This coming Friday, February 12, Representative Scibak, Anthony Boschetti, DMD, and Guisy Romano-Clarke, MD, will be hosting an informational forum about the importance of fluoride varnish and children’s oral health. The event will be held in South Hadley at the Criterion-Rise and Shine Academy (30 Old Lyman Road) from 10am-11am.

Oral health is an essential part of overall health. Dental decay is caused by a bacterial infection in the mouth and is the most common chronic childhood disease. If left untreated, dental disease can interfere with basic life activities, such as eating, speaking, learning and working.

Fortunately, dental disease is almost entirely preventable when kids have regular access to preventive measures such as dental screenings, information about prevention, and fluoride treatments, and appropriate referral to a dentist. Often those most at risk, especially young children, are seen more often by their medical providers, who can provide those services and increase access to care.

Currently, children enrolled in MassHealth are able to receive the fluoride varnish during their annual checkups through their pediatrician, but children in private insurance are not able to receive this treatment. At the forum, Representative Scibak will talk about a bill that he sponsored that will bring private insurers in line with best practices and provide all children in the Commonwealth with access to this effective preventive measure.

The forum will discuss why this treatment is so important, and how you can help Rep. Scibak make this treatment accessible to all children. A demonstration of the simplicity of the fluoride varnish will be provided. Please join us!
-Brittany McDaniel

On Thursday, the Connector Board will convene for its first of two meetings this month. The meeting is from 9:00-11:00 am on the 21st floor of One Ashburton Place, Boston. We expect that the 2011 Affordability schedule and Commonwealth Care premiums and co-pays will be on the table.

We urge the Board to take a measured approach in determining affordability for Massachusetts residents. The Affordability Schedule for the individual mandate should not require people to spend a greater share of their income on health insurance from year to year. Similarly, it is especially difficult in this economic climate for low- and moderate-income people to make ends meet. We encourage the Connector Board to keep premiums and cost-sharing stable.
-Suzanne Curry

Last week’s release by the Attorney General of preliminary findings of her Investigation of Health Care Cost Trends and Cost Drivers (full report (pdf); summary press release; Globe front page story) crystallizes the need for a two-track approach to reducing health cost growth and improving care.

The report finds that the highest cost providers have geographic market dominance. This key factor influences the price of health care to insurers, and not a range of other often-cited reasons.

The report concludes that “Price variations are not correlated to (1) quality of care, (2) the sickness or complexity of the population being served, (3) the extent to which a provider is responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities are specifically NOT the major causes of rising health care costs.”

As shown in the above chart, taken from the report, “Massachusetts health care costs, which are growing by 7.5 percent annually, are mostly the result of rising prices, not patients getting more imaging tests, surgery, and other procedures.” As Georgia Maheras points out in a letter to the Globe published yesterday all too often, patients are blamed for using too many services or being too sick. This report shows that this is not the case.

The report also identified a number of contracting practices that perpetuate pricing disparities and interfere with markets, including parity agreements that tie prices between competitors, guaranteed inclusion clauses that prohibit insurers from limiting networks, supplemental payments that evade contract provisions based on service volume or cost, and growth caps that limit a provider’s expansion.

Blogger Maggie Mahar is covering this with solid analysis (see part 1 and part 2; a part 3 is to come) that concludes that Massachusetts should re-examine price setting. Mahar looks to the Maryland hospital rate-setting experience (as have we) for an example of a system that protects consumers and government against market failures inherent in an unregulated system.

We think the report highlights the urgent need to take action to correct the market distortions that result in higher and higher medical costs. The same day the AG report came out, the Health Care Financing Committee approved a bill promoted by insurers (H. 4452) that would set up a special high-deductible plan that would pay providers 110% of Medicare charges, a substantial cut from current rates. The bill appears to be on a fast track, as it was referred directly to the House Steering, Policy and Scheduling Committee, bypassing the Ways and Means Committee.

While we oppose the bill as written (why should small businesses have to buy a high-deductible plan in order to take advantage of lower rates?), the bill’s movement shows growing support for intervening to counteract destabilizing market forces.

The report suggests a two-track approach. In the short-term, some kind of circuit breaker is critical to rein in prices that cannot be controlled by the market alone. Society needs to step in and collectively prescribe a fair mechanism for setting health care prices and insurance premiums in a way that promotes the goals of affordable access to quality coverage.

