Changes coming to A Healthy Blog and Our Website (

Changes are coming to this website and our blog.

We are completely revamping our website. We’ll have a whole new look and feel and we’ll be making it a lot easier to get involved with our community organizing team, share your personal health care story, and connect with our HelpLine counselors directly. That also means that A Healthy Blog will be undergoing some changes to better integrate A Healthy Blog with the whole site. And that means that there will be some changes for subscribers to our blog as well, and we’ll be posting information about that in due time.

We’re not straying from our mission – to provide the latest updates, information and commentary on health care policy developments in Massachusetts from the Health Care For All vantage point. Please feel free to use the comments to give us your feedback.

Stay tuned for more — much more — very, very soon.

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House Budget Debate: Call Now For MassHealth Dental Coverage and Staffing

This week starts the budget process in the state House of Representatives. For the next 3-4 days, the House will deal with some 888 amendments. The full budget and amendments are here. You can also download the “Amendment Book” which has the amendments summarized and categorized by topic. I counted 49 in the Health and Human Services category, another 27 in the Mental Health and Disabilities category, and 58 in the Public Health category. That’s a lot.

HCFA has been working the House aggressively on behalf of a number of amendments. With the inadequate revenue proposal moving in the legislature, the House budget comes up short on health care in many ways. HCFA is supporting a large number of amendments to restore funding and invest in health care.You can see the amendments we are asking Representatives to support here (pdf).

Among our top priorities are two key MassHealth amendments:

  • Restore Dental Care For MassHealth Adults: Cuts to the MassHealth adult dental services in 2010 left over 700,000 people without access to dental care beyond cleanings and extractions, including 120,000 seniors and 180,000 people with disabilities. Dentists can identify cavities during an examination, but with the exception of a small number of billing codes, fillings are not covered. Left untreated, a simple cavity can lead to serious medical problems.

Support Amendment #204 (Scibak) to fully restore MassHealth adult dental benefits.

  • Provide Adequate Administrative Support for MassHealth: Since 2008, MassHealth operations staff has been sharply cut at the same time the number of MassHealth members has risen dramatically, resulting in paperwork processing backlogs, gaps in health coverage, and delays in enrollment.

Support Amendment #158 (Brodeur) to provide $3.3 million for MassHealth operations staff.

The HesterPrynne blog has a good overview of the process, and what to expect on the hot button issues, here. As the post explains, the House budget contains several provisions aimed at “cracking down on fraud and abuse” in welfare programs, and a number of amendments would go even further. Many of them would interfere with or prevent people from getting benefits they need, including health care. We are working with a number of groups to oppose these provisions.

The Mass Public Health Association is supporting a number of public health amendments, listed in their blog post here, including reversing cuts to smoking prevention and cessation services, the successful Mass in Motion program, environmental health and health care quality. We are also lobbying hard on these public health issues, and urge people to work with MPHA to support investments in our public health system.

We are also focusing on mental health parity, on assuring full implementation of the ACA, and health equity. Many of the amendments we are actively supporting can be found here.

We urge our friends to contact their Representative today to voice support for these amendments.

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House Budget: Funds ACA, Cuts Dental, Cuts Public Health. But It’s Mostly About the Revenue.

It’s all about the revenue.

On April 10, the House released its proposed budget for the upcoming fiscal year. With the House counting on much less revenue than the Governor called for, they used two strategies to bring the budget into balance: make lots of cuts, and use lots more one-time revenue sources. Although transportation and education face the biggest cuts compared to the Governor’s proposal, there are some gaping holes in health care as well.

What follows is based on our first quick read of the House proposal. We’ll update with some more details and links as our friends do their reviews.

ACA Coverage Mostly Funded
The House proposes to fully fund the ACA Medicaid expansion. The budget also includes the Governor’s (and our) proposal to maintain affordability for people transferring from the Commonwealth Care program, by providing a “state wrap” to supplement federal tax credits. Without this wrap, these low-income adults would face major premium and cost sharing increases. We commend House Ways and Means Chair Brian Dempsey for keeping the state’s promise of affordable coverage for those who need help paying for coverage.

The House also adopted the Governor’s proposal to extend MassHealth coverage through the end of the month, to reduce gaps in coverage as people transition between plans, and to maintain our extended eligibility for pregnant women.

