reform 2012

5 Quick Facts About Mass. Health Reform You Now Need To Know

Prominent backers of Massachusetts health reform speak at the State House after the Supreme Court ruling. (Carey Goldberg/WBUR)

Now that the Supreme Court has upheld the federal health overhaul, which was based on the Massachusetts model, the state’s experience becomes more relevant than ever for the rest of the country. WBUR’s Martha Bebinger has been covering Massachusetts health reform since soon after its inception almost a decade ago. What better time to ask her to distill it all into a 5-part FAQ?

WBUR’s Martha Bebinger

1. Does the requirement that virtually everyone get health insurance actually work to bring universal coverage?

Let’s begin with basic numbers. The latest figures show that about 98 percent of Massachusetts residents now have health insurance, up from 94 percent before the reform (this earlier number varies a bit depending on the source.)

2. Does the threat of having to pay a penalty if you don’t get health insurance actually work?

Some economists say that yes, the threat of the penalty has been the key reason that more people have been signing up for their employer’s insurance or buying their own, but I haven’t seen that quantified.

What we can say is that only a small percentage of the Massachusetts population has actually been penalized since the state reform passed in 2006: About 200,000 in a state of about 6.5 million. And as the penalties rise (see the chart at left) the number who pay them has been dropping.

The number of residents who, according to their state tax returns, are subject to paying the penalty:

67,000 in 2007

53,000 in 2008

48,000 in 2009

44,000 in 2010

3. How much has the law cost Massachusetts? Continue reading →

FILED UNDER: Insurance, Medicine/Science, federal health overhaul, obamacare, reform 2012

June 12, 2012 | 5:48 PM | Martha Bebinger

Lifetime Limit On Oxygen For My Kid? Walsh Says No Way

(wikimedia commons)

Ever heard of a lifetime limit on oxygen?

Neither had Representative Steve Walsh when Apria Healthcare called recently. Walsh says the agent informed him that Walsh’s one year old son had hit his lifetime limit. The toddler has been in and out of the hospital since birth and is sometimes on oxygen while recovering at home.

“Well, come pick up the tanks,” Walsh challenged Apria. “We can’t do that,” the agent told Walsh, “because the oxygen is medically necessary.” Confused, Walsh says he asked to speak to a local company representative, but has not spoken to anyone yet. But he admits he has let some calls go to voicemail.

Walsh told the story this morning to a group of health care leaders gathered at a Massachusetts Health Council forum. He sees it as an example of how patients must push back when a health care provider tries to shut off a service. “What happens,” Walsh wonders, “to patients who don’t know how or when to stand up for themselves?”

Apria Healthcare Executive VP Lisa Getson says this is a case of misinformation and miscommunication. She’s says Walsh’s insurer, Unicare, told Apria that the family had reached its max for oxygen supplies. Apria passed the message to Walsh. But then Unicare reversed itself, according to Getson.

So is there a lifetime limit on oxygen or the related equipment in Massachusetts?

Here’s the state rule about what health insurance must provide to meet the “minimum creditable coverage” standard. A health plan “may not impose an overall annual maximum benefit limitation based on dollar amount or utilization that caps covered core services, whether individually or collectively, for a year or for any single illness or condition. (503.2.f.2). It looks like this would apply to oxygen. Does anyone know otherwise?

One sidebar, I didn’t realize that the Food and Drug Administration regulates oxygen as a “medical gas,” and requires regular prescription renewals.

FILED UNDER: Insurance, Medicine/Science, Money, Politics, cost, reform 2012, steve walsh

June 6, 2012 | 5:07 PM | Carey Goldberg

‘The Golden Goose Fallacy’: Fear Of Killing Health Care Jobs

(Wikimedia Commons)

Actually, the title of the “Perspective” piece just out in the New England Journal of Medicine doesn’t mention any golden geese. It’s “The Health Care Jobs Fallacy.”

But in the debate around pending Massachusetts proposals for cutting health costs, “the golden goose” — as in, the goose that lays the golden eggs and must therefore not be killed — is coming to be code for: “We must not hurt our state’s biggest industry, which provides something like 1 in every 8 jobs, many of them good ones. Our robust health care sector continues to do well despite the tepid recovery in other sectors. We must cut costs but without costing jobs.”

Responding to that sentiment, the Perspective’s authors, Katherine Baicker and Amitabh Chandra, both Harvard professors, conclude their piece resoundingly with this: “Treating the health care system like a (wildly inefficient) jobs program conflicts directly with the goal of ensuring that all Americans have access to care at an affordable price.” They argue that health care jobs “should be neither a policy goal nor a metric of success. The key policy goals should be to achieve better health outcomes and increase overall economic productivity, so that we can all live healthier and wealthier lives.”

