the Legislature to ask for more money and a few top lawmakers began to question whether the state could afford to fund the coverage law.

5) Employers saw an increase in workers who, to avoid the individual mandate penalty, signed up for their employer’s coverage, which increased employers’ outlays for health insurance.

Of course we don’t know if people who’ve gone without insurance around the country will behave like Massachusetts residents.  Continue reading

As Nation Braces For Obamacare, Mass. Tackles Health Costs

If for some reason you’re not already drowning in the rough waters of U.S. health policy — what with the Affordable Care Act’s health exchanges launching today and Congress and President Obama still duking it out over the four-year-old law upheld by the U.S. Supreme Court — well, you’re in luck. Because in the midst of all this Obamacare angst and government shutdown, our fair state this week kicks off the Oscars of health wonkdom, aka, the Massachusetts Health Policy Commission’s Annual Health Care Cost Trends Hearing.

It’s a time for state health care officials and bureaucrats to conduct a little reality check with insurers, hospitals, businesses and consumers to ensure that everyone’s making a good-faith effort to hold down medical costs.

Stuart Altman, economist and professor of National Health Policy at Brandeis University and chair of the board of the Massachusetts Health Policy Commission, says the role of the commission is to keep all of the players involved in the health system accountable and sharply focused on driving down costs while improving quality. “We’re like a big searchlight on the system to say ‘Hey this is good’ or Hey, this is not good,” and then follow up, Altman said on WBUR’s Radio Boston Monday.

Gov. Deval Patrick

Gov. Deval Patrick

Here’s a little background on the hearings, to be held at the University of Massachusetts, Boston, from the state:

The cost containment law, signed by Governor Patrick in August 2012, empowered the Health Policy Commission with monitoring health care delivery and payment system reform and developing policies to reduce overall cost growth while improving the quality of patient care. The Commission is governed by an independent board of health care experts who will use the two-day hearing to examine hospitals, insurers and provider organizations about their work to meet the new cost growth benchmark (3.6% for 2013 and 2014), improve care coordination and provide consumers with price transparency tools. Market consolidation’s impact on the Massachusetts health care system will also be a hearing focus.

If you want to get a jump on the hearings, go wild and check out the pre-filed testimony here. Continue reading

The Checkup On Shots: Vaccine Updates, Facts And Fictions

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection.  Also, when you’re talking about an 11-year-old,  preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.

 

For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:

gardasil-fact-sheet-image

Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?