Over the long term, the payment system needs to restructure its incentives to promote coordinated, patient-centered care that controls cost growth and promotes high quality. The Payment Reform Commission’s unanimous recommendations, and the QCC’s Cost Containment Roadmap point to a number of policies that are critical. These will take time to implement, and they must begin soon too in order to take effect within a few years.
-Georgia Maheras and Brian Rosman

The Division of Health Care Finance and Policy has issued its latest Employers Health Insurance Survey (the releases include a one-page fact sheet (pdf); powerpoint of survey results; a 6-page overview of health reform and employers; and a detailed “field report” on survey methodology).

In the midst of questions and challenges about the success of the Commonwealth’s reform, this 2009 report reminds us and Washington policymakers how the shared responsibility model of health reform can work to boost private coverage.

Since the enactment of Chapter 58, Massachusetts has increased the percentage of employers offering coverage to their employees. With the employer offer rate up 4% over two year, to 76%, we are climbing well above the national average of 60%. This increase occurred in spite of the recession. Most employees (80%) who are eligible for employer-sponsored insurance choose to enroll. There are large (and predictable) differences between small and large employers, with the small employers less likely to offer health insurance.

More than 95% of the Commonwealth’s employers have been determined to have made a “fair and reasonable” contribution to their employees’ plans. From the 5% who have not, the state has collected $18 million over 2007 and 2008. Another positive data point: about 90% of employers with more than ten FTEs have Section 125 (cafeteria) plans in place, to provide their employees with pre-tax payroll deductions for health coverage.

There are continuing challenges as well. The survey confirms that health plan premiums have gone up in all categories – for small and large employers, individual and family plans. Employers are generally contributing at lower rates to their employees’ plans and the employee contribution has increased significantly over the past couple of years.

The business community continues to be engaged in health reform. Consumer advocates and employers are looking towards a continued partnership as we move into addressing cost containment and advancing payment reform.
-Lindsey Tucker




The Daily Show With Jon Stewart

Atul Gawande

www.thedailyshow.com

Daily Show Political Humor Health Care Crisis

Dr. Atul Gawande appeared on The Daily Show last week talking about his new book, “The Checklist Manifesto,” detailing how pre-procedure checklists can save lives and money.

When told of the number of medical errors and infections that kill people every year, Jon Stewart appropriately asks “What if we called hospital infections terrorists?” Gawande explains that macho surgeons don’t like admitting that they might need a list, but Stewart reminded him that even Han Solo and Chewbacca used a checklist when preparing to fly through hyperspace.

Despite ample evidence that checklists are critical for patient safety, their adoption is still dangerously slow. If they won’t do it voluntarily, then government must step in. HCFA and our Consumer Health Quality Council continue to advocate for legislation requiring the use of checklists in Massachusetts hospitals. Call your legislator to support this bill, and learn more on the HCFA quality legislation website, www.hcfama.org/quality/priorities.
-Deborah W. Wachenheim

Last week Kate and Phil Villers, who should be known as the God Parents of Good Health Reform, were honored by FamiliesUSA, an organization that they founded in the early 1980’s. The award was given in recognition of their decades long commitment to improving the lives and health care for millions of people in this country.

At the national conference in Washington, advocates were treated to a remarkable list of Kate and Phil’s accomplishments, and then to some of the most humble and generous remarks that any two awardees have ever offered an audience. The two of them, in partnership, created a real movement for health reform, but in their remarks they reflected on how this movement has changed their lives.

To watch the award presentation and listen to the Villers’ remarks click here and scroll down to “Day Two – Luncheon Awards.”

What may not be evident from that video is that both Kate and Phil continue to spend every day working hard on social justice issues and toward achieving comprehensive health reform across the country, and they share a great deal of responsibility for the gains we made in Massachusetts. Kate is the Founder and President of Community Catalyst – our national sister organization in the struggle for health equity, comprehensive high quality care for all. She is also a beloved member of HCFA’s board of directors, and they are both trusted counselors for both HCFA and CC. Working with the Villers is among the great pleasures of being part of the 30 Winter Street family. I am delighted that they have received some of the national appreciation and thanks that they deserve, and I hope that you will join me in extending our personal gratitude for their continuing commitment and enthusiasm for achieving a comprehensive, patient centered, affordable, culturally competent, high quality health care system for all.
-Amy Whitcomb Slemmer

As we celebrate Children’s Oral Health Month and work to ensure that oral health is protected in the budget, the media has made a point to highlight the importance of oral health and the link to overall health.