Goose for dinner, anyone? WBUR’s Martha Bebinger spoke today with Professor Chandra, of the Harvard Kennedy School of Government. Their conversation, lightly edited:

There is a controversy in Massachusetts right now about how to cut health care costs without compromising the quality of the health care. Do you see yourself as taking on this issue right now?

No, I don’t. We were motivated much more by the national debate, in particular the fact that in Washington we seem to be drawn to evaluating health care policy by whether or not it’s job-creating or job-killing. You may have heard Speaker Boehner refer to Obamacare as ‘the job killing act,’ and the president is quick to respond that it will create jobs. Our view is that this is all a total distraction. We shouldn’t expect the health care system to both deliver health care, keep it affordable and at the same time create jobs because that’s not something that it can do.

‘For every job in health care, the salary is not created out of thin air. Some Massachusetts resident paid for that job in the form of lower wages, or higher taxes.’ – Prof. Amitabh Chandra

Let me give you an analogy with the car industry. We really can’t ask Toyota to sell Camrys for $30,000 and create jobs. The Camry will cost $50,000 dollars. If we care about employment in the United States, as we should, we should think about employment policy directly, perhaps by expanding unemployment insurance benefits or creating a job creating program. It’s really difficult to give the health care industry two conflicting charges: That you need to give health care at low cost and be responsible for employment growth.

The health care system should be viewed by one criteria, and one criteria alone: How much health care does it deliver for the amount of money that’s going into it? All these jobs aren’t creating high-value health care. In other industries, when you see job growth, we think, ‘Oh this is wonderful.’ We don’t in health care because we have a lot of evidence that our health care system could be doing a lot more for a lot less.

Well, part of why that’s true is because we have hospitals in every politician’s district and we don’t have Toyota factories in every district. Continue reading →

FILED UNDER: Medicine/Science, Politics, reform 2012

June 6, 2012 | 8:33 AM | Carey Goldberg

Mass. House Overwhelmingly Passes Its Health Cost-Cutting Bill

Last night, the Massachusetts House of Representatives passed its version of what some call Health Reform 2.0 — its bill aimed at cutting health costs in Massachusetts — by an overwhelming 148 to 7. The bill differs from the Senate’s, so the two bodies must now negotiate a compromise. WBUR’s Martha Bebinger reports:

The House adopted dozens of amendments but did not make major changes to its health care costs and quality bill. At the request of public health advocates, the House moved $20-million from a charge on hospitals and insurers into a fund for healthy lifestyle programs. Rep. Jason Lewis says prevention is a critical part of controlling health care costs:

“This is all about transforming the health care system in Massachusetts from what I would call a ‘sick care system’ to a ‘well care system.’”

‘The market is most certainly not working. The market is absolutely broken.’ – Rep. Steve Walsh

But some business leaders say this charge is one of several in the bill that would increase — not lower — health insurance premiums. The Senate uses the same charge to fund the Prevention and Wellness Trust Fund and imposes it for five years, much longer than the one year approved last night by the House.

And another report from Martha, about how hospitals are keeping a wary eye on the differing House and Senate goals for capping health care cost increases in the coming years:

The House and Senate agree on tying health care cost increases to the state’s general economic growth, although the House sets a tougher initial target. Dr. Gary Gottlieb, president of Partners HealthCare, supports the idea of a target.

“I don’t know what the right number is. I know that the notion should be that we should try to really be accountable on reducing the growth in health care costs,” so that “health care costs won’t crowd out other parts of the economy.”

Many hospitals are worried about Massachusetts becoming the first state in the country to link health care increases to the Gross State Product. And there’s one more twist. Some low cost hospitals say the target should be more aggressive for high cost hospitals.

And a bit more from Martha on cost-cutting: Continue reading →

FILED UNDER: Money, Politics, reform 2012

June 4, 2012 | 11:53 AM | Carey Goldberg

Soda Tax Proposal Survives Near-Death, Up For Debate This Week

We’ve been hearing for many months about a brewing proposal to lift the state sales tax exemption on soda and candy (including this CommonHealth opinion piece in favor of the idea, by two leading pediatricians.) But in the bubbling political ferment in the State House over cutting health costs, nothing is a done deal until it’s a done deal.

So though many public-health-oriented personae have come out in favor of lifting the soda tax exemption — including the Healthy People/Healthy Economy coalition way back in late 2010 — for a while it was looking last week like the actual soda-tax amendment might not be filed and the proposal might not even come up for debate this legislative session.

That’s what I hear from Andy Tarsy, head of the Alliance for Business Leadership (formerly known as the Progressive Business Leaders Network) and one of the leading forces pushing for the soda exemption to be lifted. But he says he’s happy to report that Reps. Khan of Newton, Lewis of Winchester and Sciortino of Medford did move to add the soda-tax amendment to the pending health reform bill on Friday, and it could come up for debate tomorrow or Wednesday. The revenue from the soda and candy taxes would go into a fund to promote prevention and wellness.