A few key items were left out of the House budget. First, the budget shortchanges the administrative staff MassHealth needs to process the applications and renewals under the complex changes that the ACA will bring. The House slices over 60% from this line item (4000-1602). Representative Paul Brodeur will propose an amendment to add back funds, which is critical to improve application and eligibility review processing times, reduce paperwork backlogs and decrease call-waiting times.

The total MassHealth budget is over $200 million less than the Governor wanted. We’re not sure what the implications of this will mean for people who depend on MassHealth for their health needs. The budget apparently rejects coverage for a small number of legal immigrants who would not be picked up by the ACA, and for a group of people with disabilities who the state planned to use the standard MassHealth income calculation for their coverage.

Medicaid Dental Services Not Restored
The House budget continues the shameful policy of providing only limited dental benefits to adults in MassHealth, including 120,000 seniors and 180,000 people with disabilities. While the Governor proposed to restore these benefits effective January 1, under the House budget over 700,000 low-income people will face worsened overall health due to lack of good dental care. The cuts force people to use costly emergency and inpatient hospital settings and to seek temporary relief of pain caused by lack of access to restorative care. Cuts have also created a major cost shift to the Health Safety Net program. Representative Scibak will be filing an amendment to fully restore dental benefits in Masshealth, and we urge everyone to contact their Representative to support this amendment.

Public Health Takes It Again
In what has become a continuing refrain, the House again imposes more and more cuts on public health. For example, look at the DPH’s funding for health promotion and disease prevention. In addition to keeping people healthy and improving the quality of life, this work is the lynchpin for reducing health care costs. In 2010 this line item received a bit over $6 million, a very small sum for the value it provides. This year, the Governor proposed just $3.3 million, a cut from last year’s $3.4 million. The House proposal for this work: a paltry $2.3 million (full details from MassBudget tool here). Smoking cessation got cut, too (details), just as the state looks towards a long-overdue tobacco tax increase. The cut will reduce our capacity to provide cessation help, just when the tax increase drives demand for people to try to quit smoking.

We will continue to review the budget, which will be debated the week of April 22. But the bottom line is that without sufficient revenue, the state will be forced to make real cuts and bad choices. The long-term health of the state requires adequate investments in a broad set of basic needs. We continue to call on the legislature to reverse the years of tax cuts and the systemic, structural imbalance in our state finances, and approve a progressive tax package that allows are state to grow and thrive.

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HCFA Hosts Legislators At Bill Cosponsorship Fair

Last Thursday, Health Care for All hosted its bi-annual legislative cosponsorship fair for the new session on Beacon Hill.

HCFA invited senators, representatives, and their staff to engage HCFA policy staff in a dialogue about our legislative priorities this session (link forthcoming). Legislators visited tables where they could learn about recent developments and our proposals in health reform, children’s health, prescription reform, oral health, and private insurance. Legislators could then agree to cosponsoring our bills in these fields. Representatives from HCFA’s Helpline were also available to inform legislators about the help they could provide to constituents.

The event proved a success, with a steady stream of senators, representatives and their staffers engaging with HCFA staff. Representative Sanchez, who sponsored the event, began with praise both of the event and HCFA itself (specifically noting the utility of the Helpline), and encouraged attendees to spend time talking with HCFA staff. They took his advice: the room was lively for two hours with passionate conversation about policy. Both legislators and their staff found a great opportunity for an education on over fifteen upcoming legislative proposals, and by the end of the event many in attendance had put their names down as cosponsors.
-Devon Branin

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Governor 2014 Budget Continues Commitment to Health

Governor Patrick released his Fiscal Year 2014 budget proposal today, which continues this administration’s strong commitment to ensuring access to affordable, quality health care for everyone in Massachusetts.

Budgets have both a revenue side and a spending side. This budget uses both to improve the health of the Commonwealth and reduce health spending growth.

The targeted revenue includes a long-overdue increase in the tax on cigarettes and other tobacco products, which will reduce the use of tobacco and swiftly bring improved health results. Making our tax system more fair (by simultaneously increasing income taxes, cutting many corporate tax expenditures, reducing the sales tax and increasing the personal exemption) will reduce the tax burden on lowest-income residents, which will directly improve their health.

