When I was asked by Governor Patrick to become his Secretary of Administration and Finance, I was of course greatly honored – and also mindful of the major challenges that awaited me in helping to assemble the Governor’s first budget in a difficult fiscal environment.
I have to admit that, at the time, I wasn’t thinking about health care reform as a significant part of my job portfolio. But I quickly learned otherwise. As Chair of the Commonwealth Health Insurance Connector, I’ve found myself steeped in the details and decisions of helping to implement Massachusetts’ historic health care reform law. In truth, barely a day goes by when I’m not spending at least some of my time wrestling with the particulars of putting health care reform into action.
Now, my prior professional experience centered on public finance – not public health – so I’ve had a steep learning curve for this task. Fortunately, I’ve had the benefit (truly, the privilege) of being able to work with and learn from some extraordinary people whose vast knowledge about health care is matched by a deep commitment to making our groundbreaking reform effort a success: Jon Kingsdale and his terrific staff at the Connector; my fellow Connector Board members; Health and Human Services Secretary Judy Bigby; and health care advocates from diverse interests that helped forge common ground and make health care reform a reality in Massachusetts.
Upon becoming Chair of the Connector, I was immediately struck by the progress that had already been made in implementing health care reform – particularly the creation of the Commonwealth Care subsidized health insurance program (now with over 50,000 enrollees) and the enrollment of tens of thousands of previously uninsured individuals in the MassHealth (Medicaid) program. I was also deeply impressed by the commitment and collegiality exhibited by the Connector’s Board members. Despite having other (very demanding) jobs, they have spent enormous amounts of time and energy wrestling with complicated health care decisions that will affect the lives of countless residents of Massachusetts – throughout the process always striving for consensus and treating one another with respect and courtesy. It’s truly a great honor to work with them towards expandi! ng acce ss to quality, affordable health insurance and achieving the immense promise of health care reform in the Commonwealth.
Last week was a major milestone in that effort. On Thursday, the Connector awarded its “Seal of Approval” to a wide variety of health care insurance plans. These plans will be available for individuals and small businesses to purchase through the Connector starting in May. This was the culmination of a process that started with initial bids that came in at higher prices than many of us hoped for. But through cooperation between the Connector, insurers, and Governor Patrick – who personally asked insurers to “sharpen their pencils” and help find ways to reduce costs – a second round of bids yielded much better prices. With the final bids, the average uninsured person living in the eastern part of Massachusetts will be able to buy quality health insurance including drug coverage for as! low as $175 per month. Notably, even the most “basic” plans to be offered through the Connector cover preventive care prior to the payment of deductibles – and many cover all doctors’ office visits pre-deductible.
Of course, many important decisions lie ahead for the Connector. For example, on March 20, the Board will meet to vote on draft regulations to define minimum creditable coverage – the minimum level of health insurance that would satisfy the health care reform law’s “individual mandate” (requiring Massachusetts residents to have health insurance coverage). In developing these regulations, the Board will have to address and balance issues of affordability, choice, and the importance of ensuring quality coverage and care. Then, in April, the Connector will begin considering how to implement the “individual mandate,” including providing exceptions for people who lack access to affordable health insurance.
Meanwhile, the Legislature has begun working on the state budget for fiscal year 2008, which includes funding for health care reform. I was very proud that, in a challenging fiscal environment, the budget filed by Governor Patrick in late February provided the resources to keep health care reform moving forward. I know that the Administration looks forward to working with the Legislature in the coming months to make the needed investments in health care reform and other crucial health initiatives.
There are many challenges that lie ahead in implementing health care reform. But I am confident that all who have a part in making this law the success it can and should be will rise to the occasion – and keep Massachusetts moving forward on the path towards offering the quality, affordable health insurance that the people of our state need and deserve.
