Richard T. Moore (D-Uxbridge), Senate Chairman of the Legislature’s Joint Committee on Health Care Financing and the Special Senate Committee on National Health Reform, says the public deserves full and honest answers from both hospitals and insurers on the troubling issue of rising health care costs:

With the new year upon us, there is widespread concern about recently announced dramatic increases in health insurance premiums by most carriers. Despite near universal interest in health care cost containment, health insurance costs continue to spiral upward. Small businesses, in particular, are reporting that their premiums are increasing as much as thirty and forty percent over the previous year. Increases of this magnitude appear to be out of line with national trends in health care spending. Clearly, an explanation from providers and insurers of the factors causing dramatic increases in premiums is required!

In particular, the impact of premiums on small businesses is especially unsettling. The Commonwealth’s economic recovery is closely tied to the ability of small businesses to grow and survive. With unemployment continuing to be a serious problem, despite other hopeful economic indicators, businesses are unlikely to increase their workforce if the added cost of health care benefits continues to overwhelm their bottom line. Even larger businesses are challenged to maintain the historic level of insurance benefits for their employees.

Additionally, state and local government budgets and those of human service providers are closely tied to employee benefit costs. Dramatic increases in health insurance costs make it more difficult of municipalities and non-profit service providers to retain or hire the employees needed to deliver essential services. Increases in the employee share of health costs in a time when wages are being frozen or cut, are a growing burden for workers in both public and private sectors.

Related to concerns about higher premiums is the trend toward higher co-pays and deductibles. With so few individuals holding health savings accounts, the crunch of credit card debt and lack of credit availability, these higher out of pocket health costs are likely to lead to health care related bankruptcy and, especially, to inability to access needed care. We all know that failure to have access to needed care early in the development of illness is likely to result in higher health costs as the illness progresses.

A report released last week by Centers for Medicare and Medicaid Services revealed that health care spending rose 4.4% in 2008 – the smallest increase in fifty years – since the spending was first tracked in 1960. How can higher premiums for health insurance and increase co-pays and deductibles can be justified in light of this report? Read more…

Richard T. Moore (D-Uxbridge), Senate Chairman of the Legislature’s Joint Committee on Health Care and the Special Senate Committee on National Health Reform, argues that expanded access to health insurance is also leading to cost savings and improved quality of care:

As some pundits and so-called experts compare features of the landmark Massachusetts Health Care Reforms (Chapter 58 of 2006 and Chapter 305 of 2008), they assert that Massachusetts only addressed access and not quality improvement or cost control.

They concede that Massachusetts did succeed at expanding access to health insurance based on the current estimates that some 97.5% of Bay State residents are now insured, which is a higher percentage than any other “health reform state” has been able to achieve! However, claiming that Massachusetts only achieved expansion of access misses two important features of our success. Furthermore, claims that health reform is unaffordable for Massachusetts have been soundly disproven by the Massachusetts Taxpayers Foundation.

First, expanding access does, in fact, improve quality and ease cost shifting. People with health insurance are generally healthier and are less likely to have to rely on expensive emergency department care because they are able to get lower cost routine preventive care and better management of their chronic conditions. A study by Harvard Medical School for the Centers for Medicare examined Medicare claims between 1996 and 2005 and found that individuals who were uninsured before becoming eligible for Medicare at 65 had significantly higher spending than did those with coverage prior to Medicare enrollment. The uninsured have postponed needed care, making them generally sicker and therefore, more expensive for taxpayers. Access to health care saves lives and money! It improves quality of life and helps contain costs.

There is much more to Massachusetts Health Reform than expanding access, however. Both Health Reform I [Chapter 58] and Health Reform II [Chapter 305] established a strong foundation for improving health care quality and reducing health care costs – in short, making health care accountable.

Recently, the Boston Globe reported significant improvements in reducing hospital acquired infection rates. According to this report, Massachusetts’ largest hospitals say they have significantly cut the number of patients who acquire painful, costly, and sometimes deadly infections in their operating suites and intensive care units (ICU’s), suggesting that pressure from government regulators and patient groups, as well as a shift in doctors’ attitudes, is starting to make medical care safer. This fifty percent reduction in intravenous line infections and reduction of pneumonia from patients on ventilators has reduced current costs and even contributed to cancelling capital expansion of the ICU at Beth Israel Deaconess Hospital.