This revenue supports new spending targeted at restoring vital health benefits, like adult dental benefits for MassHealth members, repairing some of the damage done to our public health system, and beginning the process of implementing the delivery system transformations required to bring down health costs.

Of course, one can’t have the spending without the revenue. As the legislature considers this budget, every revenue increase they scale back or reject will lead to corresponding cuts in services.

And for subsidized health care, this budget is actually two budgets in one, as it straddles two very different health care systems. The fiscal year starts on July 1, but on January 1, the coverage programs of the federal Affordable Care Act (ACA) begin. So the second half of the fiscal year will bring a complete transformation of subsidized coverage programs. Gone will be Commonwealth Care, the Medical Security Program, and the Insurance Partnership. MassHealth expands, and the Connector covers more people than ever. The ACA also brings Massachusetts a healthy infusion of new federal funds that will allow the state to continue to provide the affordability protections for low-income people.

The online budget is in a new format, yet again, and very frustrating to navigate (here’s the utterly impenetrable user guide). It’s so bad that web pages with line item language mysteriously expire if one looks away for too long. In addition to line items, there’s a roll-up organized by function, which, alas, does not include a cross-walk to the line items. The summary for health coverage programs is here. Fortunately, most of the health care initiatives are described in prose, in a clear, detailed budget brief, here. Here are some of our highlights:

  • Dental benefits restored: At long last, the Governor’s budget proposes to restore MassHealth dental benefits for all adults, effective January 1, 2014. If adopted, this will end the cruel rationing contained in last year’s partial restoration, which only covered some services for front teeth only. Oral health is directly connected to overall health, and the cost of this benefit will result in savings for MassHealth and the Health Safety Net program.
  • ACA Fully Implemented: The budget assumes full implementation of the ACA. MassHealth expands, absorbing 325,000 more members. But the cost of their coverage will be more than made up by increased federal revenue, resulting in a net gain of $156 million. Another 150,000 low-income people will receive state assistance through the Health Connector to supplement federal tax credits, called the “State Wrap.” This supplement is critical to maintain the strong affordability protections in current programs. The brief breaks the news that the state will receive 50/50 federal reimbursement for part of the cost of the wrap, as it does now for existing programs. As a result, this coverage will save the state $50 million compared to current costs. The bottom line is a $205 million fiscal gain for Massachusetts.The budget is not the last word in the legislature on implementing the ACA. Additional legislation will be needed, and we understand the Governor will be filing a bill soon. We will be looking to write into statute the current affordability provisions and other consumer protections to lock in the gains that people depend on.
  • Focus on Prevention: The governor’s budget includes some additional funding for a number of public health programs, including more funds for substance abuse treatment, environmental health, health care quality, and community prevention. Funds are also allocated for the administrative costs of the Prevention and Wellness Trust, which will begin its competitive grant process in the coming year. The cigarette and other tobacco products tax increase also falls in this category, though we would strongly urge that those funds do double duty and be earmarked for the Prevention and Wellness Trust.

There’s lots of other important initiatives that we hope will survive the legislative process, including proposals to maintain employer contributions to our health care needs, coupled with an innovative pilot program to provide premium assistance to low-income employees at small businesses; the start of health resource planning; extending MassHealth coverage through the end of the month to prevent gaps in coverage; and a streamlined online eligibility system for all health programs, together with more funds for administrative staff to assist people with their applications.

As long-time budget watchers know, this is just the start of a long process which culminates in late June or early July. The legislature will have a number of critical large decisions to make, about taxes and spending, and thousands of minor decisions which will be critical for the people served as well. The governor’s proposal is a terrific starting point for these decisions. HCFA will be working to bring the voice of people across the Commonwealth who care about our health care system to the coming debate.
-Brian Rosman

UPDATE: The Mass Public Health Association budget analysis is here (pdf). Their topline:

Governor Patrick’s Fiscal Year 2014 budget proposal, released yesterday, includes a significant increase in funding for essential public health infrastructure and regulatory functions. These include inspections of health care facilities, pharmacies, food safety, and air quality – areas which are severely strained and currently pose unacceptable risks to the public. Most other Department of Public Health (DPH) programs – including chronic disease prevention and direct service programs – are level funded. The result is a modest overall increase in DPH funding.

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LA Times Looks At Global Payments in MA

Outsiders can often see you with better perspective than people close to you. At least smart outsiders who know what they’re talking about.

