When we embarked on the mission to expand access to health insurance three years ago, our goals were to expand access to Medicaid and Children’s Health (SCHIP), restore Medicaid cuts necessitated by the Recession of 2002-4, expand access for small businesses and their employees to the Insurance Partnership, provide affordable insurance to the middle class, and get to universal coverage, in part, through an individual mandate. We wanted to reduce cost-shifting in health care and maintain or expand the partnership with employers in providing access to health insurance. Of course, the goal was not simply to expand the actuarial pool to ease the double-digit premium rate increases, but to connect the newly insured to primary care providers in order to reduce the reliance on emergency departments and their high quality, but expensive care.
Our goal in expanding Medicaid and SCHIP was to enroll about 85,000 adults and children, and we are well on the way with over 73,000 now enrolled. We sought to enroll 160,000 in Commonwealth Care (subsidized insurance), and we have reached that goal. We have also enrolled 56,000 in Commonwealth Choice (non-subsidized, “affordable” insurance), although we believe there could be as many as 150,000 more to be reached in this category.
We have succeeded in increasing provider rates for hospitals and physicians and more support is scheduled, and will be needed in the coming fiscal year – especially in the recruitment and retention of primary care physicians. We have launched a statewide infection prevention program, made more progress in health information technology, and established a first in the nation pediatric palliative care program that has already helped over 150 families with seriously ill children. We have restored Medicaid benefits that were cut during the hard fiscal times, and hope that we will never revisit such policies. We have launched the Quality and Cost Council, and the Health Disparities Council which promise to drive significant improvements in the quality of care and to focus efforts to contain the spiraling cost of health care.
In December, the Patrick/Murray Administration submitted its request to extend the 1115 Medicaid Waiver in consultation with representatives of both the House and Senate for the first time since the Waiver was initially requested. In short, no other state has yet achieved the level of success in expanding access to care that Massachusetts now enjoys!
However, as we said when Chapter 58 became law, health care reform is not a one-time event, but an evolving process over a period of several years. We have not enrolled every resident. We cannot guarantee that having insurance guarantees access to health care. We cannot guarantee that health care is being delivered at the best quality and safety at the most reasonable cost. We cannot sustain our success without continuing to cooperate toward further reform.
Not long ago, Senate President Therese Murray set forth a framework for the next phase of health reform in Massachusetts. House Speaker Salvatore DiMasi, on this blog site, has joined in support of several of the key elements expressed by Senator Murray.
In the coming months, we will begin discussions on how to expand access to primary care providers. If Massachusetts residents, even with health insurance, must wait to see their primary care physicians, cost will not be reduced because they will turn to emergency departments for timely care. The approval of limited service clinics by the Public Health Council should be applauded for this step to revise the business model for primary care, but we must also expand the base of primary care physicians and nurse practitioners.
Among the options being explored are forgiveness of educational debt which can reach $200,000 for an individual physician; continued increase in levels of reimbursement for primary care services by all payers beginning with the public sector; assistance with housing costs; assistance with medical malpractice premiums; and expansion of the number of medical students and residents devoted to primary care practice.
We want to make the financing of health care more transparent by such mechanisms as a public process for justifying increases in health insurance premiums, including the costs charged by hospitals, physicians, and other providers on which those premiums are based. It would help to expand the use of health information technology, reduce unnecessary administrative burdens if insurance companies and providers used the same billing codes and if we reduced the medical record storage requirements. We need to continue efforts to prevent infections, patient falls and medical errors making health care more safe for patients. We ought to reform our medical malpractice insurance system so that more patients are helped, the veil of secrecy is lifted, trust is restored, lessons are learned to improve the system, and costly defensive medicine would no longer be needed.
Other reforms such as use of the “medical home” concept to incentivize physicians and other providers to coordinate patient care such as we are now doing with some Medicare-Medicaid dual eligible elderly would go a long way toward treating those with chronic illness who are among our most expensive patients.
We’ve come a long way in a short time toward improvements in our health care system, but we still have much work to do. All of us – every resident – needs to be part of this reform by being better health care consumers and by paying more attention to staying well in the first place. We need the continued cooperation of the federal government by renewing the 1115 Waiver along the lines proposed by the state. We need the continued partnership of employers who want to make health reform work, not the few who look for ways to get around their social responsibility to their workers and society. We need the continued support of insurers to resist taking the easy path of raising premiums in Commonwealth Care and Commonwealth Choice when devising premium rates for the New Year. We need the engaged leadership of our Governor to keep us all together to make health reform the unprecedented success that is, and should continue to be!