A strongly-worded letter-to-the-editor in the Boston Globe today from Dr. David S. Samuels, President of the Massachusetts Dental Society commends the Governor on his attempt to repeal the tax exemption on candy and soda to seek higher taxes on smokeless tobacco and cigars. These initiatives will help to reduce tooth decay and decrease rates of oral cancer while helping the state raise revenue to maintain crucial programs. However, Samuels points out, it is also critical to include restorative dental benefits for adults on MassHealth. With these crucial services cut, Samuels explains, patients who need treatment “will likely now end up in a hospital emergency room, which is far more costly for the state than having care provided in a dental office.”

A story in the State House News yesterday also highlighted oral health. At a meeting of the Legislative Oral Health Caucus yesterday, over 60 advocates, legislators, and staff discussed oral health in the FY11 budget and important legislation being considered this session. Senator Chandler, Representative Scibak, Dr. John Morgan, Chair of the Oral Health Advocacy Taskforce, and Dr. Frank Robinson, Executive Director of Partners for a Healthier Community spoke and drew attention to the fact that dental coverage is important health coverage. Adults who are covered by MassHealth are largely those with health and disability conditions that make oral health coverage even more important, i.e. mental retardation, HIV, heart disease and diabetes, elders in nursing homes and public housing, and pregnant women. The Commonwealth has come a long way in integrating oral health into overall health care- approximately 76% of MA residents have some type of dental coverage. However, this number still lags behind that of medical insurance, where 97% of people in Massachusetts are covered.

As Massachusetts remains in the national spotlight, we hope that the legislature continues their leadership in promoting oral health as part of overall health. Preserving all MassHealth adult dental benefits in their state budget recommendations will certainly keep us moving in the right direction.
-Christine Keeves

The New York Times Health section has recently included some interesting reporting on patient safety.

Last week’s paper featured an article written by two 4th-year medical school students at Harvard. They discuss the lack of focus on patient safety in medical schools’ coursework while also highlighting examples of some schools that go beyond the norm in teaching about patient safety (eg. having parents of children who have been injured or killed by medical errors speak to students, putting a human face on the problem). The article also mentions the Open School of Health Professions program at the Boston-based Institute for Healthcare Improvement through which thousands of medical, nursing and pharmacy students participate in discussions and courses relating to medical error reduction and quality improvement.

The authors also point out the difficulty that students (and non-students) can face when they recognize errors or have quality concerns but feel they cannot raise their concerns with more senior practitioners. From the patients’ perspective, this article gives hope that as more incoming practitioners learn about patient safety and feel more confident speaking up, there will be fewer medical errors and better quality care.

Yesterday’s Times includes an article about the increasing use of medical simulation to allow medical providers to develop skills in particular areas without putting an actual patient’s life or health at risk. The article focuses on how simulations can help to develop teamwork and improve communication among those providers working together on caring for a patient. As Dr. Mark Smith of Banner Health in Arizona says, “We take such better care of our patients when we’ve got these skills. It’s no longer acceptable to learn on patients. It’s just not right.” While simulation cannot completely replace the actual practice of medicine as a learning tool, it can hopefully help to get medical providers to a higher skill level before they start practicing on real people.
-Deborah W. Wachenheim

The Massachusetts Legislative Oral Health Caucus meets Wednesday, Feb. 3 from 10:30 am until 12:00 pm in Room 437 at the State House.

Formed in 2005, and believed to be the first in the nation, the group’s main purpose is to educate members of the General Court about the importance of oral health and its connection to overall health. The Caucus develops legislative, budgetary and regulatory strategies to improve oral health policy in the Commonwealth.

Tomorrow’s meeting will focus heavily on oral health in the budget, with presentations from caucus co-chairs Representative John Scibak and Senator Harriette Chandler. The caucus will also hear from Dr. John Morgan, current chair of the Oral Health Advocacy Taskforce, and Dr. Frank Robinson, Executive Director of Partners for a Healthier Community, Inc.