Leslie Kirwan is the Secretary of Administration and Finance for Governor Deval Patrick
I feel that there is an entire population that is being overlooked in this self-congratulatory atmosphere. Universal affordable health care coverage? I’m just turning 56 years old. I work for the Commonwealth of Massachusetts as an adjunct professor in the state college system. I earn just over the $29840 cut-off for subsidized care. I do not have health insurance. I do have a physician, and on the occasions when I visit him, I pay the bill.The cheapest possible plan for my age group is over $300 per month. That’s with no prescriptions and a high deductible. Those premiums will be a $3600 a year drain on my strained finances with no advantage unless there’s an emergency. The population that is being overlooked is those who are self-sufficient and of modest means, self-employed artists and writers and three-quarter time college professors. On a $30,000 a year income, I pay real estate taxes, homeowner’s and automobile insurance, and teach English to the youth of the Commonwealth. I am not going to sign up for the insurance plan. I can’t. Please realize it is not a wonderful gift to everyone.
Thank you, Secretary Kirwan, for your role in tackling such a huge and vitally important issue for all of us in the Commonwealth.
I respectfully will point out that one major component that’s been missing from this health reform public policy work is the following: We urgently need better fiscal stewardship of our healthcare spending in this state; it is sorely lacking in this Chap 58 law.
The folks who pay the healthcare bills in this state–the workers, taxpayers, families, individuals and employers who try to do the right thing–their needs have largely been abandoned with the law’s lack of cost control and the mandate that folks above 300% poverty MUST purchase a private product for their coverage. To my knowledge, ALL of these products will be sold at a profit.
See below for a list of legislative inititatives that are essential for beginning the needed improvements to this well-intentioned but fatally flawed “individual mandate” health reform approach.
Continuing the state’s dismal fiscal stewardship of healthcare spending is the primary reason why there are many advocates upset about the Chapter 58 law, not because “it wasn’t their idea” (that’s what some have said to try and marginalize and silence any dissenters from the tightly orchestrated Chap 58 cheering section).
The truth can be uncomfortable but I feel morally obligated to speak it on this issue of such vital importance to the lives of so many. People’s health (physical, mental, it’s all related!) and their financial health are in peril now and will continue to be under this Chap 58 reform unless it is changed significantly.
The private insurance mandate was as harmful and flawed when Romneey signed the law last April as it is harmful, expensive and unworkable now. It’s tragic how much energy and money has been expended on this ill-fated course but I want to believe that you, Governor Patrick, Secretary Bigby, and others in state leadership have what it takes and will get our state on the right track to achieve quality, affordable universal healthcare reform.
And yes, of course some of what the law accomplished already is good; it’s great that the 100k folks living near poverty level(~$9,600/yr) are now covered thru C. Care and MassHeath, but it’s not secure coverage when the financing is built on a house of cards. As you know all too well, we’ve got a >$1.3Bil state budget deficit upon us!!!
I am so glad to hear you say that the other 500k uninsured people in this state who still lack coverage “need and deserve” quality , affordable health insurance; thank you for ending your post here on that note.
But it’s so sad to know that when the affordability definition in this law is FINALLY created, many of the 500k who today remain uninsured will only have the option to submit paperwork to the “connector”, our new and expensive layer of hc bureaucracy, to request permission to remain uninsured because there is no “affordable” product available to them.
The flaws in this law are tragic but we can do better, together. I sincerely mean that and am working hard with others across the state to make it happen.
Readers should recall how shocking it was when legislative “leadership” who profess to want health care for all turned against the citizens health care amendment in recent months. The amendment seeks to establish “comprehensive, affordable and equitably financed health insurance” as a constitutional guarantee for all state residents; we could really use those legal protections to guide state health reform about now.
Secretary Kirwan, I want to believe that you will do the right thing and carry out successful, far reaching health system reforms that will work for all of us.
You may be familiar with the following health reform champions and their pending legislation, but just in case you are not I want to share these as suggestions for getting health reform more squarely on track to success:
Senator Tolman and his legislation for uniform billing to reduce the current admin. complexity and financial waste, along with his bill that addresses the universal coverage issue for the long-term and creates a MA Health Care Trust.