Senator Richard T. Moore, Senate Chairman
Committee on Health Care Financing
Senator Richard Moore,
I am uninsured and cannot afford the “affordable”health insurance.I am a 57 year old homemaker and lost my health insurance when my husband retired.He was forced to retire for health reasons.This is the worst law I have ever lived through.The facts are that most of the citizens that signed up are getting free or almost free insurance.The rest of us are being overcharged with high dedutables.The lawmakers and Governor Patrick won’t listen and realize this is a mean law and will only hurt us.When will all of you help to put through a truely affordable health reform?There is a real disconnect between what is being said about this law and what it really is.To force this mandate and then when citizens cannoy sign up because they can’t afford the insurance the State fines us.This is not a true Democracy.All the citizens should matter.
All the state politicians were paid-off by the insurance lobby and now we are paying for it.
Norma should file an appeal if she cannot actually afford any of the policies that are available. There is a procedure for that to take place. “Get Smart,” needs to take his or her own advice and get smart, and also be honest. I’m no fan of Mitt Romney, but even the “insurance lobby” couldn’t afford to pay him off. Get smart should get real!
Mr. Moore needs to “get real” himself, although many of us rightly wonder if he is even capable of doing that. Can he hear how he sounds in his reply to Norma above? Norma writes in expressing that she is afraid of the insurance mandate fines, is rightly afraid of remaining uninsured, and feels betrayed and abandoned by her government?
Mr. Moore’s pathetically inadequate reply to Norma is that she should “file an appeal”; she should submit paperwork to the state requesting state permission to remain uninsured!! (that’s what a “waiver” or “mandate appeal granted” really amounts to)
Our state MUST DO BETTER THAN THIS SHAM LAW that feeds the beast of HMO’s and insurance companies and their $20Mil CEO retirement bonuses while abandoning the health care needs of its citizens. There are much better ways to accomplish health reform and true health care for all – but these approaches require putting regular people’s needs ahead of moneyed corporate interests, so I guess we won’t be seeing that anytime soon in Massachusetts. (look at http://www.Healthcare-Now.org for one example)
Lastly, Re: Mr Moore’s reply to “Get Smart” I have this to say-
Duh, Romney didn’t need paying off – he’s one of them. Romney’s all about making the rich richer off the backs of working people and the middle class. It’s members of the so-called “Democratic” legislature who were paid off, in more ways than we peon citizens will ever begin to know of…
But here’s one from a Boston Globe that ran while the health insurance law was being crafted:
“…In the case of the Las Vegas trip, the conference for DiMasi and other House speakers is hosted by the Massachusetts-based State Legislative Leaders Foundation, a group that is funded by special interest groups including Massachusetts-based firms such as…BLUE CROSS BLUE SHIELD of Massachusetts.
…Lakis, however, acknowledged that lobbyists typically swarm the periphery of the foundation’s gatherings, buttonholing lawmakers to push their agendas and legislation at every opportunity.”
Mr. Moore:
Get-Smart gets it and so do many others in MA and across the nation. What is truly going on in MA, although you try to spin this as a success, is a scam that is so far-reaching, it is frightening.
Regarding your suggestion that Norma file an appeal, read on:
The “robust” waiver promised by the Connector and the “generous” waiver stipulated by the law itself are non-existent. For those 300% and below FPL, the process to request a hardship appeal and then to actually appeal is draconian – a deep and expensive bureaucratic maze meant to confuse, bewilder and deny.
The subsidized and unsubsidized insurance is not affordable for many residents. The Connector’s affordability schedule for 2007 – 2008 failed to acknowledge current income in MA due to the lack of viable jobs, not to mention, the increases in the cost of living nearly all people in this country are facing. I doubt the Connector will do any better for 2009 since, due to the lack of any meaningful cost control, the premiums will go up while benefits are slashed.
Furthermore, the Connector did not bother to include copays in their math (Globe article, April 2007) and those who allowed themselves to be intimidated and purchased insurance although they could not afford it, may not be able to access care because they won’t have money to pay the co-pays, coinsurance or deductibles.
The coverage is not comprehensive and low-to-middle income residents will have a difficult time paying for dental and other non-covered items, not to mention copays which are scheduled to increase while incomes remain stagnant or decrease.