Please join us at the State House tomorrow to learn about the impact of budget cuts on oral health care and overall health of Massachusetts.
-Courtney Chelo

This past Friday the Massachusetts Attorney General’s Office announced new regulations designed to protect Massachusetts consumers by preventing the deceptive marketing of discount health plans.

For many, these plans are pure scams - deceptively sold as insurance but providing no real insurance benefits.

A discount health plan requires you to pay a monthly or annual fee and in return you receive a discount on a limited number of medical services and providers. However, doctors may charge patients enrolled in discount health plans a higher fee than the doctor actually receives as reimbursement from an insurance company for the same services. Thus, the discount may not save the patient as much as it appears.

Discount health plans are not the same as health insurance and purchasing one instead of health insurance may subject people to a tax penalty under the individual mandate of up to $1,068 per year.

In some cases, a discount health plan may provide a good supplemental benefit for individuals who have health insurance with high-deductibles. These plans may also provide supplementary dental, vision or prescription benefits.

The new regulations are designed to protect consumers from deceptive advertising practices and enable people to make informed decisions and navigate your way through the complex health care system. Specifically, the regulations require discount plans to disclose that they are not insurance coverage and that enrollees are responsible for paying out of pocket for all services or products they receive. Discount health plan organizations are also now required to maintain and provide consumers with up-to-date written contracts with all participating health care providers.

You should consider all state-subsidized health insurance options before purchasing a discount health plan. For more information, please call the Health Care for All Helpline at 1-800-272-4232, and check out the Attorney General’s helpful consumer advisory (pdf).
-Shoshana Speiser

On January 27, dozens of lawyers, doctors, survivors of postpartum depression and their families, and legislators gathered at the State House for a press event and hearing on H. 3897: An Act Relative to Postpartum Depression. The bill, sponsored by Representative Ellen Story (D-Amherst) and twenty co-sponsors, is designed to “bring postpartum depression to light.” The bill provides for: 1) universal screening; 2) a comprehensive referral network; 3) education and awareness for both the public and professionals.

Twenty-four people testified at the hearing before the Joint Committee on Financial Services and offered their professional and personal experience with postpartum depression. Many of these individuals also spoke at the press event. Although their experiences differed, all of the people who testified seemed to agree that the majority of women who suffer from postpartum depression are not diagnosed and that the illness, if diagnosed, is easily treatable.

Dr. Ed Tronick, Director of the Child Development Unit of Children’s Hospital, said, “This bill is a long time coming, and our attention to postpartum depression is a long time coming.” He and others shared the findings of their research on infant development; postpartum depression not only affects the mother but it also significantly impacts her child’s development. Several other doctors, including psychiatrists and pediatricians, expressed their support for the bill based on their interactions with patients who had suffered from the illness and their research studies.

All of the doctors who spoke were in favor of the three aims of the bill, although some did express concern about “legislating the practice of medicine” and hindering clinical judgment. Several doctors, however, stated that they believe the bill is necessary because a simple screening tool would “catch” many instances of postpartum depression that would go undiagnosed without the use of a screening tool. Dr. Alison Schonwald, a doctor in the Developmental Behavioral Outreach Unit at Children’s Hospital, spoke about the successful implementation of screenings in light of Rosie D., a court case that resulted in MassHealth’s requiring a validated mental health screening at every well child visit; she said these screenings would not be in place but for the decision. Dr. Schonwald said that she believes the passage of this law is necessary for the successful screening, diagnosis, and treatment of postpartum depression. Dr. Janice Goodman, Associate Professor in the School of Nursing at the MGH Institute of Health Professions, agreed. She said, “Simply asking, ‘How are you feeling?’ isn’t enough. Without a screening tool, even the best provider will miss most patients who suffer from postpartum depression.”

Several survivors of postpartum depression also shared their touching stories. Two of the women testifying said that when their depression was overwhelming, yet still undiagnosed, they went to the emergency room for treatment. Marylou Sudders, President of the Massachusetts Society for the Prevention of Cruelty to Children and former Commissioner of Mental Health, spoke not from her professional experience but instead described the effects of postpartum depression on her family. She said that she wished that her mother had been diagnosed rather than dismissed and listened to rather than ignored.

We agree with the Globe’s editorial today: “Early detection could stave off far more serious problems for mothers and their babies, whose well-being is deeply linked to the first few months of care. And universal screening would ensure that no woman falls through the cracks. The sooner new mothers can be diagnosed, the sooner they will recover.”