“The good news is that prevention efforts and funding for public health are going to be at the center of the debate in the House this week,” he said, “and that closing the loophole that takes soda outside of the sales tax will be on the table — along with closing the loopholes that affect tobacco products. And that debate is essential to making the commonwealth healthy.”

I’m wondering whether the amendment’s chances might be affected by the splashy news out of New York City last week that the mayor is proposing a ban on the sale of big-sized sodas. That proposal has sparked major controversy, as has the Massachusetts soda-tax proposal. The Herald turned a big thumbs-down on the Massachusetts plan in an editorial titled “Hands off the Snickers.”

Readers, should soda and candy be sales-tax-free? I have to confess my own bias: They have so little nutritional value that in my own supermarket lexicon, I think of them as “not food…”

FILED UNDER: Medicine/Science, Personal Health, obesity, reform 2012, soda tax

June 4, 2012 | 7:48 AM | Martha Bebinger

Are We Lowering Health Costs Or Just Shifting Them To Consumers?

“You guys on Beacon Hill back off, the market is working.” That’s the message, more or less, from most hospitals and some business leaders to the House and Senate — particularly to the House, which takes up its health care cost bill tomorrow.

The evidence of market success? Hospitals are agreeing to contracts with lower rates of increase and insurance premiums are rising at their lowest rate in five years. A few employers are actually reporting a cut in premiums.

Why are premiums down and why are hospitals able to take a lower increase than in recent years? I haven’t seen much firm evidence that answers this question. But the latest report from the state’s Division of Health Care Finance and Policy has some important analysis on the premiums question.

"Massachusetts Health Care Cost Trends: Premiums and Expenditures" Division of Health Care Finance and Policy

Take a look at the far right column on this chart and note the premium increase in 2010 when “adjusted for benefits.” If you put back all the costs that have shifted to members (higher co-pays, deductibles, co-insurance, etc.), premiums in 2010 would be rising at almost the same rate they have for the last decade or so. In healthcare-speak, this is called “benefit buydown.” The market is producing lower premiums, but it is because patients are paying more health care costs on their own.

When I contacted the Division to see if I was reading the chart correctly, they sent a statement with a more nuanced view:

The data that the Division has collected indicates that benefit buydown is a likely contributor to the recent decrease in premiums. Other contributors include a decreasing trend in medical claims expenditures, reflecting lower utilization (likely related to the recent recession).

I called a few people to get their reaction. Continue reading →

FILED UNDER: Money, health reform 2012, reform 2012

May 30, 2012 | 11:42 AM | Martha Bebinger

Revised House Health Costs Bill Is Out

This is an updated version of the story. For more on the latest House bill and comparisons with the Senate version, click on the audio bar on the right.

Martha Bebinger On The Revised Bill

On Beacon Hill, the House has made few changes to a health care cost control bill despite intense pressure from hospitals and some business leaders.

When the House released a draft of the bill earlier this month, critics said it would put the state’s golden goose — its health care system — at risk. They objected to the health care spending target and to a penalty that expensive hospitals would have to pay if they can’t prove they have higher quality. Rep. Steve Walsh said the spending target and that penalty are still in the bill.

“It’s a disingenuous comment to suggest that asking people to show their quality will kill the golden goose,” said Walsh, the House point-person on the health costs bill. “We have the best systems in the world, I think they’ll continue to be the best but as President Reagan said, ‘Trust but verify.’”

The House makes one significant revision in the bill. The new entity that would set guidelines and monitor compliance with required changes would be within the Executive Office of Health and Human Services. But it would still be independent, as is the Group Insurance Commission.

Walsh won praise for his efforts to craft reasonable solutions from the Greater Boston Interfaith Organization and the state’s largest physician group, Atrius Health. Continue reading →

FILED UNDER: Politics, health reform 2012, reform 2012

May 23, 2012 | 3:31 PM | Carey Goldberg

High-Cost Hospitals Perhaps Thorniest Issue in Health Reform 2.0

cactus thorns

If i had to vote right now on what’s shaping up to be the thorniest, stickiest, trickiest issue as Massachusetts moves toward the cost-cutting phase of health reform, I’d say “High-cost hospitals.” Or to use the lingo, “Price disparities.”

I snitched the evocative adjective “thorny” from our amazing State House News Service colleagues in the political trenches of Beacon Hill, who wrote today about “one of the thornier issues” — “whether to charge high-cost providers a luxury tax to support cash-strapped safety net hospitals.”

