Postings to this blog over the past several weeks have addressed many aspects of our health reform law, including the challenges and successes that we share. This past week, I continued my work to educate and analyze these issues with fellow legislators and counterparts in states across the country. The Annual Meeting of the National Conference of State Legislatures was an opportunity to do just that. Over 9,000 legislators, legislative staff, advocates, and other policymakers—domestic and international—came to the Boston Convention and Exhibition Center to share best practices, new developments, and evidence to inform policy development in many areas.
As health reform continues to dominate state agendas across the country, one session in particular consisted of perspectives from a few states in varying stages of reform, and demonstrated the need for flexibility in state approaches to expanding access to health care, and the tensions between access, cost, and quality. I was joined on a panel by officials from California, Indiana, and Vermont to discuss the substance of pending and enacted health reform proposals in our respective states, and the policy and political challenges we face.
California has several proposals on the table—from both Democrats and Republicans, from both the Executive and Legislative branches, and from both the Assembly and Senate. The proposals include elements that are familiar to us in Massachusetts—individual mandate, employer contributions, increased Medicaid reimbursement rates for providers, expanded Medicaid eligibility, and a focus on prevention and public health. Political divides persist, however, and it remains unclear what the resolution will be. The Healthy Indiana Plan creates a system of health savings accounts for their uninsured, low-income residents, funded by a combination of an increased cigarette tax and federal Medicaid match, subject to approval of their Medicaid waiver. Finally, Vermont’s health reform implementation is in full swing, with a combination of state-subsidized insurance and an employer contribution. It features aggressive chronic care management, increased tobacco taxes, and changes in their State Children’s Health Insurance Program (SCHIP) and Medicaid eligibility, but an individual mandate contingency that is deferred until 2010.
We share the same challenges of increasing access, containing costs, and improving quality of medical care, all while reaching toward universal coverage, but we differ in important ways, including, but not limited to, numbers of uninsured, rural issues, and the sources and levels of state and federal funding available. Still, we should all be encouraged by the growing number of courageous states (to paraphrase Justice Brandeis) not just talking, but acting, as laboratories of reform, all while awaiting further signs of support from the federal government. And, one thing continues to distinguish Massachusetts—our long history of bold and successful legislative initiatives to improve the health of our residents.
Salvatore DiMasi
Speaker of the Massachusetts House of Representatives
Speaker DiMasi,
I am curious as to which successes allude to. So far, all Chapter 58 has done is increase insurance company revenues while terrifying working people who wonder how they are going to pay for the Individual Madate. It may also have been successful in driving some less wealthy citizens out of state, exacerbating the mortgage default crisis, and increasing the problem of “brain drain”, as smart young entrepeneurs flee for greener pastures.
Are you encouraging legislators in other states to throw their constituents under the insurance bus as you folks have done to Bay Staters? If the plans offered through the Connector represent quality care at bargain prices, perhaps you members of the General Court would care to lead by example. I call upon you ladies and gentlemen to give up your current tax payer subsidized plans (We pay 80-85% of costs.) and purchase one of the worthless Connector policies. Any takers?
What this law has not done is expanded access to health care nor qualified as serious reform.
For those interested in seeing all citizens receive the heath care they need, visit http://www.defendhealth.org
I have a question,why are you and others like you still in office? I cannot see how this helps the citizens and business to stay in Mass.At a time when forsclosures, gas prices,rents,food prices. What does our State do? Force a bogus law to force people out. Well my wish is to vote out every last one who voted for this. This is our State not theirs.it belongs to the the people. “WE THE PEOPLE”
”
* Ron Norton posted:
Comment posted August 10th, 2007 at 5:15 pm
Speaker DiMasi,
I am curious as to which successes allude to. So far, all Chapter 58 has done is increase insurance company revenues while terrifying working people who wonder how they are going to pay for the Individual Madate. It may also have been successful in driving some less wealthy citizens out of state, exacerbating the mortgage default crisis, and increasing the problem of “brain drain”, as smart young entrepeneurs flee for greener pastures.”
In the near future they might flee, but in a few years there will be no place place to flee to. The insurance have a big plan to control all govt. subsidized health care in America. In MA it means billions, and across the nation it means trillions. The politicians are there, as Ann Malone has said many times, to fullfill the agenda of the insurance companies.
The national campaign by insurance companies to place article in big media to get people speak in their terms is in full swing. As in, “the problem is not access to healthcare, but not having health insurance.”
Take this MSNBC article for example…
http://www.msnbc.msn.com/id/20228552/
“U.S. ranks just 42nd in life expectancy
WASHINGTON – Americans are living longer than ever, but not as long as people in 41 other countries.
For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.
snip////
Researchers said several factors have contributed to the United States falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say.
more…”
This is not even a one to one example. As David Himelstein MD pointed on this board, access to healthcare and health insurance are two different animals. Still, who will make the distinction?