We urge the committee to take into account the personal stories heard at the hearing and report out favorably H. 3897.
-Alyssa Minsky, HLA Attorney

Governor Patrick released his H. 2 budget proposal today, for fiscal year 2011, starting July 1. The budget continues the Governor’s strong commitment to health reform and the state’s vital health infrastructure. There are some cuts, including some painful cuts that we will do our best to overturn (there are also some important increases). But given the extraordinarily challenging economic situation, we profoundly appreciate the Governor making health a top priority for his administration. To the extent cuts are proposed, the Governor and EOHHS Secretary Bigby have made clear that these are temporary cuts that will be restored as revenues return.

As usual, the administration has provided a wealth of information online, making the Massachusetts budget proposal among the most transparent in the country. Key health-related resources include a detailed examination of the health issues in the budget, and a budget briefing on health reform.
As always, the best instant analysis comes from the Mass Budget and Policy Center, including a concise summary of the health care proposals.

The budget includes several of we have long termed “win-win” policies. These are revenue proposals that both provide needed funds for health needs and improve the public health by discouraging consumption of unhealthy products. The public health impacts also reduce the cost of health care in the state, further benefiting the state budget. This strategy has been a successful tool, and we strongly applaud the Governor’s bold steps.

First, the Governor proposes to remove the sales tax exemption from candy and soda. This policy would put us in line with 40 other states, including Connecticut, Maine and Rhode Island, which do not exempt candy and soda from their sales tax, and it attacks obesity, a critical health crisis. Second, the budget closes a loophole that exempted cigars, smoking tobacco, and smokeless tobacco from the 2008 cigarette tax increase. By closing the loophole, the Governor’s budget discourages harmful tobacco use, particularly by teens. Revenue from both of these changes is earmarked for health care programs.

The budget also anticipates the extension of enhanced Medicaid funding, now scheduled to end on Dec. 31, 2010. Given the strong, bi-partisan support for extending the increase in state reimbursement rates (ours increased from 50% to 61%), this is an appropriate, prudent step that forestalls deep cuts that would have been damaging to the state’s economy.

With these revenue measures (along with others), the Governor is able to recommend a budget that continues our success in health reforms. Funds are provided to allow MassHealth enrollment to grow by 3%, including a substantial strengthening of children’s mental health services. The Commonwealth Care program is also slated to expand, by some 20,000 people. While there is much to cheer in the budget proposal, we highlight a few of the specific issues that jumped out on a first read:

MassHealth Adult Dental Care: The Governor proposes restructuring adult dental benefits for adults in MassHealth and Commonwealth Care, similar to the unadopted proposal from last fall. MassHealth would continue to cover preventive and emergency care, excluding restorative services. These would be available at Community Health Centers through the Health Safety Net, though the CHC dental system does not have the capacity to absorb all of the demand for services. This cut will have serious long-term impacts, including increased costly emergency room visits, job loss, and poor overall health for Massachusetts. We will work with the Administration to ensure all enrollees can access and afford the care they need.

Legal Immigrant Coverage: The Governor proposed a substantial increase in funding for the temporary “Bridge” program for special status legal immigrants. We commend the Governor for his ongoing efforts to provide benefits for this group, yet we also believe it is fundamentally wrong to separate a population based on immigration status. We strongly support full reinstatement of legal immigrants into Commonwealth Care, and we know the administration agrees with this goal. Until these funds are available, we will work with the legislature and the Administration to ensure that all immigrants have access to the temporary Bridge program, and that services are fully available to all enrollees.

Prescription Advantage, the state sponsored prescription assistance program for low-income elderly and some disabled individuals had yet another reduction in its budget. We were pleased that funding was allocated for outreach grants, thought a surplus in the Connector’s budget, and funding was increased for the DPH tobacco control program.

As the budget moves through the legislative process, we will keep our eyes on the big picture and small details that matter for vulnerable people dependent on our collective efforts through state government.

Today marks the two year anniversary of Yolanda Torres’ death. Yolanda was a remarkable young woman who shared her story of living with mental health needs in testimony before the Mental Health and Substance Abuse Committee in May 2007.

With the support of her family, Chapter 321 of the Act of 2008 (An Act Relative To Children’s Mental Health), has become known to many as Yolanda’s Law.