This is exactly the sort of improvement in quality and cost reduction envisioned by legislators when provisions – and funding – for a statewide infection prevention program and links to the CDC infection reporting system were included in the Massachusetts health reform law in 2006 and the Quality and Cost law of 2008. Read more…

State Senator Richard T. Moore’s Sept. 11 post on SB 2028, a health emergency/flu pandemic preparedness bill, brought a wave of criticism — including calls for his impeachment — mostly from individuals and organizations with a strong anti-government bias. I asked Sen. Moore, a Democrat from Uxbridge, to respond. So here he is:

While I always take into account the legitimate concerns of my constituents, many mistruths have been promulgated over the past several weeks. It is worth noting, that NONE of the provisions of this bill take place, unless the Governor were to declare a statewide public health emergency, which in itself is very rare. For any of this to take happen, it would be an extremely dire situation. I would like to further clarify what this bill does not do, and what it does do:

This bill does NOT mandate, require, or force vaccinations upon individuals, in the event of a statewide pandemic or public health emergency. While the Commissioner of Public Health may recommend statewide vaccinations, every individual has the right to refuse that recommended vaccination. This bill simply enforces common sense by ensuring that if someone refuses the vaccination, they stay home and stay out of risk of infecting themselves, loved ones, co-workers, children, or the general populace.
There are NO “quarantine camps” or institutions that individuals would be placed in if they pose a risk to the general population’s health. Individuals who act irresponsibly in posing a risk to society can face a punishment that results in an order to stay home, or a fine. Again, this fine is simply a protection against individuals that act irresponsibly in the case of a pandemic. Read more…

Richard T. Moore (D-Uxbridge), Senate Chairman of the Legislature’s Joint Committee on Health Care and the Special Senate Committee on National Health Reform, writes that the latest target of anti-government advocates is Senate Bill No. 2028, a pandemic and emergency preparedness plan that gives officials authority to quarantine individuals if necessary:

This summer, vividly and loudly dominating our TV news and print media, America witnessed a raucous display of distrust of our own elected government in the health care town hall meetings. The President and Congress are seeking to expand access to affordable health insurance, and therefore health care, to all Americans. But some of our fellow citizens, skeptical of anything government does, demonized those who tried to explain the proposals before Congress and shouted down explanations rather than engage in a reasonable discussion of the problems and possible solutions.

The anger over health reform efforts by the national government to help Americans expand their right to life, health and happiness has, apparently spilled over to Massachusetts in the form of anger at efforts under discussion in the state government to protect the rights of all citizens during a time of public health emergency. For more than a century, government has had extraordinary powers to respond to an epidemic, and it has generally exercised those powers responsibly. However, legislation aimed at modernizing and refining those powers to preserve individual liberty while protecting everyone from epidemic has been seen by some as more “big brother” government. Read more…

This August, while Congress is in recess from the heat of Washington, DC, members of Congress are back in their districts seeking the light that comes from honest discussion and debate with their constituents about national health reform. Unfortunately, special interests and partisanship are preventing people from learning what’s really in the proposed legislation, and opportunities for reasoned exchanges of ideas are being disrupted by shouting and name calling. An example of this un-American tactic was witnessed recently when Congressmen Jim McGovern and Richard Neal held a town meeting on health reform at the University of Massachusetts Medical School, and faced insults and misinformation.

Our Congressmen, and many of their colleagues across the country, are being subjected to attack from those who don’t want to change how health care is delivered or funded, because special interests and partisan politicians want a system which keeps taking more of our money and delivering less care. Others want to derail reform purely for partisan gain. However, anyone who has studied the trends in health care costs and quality knows full well that individual citizens, businesses, and government can’t afford to keep doing what we’ve been doing in how we deliver or pay for care. Read more…

Most Americans are concerned about the rising cost of health care, eroding health benefits, and rising health insurance costs.  While a majority of Americans, and nearly all Massachusetts residents, have access to health care, it seems as though we keep paying more for health, but getting less care. Only ten years from now, if nothing is done at the national level, Americans can expect to pay 68% more than at present for health insurance and out of pocket costs of health care. Women, especially in a deteriorating economy, are more likely to be adversely affected by the cost of health care.

There are also a significant and growing group of our fellow Americans who have no health insurance, have inadequate benefits, or who are worried that if they lose their job, they will lose their benefits.  Estimates suggest that the number of uninsured in the U. S. will grow from the current 46 million to 65.7 million people by 2019 – ten years from now.  How health care is reformed nationally should be of direct interest and concern to all of us, especially to Massachusetts where significant reforms are already being implemented with 97.4% of our people already covered. 

The U.S. House of Representatives and U.S. Senate are now working feverishly to mark up health reform bills over the next few weeks that, if successfully reconciled and enacted into law, will make health care more affordable and reduce the cost of care.  Everyone – individuals, families, employers, taxpayers, health care professionals, insurers – has an important stake in the outcome of the growing debate.   It is President Barack Obama’s top domestic legislative priority.