All plans are HMOs which are not as interested in patient care as they are in profits for their stockholders. Thus, that fact combined with the fairly recent proclamation by the Connector that. due to the high costs for the state, they will have to “push providers” to limit care for chronic conditions and substance abuse by providing better oversight is a clear indication that care for residents enrolled in Commonwealth Care and Choice is about to take a downward slide from what is already down.
There is a serious shortage of doctors in MA and, on top of that, many who will have nothing to do with Commonwealth Care. Those who did sign up to see Commonwealth Care patients will be hard-pressed to continue as the amount paid to them wasn’t enough to cover their overhead and that amount is being decreased because Gruber doesn’t think they should be paid more than Medicaid pays. In fact, there are some real horror stories about patients not being able to find PCPs that will see them, much less, specialists.
Increasing penalties to force people to sign up for health insurance truly shows that you and the rest of your crowd, including Deval Patrick, don’t care about the well-being of MA residents. If people cannot afford the premiums, what makes you think they can afford the penalties?
Thus, it seems your goal must be to have people stop heating and eating. Maybe they should move into cardboard boxes in back alleys so they can afford to purchase insurance? As long as you save face. All eyes are on MA and you have so much at stake.
To sum it up, the health care crisis in MA has not been addressed by this law. Mandating that everyone have health insurance does not mean that you have provided health care to all residents. What you have provided for many, however, is either another monthly bill or a tax penalty to add to their stress, and stress is definitely not conducive to good health.
By the way, in the Globe article that talked about firms finding their way around the law, you were quoted as saying you were going to publish a list of those businesses. Have you done that yet, and, if so, where can I find it? I’d like to congratulate them because if they had not found a way out, they may have had to shut their doors and many residents would have lost jobs.
Thank You Get Real,
Your response to my post should have come from Senator Moore.Does the Senator know what the appeal process involves?Well a person has to be homeless,in foreclosure,have shut off notices it is beyond belief.Senator Moore says nothing about the cost of the insurance and what their going to do about that.The Mandate in itself is an invasion of privacy.What we need in this State is term limits.The career politicians are ruining our State and we must put a stop to it.Their attitude is they do not need to answer to the citizens and do what they want.We the people need to take our State back and save it from greedy politicians.
Can Senator Moore please address the concerns of Reporter, Get Smart and Norma? I doubt it.
The fact is that the penalty money from residents failing to meet the mandate directly go into the Commonwealth Care Trust Fund as do any further penalty collections. It is then used to subsidize the cost of the low or non-payors. This saves money that would be needed from the federal government (CMS), but is an indirect tax on those who can not afford the expense in the first place.
Residents are unwitting “cash-cows” in this scheme. They are also subject to all criminal penalties inherent in the jurisdiction of tax evasion if the are unable to pay.
Is this what was intended by this “Emergency” measure? What is the true underlying intention?
Norma, Get-Smart, Get Real and Huddled Masses,
Mr. Moore is more than likely not going to respond to any of us because a meaningful response from him would give credibility to our concerns.
I had the unfortunate experience of speaking with Mr. Moore’s aide this afternoon. He tried to deflect my statements that the insurance is unaffordable even at the high end of Commonwealth Care and that the penalties are going to cause hardship regarding paying core-living expenses and property taxes onto the fact that the law is new, give it a chance. I asked him, “On whose backs?”
The kid was a double-talker from way back and showed absoulutely no concern for the financial hardships this law is causing to more than 300,000 low-to-middle income, hard-working MA taxpayers.
Gee, I wonder who he learned that from? Maybe his boss who took an oath to work for best interests of the people of MA?
Great responses-I keep checking in here for an update by our fearless Senator Moore but I guess he is away on an insurance company supplied junket to Vegas where he can p#$ss away even more of our future. The eyes of the nation are on MA. and none of them like what they see Moore.
I got hit with an ER bill for $1102. I was shocked. At 48 years old, I have had all types of insurance in my life, even the cheapest bare bones plan out there when I was unemployed before, and it always covered 100% emergency room services. Neighborhood Health Plan told me that my deductible for ER and other services combined is $2,000. What kind of “benefit” is that? If I had known it would be that costly, because I wasn’t provided any information from them except a card in the mail, I would have endured the pain and figured out another route. All I needed was antibiotics for a urinary tract infection so I guess I will continue to resort to buying antibiotics overseas because this law was clearly created to provide health insurance companies more clients and it’s been a major windfall for them. Health Care for All and the rest of the crew who created this law should register as lobbyists for the health insurance companies because that’s what they are.