Lisa Lambert of the Parent/Professional Advocacy League has posted a remembrance of Yolanda and some thoughts on her legacy.

Matt Noyes

Policy Manager

The Members Lounge at the State House was a standing room only today when the Disparities Action Network (DAN) presented an event titled, Investing in Health Equity: Taking Action to Reduce Health Disparities in Massachusetts. Health Disparities Council Co-Chairs Representative Rushing and Senator Fargo welcomed the crowd, emphasizing the importance of addressing disparities to improve public health and reduce health care costs.

The briefing featured a segment of the award winning documentary Unnatural Causes, which highlighted the social and geographic issues that impact health outcomes. Public health experts in the film described the link between areas with high rates of diabetes, hypertension, and asthma complications and the composition of those neighborhoods in terms of food access, green space, public safety, and other socioeconomic conditions. The film emphasized the importance of social and economic policies that address health disparities by attacking their root causes.

State experts addressed questions about health and place with the energetic crowd. Mr. Elmer Freeman (CCHERS), Professor Renee Landers (Suffolk University Law School) and Dr. Nancy Norman (Boston Public Health Commission) all discussed the need for a coordinated state strategy to improve health disparities in Massachusetts. The state’s Executive Office of Health Equity was highlighted as an important leader to coordinate strategies and develop solutions that involve all of the relevant agencies in state government, such as education, housing, transportation. Legislation to codify the Office in statute is currently before the Health Care Financing Committee (S.810).

The Disparities Action Network thanks Representative Rushing and Senator Fargo for their support of this event, and leadership in the legislature on health disparities. The coalition also recognizes the continued commitment of Secretary Bigby and the Executive Office of Health and Human Services in working towards health equity in Massachusetts.
-Brittany McDaniel

House Bill 3897: An Act Relative to Postpartum Depression will have a hearing on Wednesday before the Joint Committee on Financial Services.

The bill ensures that pregnant women will be able to receive universal screening and referral to treatment for depression during the perinatal period. Approximately 15% of new mothers in Massachusetts suffer from postpartum depression. Lead sponsor, Representative Ellen Story (D-Amherst) will be holding a press event prior to the hearing at 9:30am at the Grand Staircase in the State House. Following the press event, the hearing will begin at 11am in Gardner Auditorium.

We encourage everyone to attend this event and contact your legislator about providing postpartum depression screenings for Massachusetts women. You can also download a fact sheet on the bill.
-Brittany McDaniel

All the hand-wringing about the “meaning” of the Scott Brown victory for health reform seems misplaced.

First, polling of Massachusetts voters taken right after the election shows a very confused message. This blog post by Maggie Mahar is long, but is the best summary of the polling data. Bottom line: “the Massachusetts special election does not serve as a referendum on health care legislation. The voters who chose Brown chose him for myriad reasons. They say that they knew he opposed the legislation; about half of his voters counted this in his favor, while half counted it against him. Go figure.”

Part of the confusion stems from public knowledge gaps. National polls show support for the policy elements of reform is much higher than support for “the health reform bill.” Nate Silver of the 538 blog has great analysis and charts here.

More important is this: the impact of the election depends on what we do now. It’s what’s next that counts, not what happened. It’s up to us.

If we take our collective energy for health reform, and continue to let our representatives know that this matters for us, than we can make it happen. Families USA President Ron Pollack said it well, in an open letter to Congress you can sign:

Health reform has never been easy. That lesson has come up throughout this year’s legislative process – as if decades of failed reforms had not yet made that clear.

Health reform, however, is an imperative for our nation’s families. Without reform, health costs will continue to grow much faster than wages. Without reform, many millions of hard-working people and their children will join the ranks of the uninsured and underinsured.

And without reform, businesses, staggered by increasing employee health costs, will either drop coverage or will be unable to make needed investments. As a result, our nation’s economy – and the ability to create good jobs – will suffer.

We must not let that happen.

Some members of Congress have said that we should abandon health reform for a later time. But make no mistake, if we abandon reform now – after moving further than ever before towards meaningful reform – we will not get back to this crucial agenda for a long, long time.

Some other members have suggested that we play “small ball”: adopt only the most popular measures, such as prohibiting exclusions of coverage for people with pre-existing conditions, and drop the more systemic reforms.

Unfortunately, that will not work.