We know from the media that the Obama administration and congressional leaders have made a very public commitment to build on the existing employer-based insurance system.   Read more…

Massachusetts is not only a state, but is established as a “Commonwealth.” Our first Governor of the Province of Massachusetts Bay, John Winthrop, defined what that meant in his famous “City on a Hill” sermon in 1630. In that founding document, Governor Winthrop declared it to be our duty to care for one another, to share our good fortune to meet the needs of those among us who are less fortunate, and work together to build a stronger, healthier community.

Beginning with the 2005-2006 Session, the Legislature laid the foundation for a Healthy Commonwealth with the passage of our landmark health care reform law – Chapter 58 of the Acts of 2006. In addition to expanding access to affordable health insurance, the reforms included development of a statewide infection control program, the creation of the Health Care Quality and Cost Council to set quality improvement and cost containment goals, initiation of a first-in-the-nation pediatric palliative care program, and enhancement of the state’s prevention agenda. Several other important steps such as the purchase of hypodermic needles without prescription also contributed to improving the health of the people of the Commonwealth.

By 2008, Massachusetts achieved nearly universal health coverage with an estimated 97% of her citizens with health insurance. Read more…

“We’ve given each other some hard lessons lately,
But we ain’t learnin.’
We’re the same sad story, that’s a fact;
One step up and two steps back.”
Bruce Springsteen – 1997

These are among the words of the title song of a Bruce Springsteen album a decade ago talking about blue-collar woes, lost loves, found loves that didn’t pan out, and lives chafing against the status quo. They could just as easily be the theme song for those of us working to advance health reform during an economic recession.

Massachusetts’ landmark health reform law passed in 2006 has, according to the Connector Authority’s October 2008 report, achieved an unparalleled 97% health insurance coverage. About half of that coverage is privately paid by employers and workers, and the rest is paid by taxpayers either completely or with some individual financial participation. The Commonwealth is on the verge of providing virtually universal health coverage, and the individual stories of lives saved are truly heartwarming!

Surely, no one can again ask if it’s possible to achieve universal health coverage. But now we must ask, for how long? Read more…

The opposition to asking more of those businesses who still aren’t paying their “fair share” of employee health insurance, to contribute to the costs of health care is, indeed, puzzling. More than 90% of Massachusetts businesses are, and have been, providing health care coverage to their employees. It isn’t fair for them to be asked to continue subsidizing the other businesses – including some competitors – who fail to do their part. Yet, in opposing reasonable “Fair Share” contribution rules, leading business organizations appear to be undercutting the positive efforts of many of their own major members.

If a small portion of businesses continue to get away with shifting the cost of their uninsured workers to others – including the substantial portion of businesses who help cover the uninsured through the Safety Net Care assessments, as well as paying for their own employees, how will Massachusetts support universal coverage? The businesses that already pay the Safety Net Care assessments got a hint when the state approved recently a supplemental budget that provided “one-time” increases to those assessments. Let’s remember that the “fair share” contributions were considered a more reasonable solution to funding health reform than an across-the-board payroll tax. Read more…

Editor’s note: For opposing views, read this letter to Governor Patrick from House lawmakers or this letter from Wyeth Pharmaceuticals.

The Massachusetts Legislature recently adopted a comprehensive proposal to improve the quality of health care and to contain the rapidly increasing cost of care. Both goals are essential to sustaining the Commonwealth’s landmark health care reform law and keeping high quality health care affordable to all our residents.

Some of the most exciting and meaningful reforms in the bill – promoting reform and efficiency in the health care system, improving access to health care services, enhancing transparency of health care costs and quality, and encouraging the adoption of health information technology – will dramatically improve the care provided in Massachusetts as we expand access to care for all of our residents. However, one provision of the bill – regulating drug marketing practices – has generated heated, but not well-informed, discussions with representatives of the bio-pharma industry.

Those of us who helped to draft the Massachusetts Health Care Quality Improvement and Cost Containment legislation firmly believe that marketing practices of pharmaceutical and medical device manufacturers are an important factor in driving up health care costs without, necessarily improving the quality of care that’s delivered to patients here, and across the country. There are numerous books, articles, and academic research papers that clearly demonstrate the pervasive, even corrupting, influence of such marketing practices as gifts, travel, honoraria, and other valuable incentives offered by industry to those with the state licensed power to prescribe medication. Legislators are not alone in our sincere concern. Read more…