Senator Jehlen and her bill to require the state’s health insurers to spend at least 90% of hc dollars on actual hc services (now there’s a novel idea and a darn good one).
Senator Montigney and his bill to require the state to perform bulk purchasing of prescription drugs to lower drug costs for seniors, the poor, and others (Imagine how much this would help with our state budget crisis, ie reducing the tax dollars now spent on drug coverage in MassHealth, C Care, etc).
You may want to follow the state’s Supreme Judicial Court role in healht reform, too, as they will be deciding the case that has been brought before them about the legislature’s illegal tactics that were used to kill the citizens health care amendment on Jan. 2, 2007.
Finally, let’s not overlook the citizens and residents of our state and their potential to make change. As Justice Brandeis said, the most important job in a democracy is that of citizen. Let us know what more we can do to help.
I hope readers will learn more about state health reform at http://www.MassCare.org/legislation or at http://www.defendhealth.org and then sign on for this work at http://www.masscare.org/membership-pledge-form/ , or at http://www.HealthCare-Now.org for national reform.
Thank you for this opportunity to participate in the discussion. I hope many others will join in as well. Sincerely, Ann Eldridge Malone, RN, MSN
“I was also deeply impressed by the commitment and collegiality exhibited by the Connector’s Board members.”
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That’s great Leslie. Let us know how the Christmas party went. Was that 12 “reform”s in one post?
As Ronald Reagan was once famously quoted, “Facts are stupid things.” I am afraid that most working-class people would refrain from joining the chorus of the self-congratulations offered by Secretary Kirwan, her colleagues on the Connector Board, and her allies in the health insurance industry regarding the Board’s “milestone” approval of 7 “minimally credtiable health insurance plans” by the Commonwealth Connector Board. Consequently, I am posting an analysis by the Greater Boston Interfaith Organization summarizing affordability and health insurance coverage facts concerning these seven plans approved by the Commonwealth Connector Board last week:
PREMIUMS: For a 37 year old in Boston, the premimum ranges from $154-$289 per month. For a 57 year old in Boston, the premium ranges from $347-$504 per month.
DEDUCTIBLES: 4 out of 7 plans have a $2,000 deductible for individuals and a $4,000 deductible for families.
CO-PAYS: Ranges from $25-$35 for primary care; $35-$50 specialists; up to $250 for outpatient services–for individuals or families
OUT-OF-POCKET MAXIMUM: 6 out of 7 plans have a $5,000 out-of-pocket maximum for individuals and $10,000 for families
CO-INSURANCE:
Hospitalizations: 3 out of 7 plans have a 20-35% co-insurance charge (percent of total hospital bill) for hospitalizations.
Outpatient Surgeries: 3 out of 7 plans have a 20 to 35% co-insurance charge for outpatient surgeries
PRESCRIPTION DRUGS:
Deductibles: From $200-$4000 for families
Co-Insurance: 2 out of 7 plans have a 50% co-insurance for non-generic drugs
Failure by an uninsured citizen of Massachusetts to sign up for one of these seven plans will result in a heavy financial penalty being assessed on a resident’s state taxes.
I would challenge Secretary Kirwan, the Connector Board, and Governor Patrick to find “the justice” in these prohibitvely expensive, limited coverage plans. Moreover, I defy the Connector Board members and Gov. Patrick to identify “the justice” in financially penalizing those working class citizens who elect to remain uninsured because they fairly evaluate that none of these New Coke/Edsel health insurance plans DO meet a reasonable standard of affordability and/or are minimally creditable in terms of the scope of health insurance coverage provided. Secretary Kirwan, Gov. Patrick, and Connector Board members: “Together we can…” do much better than the health insurance plans you approved last week. Working class citizens of Massachusetts: Let your legislators, the Governor, and the Connector Board know before the Board’s next meeting on March 20 that NONE these 7 plans meet reasonable standards of minimum creditability required by last year’s universal health insurance coverage law.