As a number of states have learned, insurance market reforms – as important as they are – cannot work without expanded health coverage. Insurance market reforms implemented alone will lead to skyrocketing premiums as sicker, older people secure coverage and younger, healthier people don’t. This incremental approach is a recipe for disaster – both substantively and politically.
…
One last point: The policy slurs and defamations by health reform opponents, which will undoubtedly continue, cannot be effectively answered unless and until reform is enacted into law. It is only then that Americans around the country will see its benefits.

This is your moment for political courage, vision, and leadership. We urge you to move meaningful health reform forward to its needed enactment.

What can we do?

We urge you to take two critical steps.

First, call your member of Congress today. Urge him or her to push forward with health reform - right away. We have heard that the Massachusetts delegation is not getting many calls. We need to change that. If you don’t know who your Representative is, you can look it up at WhereDoIVoteMA.com. Here are the numbers:

• Michael Capuano, 8th: (202) 225-5111
• William Delahunt, 10th: (202) 225-5601
• Barney Frank, 4th: (202) 225-5931
• Stephen Lynch, 9th: 202-225-8273
• James McGovern, 3rd: (202) 225-6101
• Edward Markey, 7th: (202) 225-2836
• Richard Neal, 2nd: (202) 225-5601
• John Olver, 1st: (202) 225-5335
• John Tierney, 6th: (202) 225-8020
• Niki Tsongas, 5th: (202) 225-3411

Second, attend a rally Tuesday. HCFA is joining with moveon.org, HCAN and many other groups to rally for health reform. We will gather at 1 Bowdoin Square, Boston (map) at 6:00 pm on Tuesday, January 26th. Click here for more information and to sign up.

Remember, it’s not over until we say it’s over.
-Brian Rosman

Two conservative research institutions recently looked at Massachusetts health reform. One concluded that, while not all the evidence is in, the plan has achieved success in reducing the number of uninsured in Massachusetts.

The other study looked at the census data that shows a steep decline in the number of uninsured, and decided that people must be lying on the survey. As a result, they say the gains in coverage must be cut by almost half. Also, people getting insurance through their employer or on their own should be counted as a “cost” of health reform, self-reported health hasn’t improved, and oh, young people aren’t moving here because of health reform. Guess which study made it to the Wall Street Journal?

The fair and balanced report came from the Pioneer Institute. The report (by Amy Lischko and Anand Gopalsami) is the first in a series of report cards on MA health reform. This installment looked at 4 metrics concerning access - (1) coverage growth; (2) Commonwealth Care and crowd-out; (3) employer coverage; and (4) use of preventive care. They gave a grade of “A” on the first criterion, a B on the second and third, and an incomplete on the fourth. The report is worth reading, and contains solid analysis from a conservative point of view.

The hit job comes from the Cato Institute, a libertarian-oriented Washington think tank that opposed Massachusetts health reform from the beginning. The authors (Aaron Yelowitz and Michael Cannon) ignore relevant evidence, make egregious errors and unwarranted assumptions, and reach a pre-ordained conclusion.

The paper’s errors were so severe that the Division of Health Care Finance and Policy sent the authors a corrections letter, calling the report “misleading and unfounded,” and requesting that the letter be posted on the Cato website.

The centerpiece of the Cato study is an assertion that the CPS (Census Current Population Survey) data showing a decline in the number of uninsured Bay Staters can’t be trusted. Since the individual mandate requires people to be covered, they reason, people must be lying to the survey takers. They liken the question asked by survey researchers, “Did you have health insurance last year?” as the functional equivalent of, “Are you breaking the law?”

Of course, there’s no evidence that anyone is lying on the survey. The DHCFP rebuttal letter goes into details about their flawed analysis. In any case, the survey data is backed up by the state’s data collected from insurers, which shows a net gain in coverage of 408,000 people from June 2006 to June 2009. This point is ignored by the Cato crew.

The Cato report goes on to look at crowd-out, focusing on a drop in private coverage among kids and adults below 150% of the poverty line. However, since all of these children, and most of these adults, were eligible for state-subsidized benefits long before Chapter 58, attributing this change to health reform is clearly erroneous. Similarly, the report maintains that a drop in in-migration to Massachusetts by young adults must be due to health reform. Yet health reform dramatically lowered the cost of individual coverage, and authorized a new low-cost plan for young adults. None of this figures in the Cato analysis.