They describe clearly contradictory views. On one side is Rep. Steve Walsh, the House point person on health reform, whose bill proposes the luxury tax of 10% on hospitals that charge more than 20% above the median price for their services and cannot justify the mark-up. On the other is Senate President Therese Murray, who “recently told the News Service she would not entertain the idea in eventual negotiations with the House.”

Sounds like a very definite no. The governor seems to be siding with President Murray; he has said he’s not convinced of the need for a luxury tax. At the other end, there are some who think even Rep. Walsh’s bill doesn’t go far enough, given repeated findings that the high prices at some hospitals do much to drive up health costs in Massachusetts, and that the high prices stem from “market clout,” not measurably better quality.

From State House News:

Walsh called Tuesday’s announcement of $628 million in federal support for new care and payment models at seven Massachusetts safety net hospital systems a “nice story,” but he said it did not change his thinking around a House proposal to tax high-cost providers and redistribute the money to hospitals that serve disproportionately high percentages of Medicaid patients. “There’s no tax in our bill. It’s a surcharge on high-cost hospitals that can’t show unique service or higher quality,” Walsh said, adding, “It’s doesn’t change my thinking. No.”

Following passage last week in the Senate of a health care cost containment bill, Senate President Therese Murray gave a short answer of “no” when asked whether she would entertain the idea of a so-called luxury tax on high-cost providers in eventual negotiations with the House. Walsh declined to comment on Murray’s position. “Didn’t see that,” he said.

FILED UNDER: Insurance, Politics, high-cost hospitals, reform 2012

May 17, 2012 | 8:47 PM | Rachel Zimmerman

Breaking: Mass. Senate Passes Historic Health Care Cost-Cutting Bill

5/18 Update: WBUR’s Martha Bebinger has a feature report on the bill’s passage.

Original post: Here’s the full, unedited press release:

Senate Approves First-In-Nation Payment Reform Bill

BOSTON – Crunching through 265 amendments during two full days of public debate, the Senate on Thursday capped a framework of nation-leading health care reforms with landmark cost-control legislation that will save the Commonwealth $150 billion in the next 15 years while improving the quality of care and increasing the transparency and accountability of the state’s entire health care system. The bill passed 35-2.

Health spending is projected to double from 2009 to 2020, outpacing both inflation and growth in the overall economy. Massachusetts residents, businesses, and state and local government continue to struggle with increasing premiums and other health care cost sharing.

“The most important goal of this legislation is to reduce the cost of health care while providing access and quality outcomes,” Senate President Therese Murray (D-Plymouth) said. “Massachusetts spends 15 percent more per person on health care than the rest of the nation and 40 percent of our state budget is spent on health care. This bill will reel in health care costs, without harming our number one industry or patient care, and remove a major roadblock to long-term job growth and essential investments in education and transportation.”

“The Senate today took bold action to address one of the most serious threats to our economic recovery and strength, and did so in a thoughtful and deliberate manner,” said Sen. Richard T. Moore (D-Uxbridge), lead sponsor of the bill. “This proposal will result in billions of dollars in savings for consumers and small businesses across the Commonwealth, and it will ensure that patients receive the highest quality of care which they expect and deserve. The Senate recognizes the importance of our innovation economy, and sought to pursue reforms in a collaborative manner with those stakeholders responsible for implementation. This legislation completely alters the landscape of our deliver system, and does so with a desire to seek the greatest value at the most reasonable cost for the residents of the Commonwealth.” Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, Politics, health care cost bill, health reform 2012, payment reform, reform 2012

May 17, 2012 | 10:07 AM | Martha Bebinger

Patrick: Use Anti-Trust Laws To Fix High Hospital Prices

WBUR’s Martha Bebinger reports:

I’ve been waiting to hear from Governor Patrick on one of the most controversial health care cost control issues on Beacon Hill: what to do about hospitals that charge three, four or five times more for an MRI (and hundreds of other services) with little or no difference in quality.

Two reports from Attorney General Martha Coakley and at least two from the Governor’s administration (the latest here) say that inflated prices based on the market clout of major teaching hospitals are a major factor driving health care costs in Massachusetts.

Governor Deval Patrick addresses members of the Greater Boston Chamber of Commerce Photo courtesy of the Chamber

Now we have some insight into the Governor’s position on this dicey problem. During a Greater Boston Chamber of Commerce breakfast Tuesday, the Governor was asked whether he wants a provision in the final health care costs bills from the House and Senate that would deal with what’s often called “price disparities” among hospitals? The Governor framed the problem as one of “market clout” and said dealing with the market clout of top Boston hospitals is in the hands of AG Coakley.

The AG, said Patrick, “has tools today to address these imbalances and we have to look to her office to use those tools.”

I called Patrick’s office to clarify. What “tools?” An aide says the Governor was referring, loosely, to the AG’s ability to file anti-trust charges against hospitals. Continue reading →