HI SUSAN, MY NAME IS CELIA BROWN AND I AM CURRENTLY A SENIOR AT BOSTON DAY AND EVENING ACADEMY. I AM DOING MY SENIOR PROJECT ON UNIVERSAL HEALTH CARE AND SINCE YOU ARE UNINSURED I WOULD LIKE TO GET YOUR FEEDBACK ON UHC. IF IT IS POSSIBLE FOR ME TO SET UP AN INTERVIEW WITH YOU I WOULD BE VERY GREATFUL.
To ALL readers Including those at the state level basically calling the people (citizens) idiots.
Why in the world would the state (commonwealth supposedly) want the people of the richest country in the world (supposedly richest) pay for health insurance?
I have to agree with what Susan mentioned on her post because we the citizens pay for our roof (rent, mortgage, vehicle insurance, food, clothing, electricity, water, gasoline for our vehicles (which is lazy being treated or controlled at the state & federal level…whatever & whomever controls or Polices that area of the market), personal repairs for the tiniest things inspection stations find on vehicles (or we get fined for that too if it’s not done on a time line for those that are “richer” as if car parts are cheap American made or not), excise tax just to have the damn car on the road even if you don’t use it and not to mention local state taxes for sales of all those expenses, we also have to pay state income & federal tax no matter what level under or above this so called “poverty & rich line” (on a weekly or biweekly basis which does matter depending on how much you make per week or every two weeks), city fees & taxes for the permission (permit from the city in Massachusetts) to run a business (super small home business for me) and on top of that we have to see a list of requirements based on the citizens of Massachusetts annual salary which excludes actual realistic spending from that actual base salary (regardless of how much that salary is)?
That’s irresponsible, a problem (not a shame) & what’s more, how is it legal that the penalty for choosing not to have health insurance (because it is ridiculed with astronomical fees by the way) will be around $200.00 or around that area & that it “WILL” come out of your tax return? How is that legal & why aren’t the people speaking up especially those that vote for these people to sit in their chair at their job working deals like that?
This does not benefit the people one damn bit & to think that people pay all these taxes and there’s no money for public schools but there is money for wars that have no merit at all in life (that placed all in the “poverty line”) but yet all your money (us the citizens) gets used not one damn bit in return to provide the citizens of Massachusetts or all US citizens if it becomes a national reform when all we have to do is sit down and say, “Do we really need more bridges and roads repaired this year (which reaches into the millions as we know) or should we really spread that wealth or a certain portion of that wealth the people have contributed from their hard earned hours at work into a “FREE” (not really “FREE” cause it would come from the citizens so this health care system would be in fact paid for) health care plan for those citizens?
So what’s it gonna be citizens? We keep listening to a bunch of people making laws to make you poorer or do we fight by raising our voices and stopping this from happening?
If you said pay the insurance than you are stupid because think about it…”RICHEST COUNTRY IN THE WORLD YET THE RICHEST COUNTRY CANNOT PROVIDE FREE HEALTH CARE FOR THEIR PEOPLE”?
Damn, CUBA must be SUUUUUPER DUUUUUPER WEALTHY cause they have health care for their people at the damn very least!!!
I wonder what product Massachusetts will mandate that it’s citizen/subjects purchase next? Perhaps we must all be forced to join a fitness club or purchase a reasonable amount of health food each week.
Three years ago when my health insurance cost rose to $700/month, I dropped it. Never really needed it anyway as I am healthy. I hurt my elbow last year, went to the doctor to have it looked at, and paid $80 out of my pocket for the visit. The $700 a month I have been saving could pay for a considerable amount of health care services.
I resent having the state force me to purchase a product that is not necessary and over priced.
What do state workers pay for their health program? Perhaps $75/month? Thats a fair price. I’ll happily pay that!