The most telling point is the report’s insistence that the “cost” of health reform should include all health insurance spending by anyone in Massachusetts affected by the law. By redefining the concept of the cost of government program to meet their libertarian mindset, the authors move into tendentious territory far removed from regular discourse.

For sure, this report is not aimed at Massachusetts, but at the ongoing national debate. In addition to the Wall Street Journal editorial, the Washington Times ran an op-ed by the authors. Next time, we hope they look at the Pioneer Institute for some guidance on how a right-wing critique can be formed.
-Brian Rosman

The Health Care Quality and Cost Council (QCC) met this week, focusing on a quality initiative aimed at improving care transitions in the Massachusetts health care system. The initiative, entitled “Reduce Readmissions and Improve Care Transitions,” is part of the State Quality Improvement Initiative (SQII). SQII was launched nationally in 2008 by The Commonwealth Fund and AcademyHealth in order to assist states’ efforts to address quality deficiencies and engage in state-level planning.

Meeting materials are here, and our full, detailed report is below the fold. (more…)

At last week’s Public Health Council meeting, Commissioner John Auerbach presented the 2009 Betsy Lehman Center Patient Safety Recognition Awards. This annual award was established in 2005 to recognize leadership and innovation in patient safety, including public awareness, education and promotion of systems-based solutions through the implementation of best practices. Eligible applicants and nominees include health care facilities, organizations and individuals. The award was presented to both Marlborough Hospital, and the UMass Medical Division of Cardiac Surgery. Commissioner Auberbach commented that 2009 “was a unique year, in that there were two applicants who were wholly worthy of the award.”

Following the presentation of awards, a panel addressed oral health in the Commonwealth. Dr. Jewell Mullen, Director of DPH’s Bureau of Community Health Access and Promotion, spoke to the importance of oral health as a part of overall health, and stressed that access to medical care is a right, and not a privilege, and that we have to treat dental care as a part of that. Ralph Fuccillo, President of the DentaQuest Foundation, presented on the comprehensive plan being developed by a large and diverse group of stakeholders that have convened as the Better Oral Health for Massachusetts Coalition. Lynn Bethel, Director of DPH’s Office of Oral Health, presented the Office’s burden document, “The Status of Oral Disease in Massachusetts,” released in November 2009. The report includes some important statistics:

• 57% of women did not have their teeth cleaned during their pregnancy
• 17% of the state’s 3rd graders had untreated decay
• 71% of non-Hispanic Black 3rd graders did not have dental sealants
• 90% of residents between ages 25 and 44 living in dental health professional shortage areas have lost at least one tooth
• 59% of nursing home residents have untreated decay
• 93% of public schools did not have a school-based oral health prevention (dental sealant) program
• Massachusetts ranks 36th in the nation for water fluoridation status
• 66% of licensed dentists with a Massachusetts address are not MassHealth (Medicaid) providers

Commissioner Auerbach closed the q&a with the panel stating that we have come a long way, and calling the room to action to keep working to improve oral health and overall health for all Massachusetts residents.
-Courtney Chelo

Yesterday, about 75 people from across the state met to discuss a new plan for improving the oral health of the Commonwealth. This movement, lead by the Better Oral Health for Massachusetts Coalition (BOHMA), is a broad-based statewide collaborative of programs, providers (dentists, dental hygienists, physicians and other health providers), lawmakers, state oral health officials, insurers, health advocates, policy leaders and consumers in communities from Cape Cod to the Berkshires.

With a focus on improving access to care for all, reducing disparities and promoting equity in Massachusetts’ oral health, BOHMA will work to:

• Increase access to oral health services and prevention.
• Promote positive policy, advocacy and public awareness concerning oral health.
• Strengthen, diversify and expand Massachusetts’ oral health workforce.
• Promote and support ongoing statewide assessment and surveillance systems.
• Form a clear oral health action plan that incorporates at least all of these elements.

BOHMA coalition members, including many members of HCFA’s Oral Health Advocacy Taskforce, have been hard at work for the past year putting together an inclusive plan. Yesterday, after a greeting from Senator Harriette Chandler, stakeholders reviewed the plan one more time. The final plan is slated to be released in March (click here for the plan draft (pdf)).

To learn more about current oral health advocacy work, please visit www.hcfama.org/oralhealth.
-Christine Keeves