The propaganda is sublte, but daily. The insurance companies have a well placed article in a major publication that uses the keywords “health insurance” everyday of the week, and I wouldn’t doubt if they have Frank Luntz working for them?
Placing these articles in big media “to educate the public” costs millions, but when the return can be trillions in the future when these policies are implemented on a national level, it’s worth it.
Dave has it just right.
The fact of the matter is that the name “Healthcare Reform” has nothing to do with neither Health nor Care nor Reform. Please look up the definition of each word and try to reconcile them with the reality of what has been created.
By using such benign wording, the public is fooled into thinking that this is a well meaning, progressive plan, when it is simply an underhanded and painful way to extract more money from an already struggling populace.
This expensive enterprise was devised by politicians and number-crunching insurance companies for the benefit of the authors, not the good people who pay for it. In this “laboratory[ies] of reform” (quote from Salvatore DiMasi) Massachusetts citizens are the unwitting sacrificial lab rats.
The architects are clearly indifferent when the human equation doesn’t fit into their pre-determined end. This fact has been demonstrated over and over again in public forums. Even here, on this very forum, there is evidence of this sad fact. Authority speaks from it’s podium but never responds to the audience.
Anyone with a jot of commonsense can see that you can’t replace one fractured system with another and call it “reform”. People need heath CARE not health INSURANCE.
True reform would be the removal of profit and expensive administrative overhead with the establishment of a universal single-payer system. Please read: http://www.massnurses.org/single_payer/faq.htm , http://www.pnhp.org/ , http://www.msnbc.msn.com/id/19886686/site/newsweek/page/0, http://massdefendhealthcare.org/.
“We can’t solve problems by using the same kind of thinking we used when we created them.” Albert Einstein
A few questions for Mr. DiMasi:
#1) There is a move to allow towns and cities to join in the state health plan system in order to save money.
- Why is it limited to municipal employees? Don’t we all really work for the state? We all work to pay the state, therefore we work for the state, too, and deserve the same accommodation.
#2)One of the largest groups is immigrants who are living here illegally. Undocumented immigrants cannot enroll in Commonwealth Care plans because the federal government, which is helping fund the state’s program, generally does not allow federal money to be used to cover healthcare for illegal immigrants. Though illegal immigrants can continue getting emergency care through the free-care pool, the pool is expected to shrink as the state gradually shifts dollars to pay for health plan subsidies.
- What is the plan for covering this gaping hole?
#3)Employers with 11 or more full-time employees are required to offer employees the ability to pay for their insurance with pre-tax dollars by establishing section 125 plans.
- What about employees in smaller businesses? They are not allowed the savings advantage of “pre-tax”. Therefore, they face greater costs. That sounds like discrimination under the law to me. Please address this.
#4) What is the policy for employers of food service staff, bartenders, and similar work? Please address the rationale for this.
#5)The law provides a special young adult plan for ages 19 to 26 – but 18 year olds seem to be excluded.
- Is this a “donut-hole” situation, or where do the mandated 18 year olds fit in? What am I missing here?
#6) How many new state agencies have been created to study, implement (including advertising) and administer Chapter 58?
- What has the monetary cost been to date?
- What is the projected cost to the state for the next 5 years?
#7) When will the state inform the general public of the massive data collection system that will be needed to manage the mandate?
Thank you in advance for your attention and your responses.
Dave,
No doubt about it, we are in the midst of a propaganda war; all part of the plan to continue the corporatization of America. The insurance industry will gladly spend billions on disinformation to keep the United States from going to a nationalized health care system. They have to; their very survival depends upon it. We currently devote about 16% of our GDP to health care spending, almost twice what other nations spend, but we don’t produce better outcomes. Not only do we have shorter life expectancies than 41 other industrialized countries, we also have a significantly higher infant mortality rate, and about 30% of all the people admitted to U.S. hospitals either acquire a nosocomial infection or suffer some type of iatrogenic injury in the course of their care. Our economy also takes a hit as jobs are outsourced to nations with true universal health care systems, thereby reducing employer labor costs. Still, everything will be alright if we all just shut up and drink the Kool-Aid…
Beth,
All good questions. It was interesting to note the other day that the penalty for corporate manslaughter (see Big Dig) is considerly less than the penalty for being middle aged, middle class and uninsured.
Apparently DiMasi is a speaker and not a listener.
I have come to the realization that this potentially helpful WBUR blog is being used for nothing but an upscale propaganda podium for the powers that be.
They post but do not answer even when they promise to – see http://www.wbur.org/weblogs/commonhealth/?p=167#comments for one example.
Just as they have used the inner city churches and the suburban chambers of commerce for proselytising to targeted audiences, our venerated WBUR may have been sadly exploited.
I will no longer read nor post to this blog, as it has proven itself to be just a fancy, one-way billboard, not the venue for exchange that we would hope and that I presume was intended.
It’s a sad and disappointing waste of good intention.
Thank you, Ms Bebinger and WBUR for the attempt at elevating the discussion. As it turns out, there is no discussion, only dictation.