That’s often the feeling I get when I read coverage of Massachusetts health developments from out-of-state sources.

Today’s exhibit is a well done article in the LA Times by Noam Levey. The online headline is “A shift in how healthcare is paid for,” with this kicker:

In Massachusetts, thousands of physicians receive more pay if their patients stay healthy and avoid costly medical care. It could become a national template.

The story has good detail and analysis about the shift to global payments already occurring in the market here:

This simple shift in how healthcare is paid for — long seen as key to taming costs — has been occurring in pockets of the country. But nowhere is it happening more systematically than in Massachusetts, the state that blazed a trail in 2006 by guaranteeing its residents health insurance. Now Massachusetts, a model for President Obama‘s 2010 national healthcare law, may offer another template for national leaders looking to control health spending.

“There have been few greater periods of change in American medical history … and this is the epicenter,” said Dr. Kevin Tabb, a former chief medical officer at Stanford Hospital and Clinics in Northern California who now heads Beth Israel Deaconess Medical Center, one of Boston’s leading hospitals. “It is striking how different Massachusetts is from the rest of the nation.”

In the last three years, commercial insurers in the state have moved nearly 1 million patients into health plans that reward doctors and hospitals that control costs while improving quality.

About 180,000 Massachusetts seniors are on track to get care from physicians paid this way by Medicare through a new initiative included in the national health law. And this summer, state lawmakers passed legislation aimed at moving 1.7 million government employees and Medicaid recipients into similar health plans.

Within a few years, close to half of the state’s 6.5 million residents could be in a health plan that pays for medical care in a fundamentally different way.

The article discusses the experience of the Blue Cross “Alternative Quality Contract,” and looks at the experience through the eyes of physicians and patients. All in all, this is as good a summary of where things are today as we’ve seen.

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Connecting Small Businesses to Coverage

Earlier this year, HCFA conducted a needs assessment, commissioned by the Health Connector, among Spanish- and Portuguese-speaking small businesses about how they provide or don’t provide health coverage to their employees. The survey is a part of the work we’re doing with the Health Connector as we reach out to Spanish- and Portuguese-speaking small businesses across Massachusetts to make sure they know about the affordable health care options that are available to employers, employees and others. Now, based on the results we got from talking with hundreds of small businesses, we’re ready to enter the next phase: reaching out to thousands of businesses and individuals across the state to enroll even more people in affordable and quality health care plans.

Connector Explains Some Options

Last week, leaders in the Portuguese- and Spanish-speaking community gathered at HCFA to learn about affordable health care options and to hear details of the outreach campaign set to launch early next year. With the Health Connector and our partners at Health Law Advocates, we trained these leaders on coverage options available to employers, employees, individuals and families. The training set up the stage for our next effort at the grassroots level, in partnership with ten regional organizations that will help us make a big difference in underserved communities. We are thrilled to have on board the following respected partners in the Portuguese- and Spanish-speaking communities:

– Massachusetts Alliance of Portuguese Speakers (MAPS)
– New Bedford Immigrants’ Assistance Center, Inc
– Avivamento Mundial-Revival Church for the Nations
– Brazilian Center
– Brazilian Women’s Group
– Massachusetts Latino Chamber of Commerce (MLCC)
– Center for Women and Enterprise (CWE)
– North Shore Latino Business Association (NSLBA)
– Hispanic American Chamber of Commerce (HACC)

We’re also reaching out in ethnic media outlets all across Massachusetts to send the message out that our HelpLine can answer their questions about coverage. We can help you navigate the complicated health care system and find the right program not just for you and your family, but also for your employees and your costumers.

HCFA HLA and Connector

We’re kicking-off this campaign on January 11, 12pm-2pm in Lawrence.

Save the date and join us for our Small Business and Consumer Outreach Campaign Launch. Here are the details:

WHEN: January 11th, noon- 2PM
WHERE: Lawrence, Massachusetts
Clemente Abascal Community Room
Sovereign Santander Bank
296 Essex St., 2nd Floor, Lawrence, MA 01840
WHAT: Health Care For All and the Massachusetts Health Connector launch an affordable health care education campaign for Spanish- and Portuguese-speaking small businesses and individuals.

–Maria Gonzalez

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