Sen. Ted Kennedy writes on the WBUR Blog, Commonhealth, about the process to renew Massachusetts’ federal Medicaid waiver, and specifically a meeting on 2/25/08 with federal Health and Human Services Sect. Mike Leavitt to discuss the renewal. Also in the meeting were Gov. Patrick, MA H&H Sect. Judy Ann Bigby, and others. Various reports from that meeting were upbeat, and that’s good news for Massachusetts. Hard slogging ahead, for sure, leading up to the renewal deadline on 6/30/08, but doom and gloom predictions for the renewal seem premature:
… Secretary Leavitt understands the importance of health reform, not just to us in Massachusetts, but to the country. Hundreds of thousands of Massachusetts residents who were previously uninsured now have good coverage, and we reignited the long-dormant national debate on universal coverage that’s now dominating the presidential campaign. The Governor is making a strong case for continued strong federal support for health reform, and I will be working right alongside him to make sure Massachusetts gets a fair deal.
“… Secretary Leavitt understands the importance of health reform, not just to us in Massachusetts, but to the country.”
If Secretary Leavitt had an honest understanding of true health reform he would not be allowing Federal money to be used to hurt people which is what is happening in MA to at least one-half of the population targeted by this punitive and wasteful law. Furthermore, the MA model is certainly not the solution to the health care crisis in this country unless his (and your) goal is to force hard-working taxpayers to choose between heating and eating or having health insurance. Health insurance doesn’t do anything for people who don’t have a roof over their heads, food in their bellies and heat during the cold months among other basic necessities.
“Hundreds of thousands of Massachusetts residents who were previously uninsured now have good coverage, and we reignited the . . .”
That’s great for those who now have coverage – “good” is debatable. However, the vast majority of these folks are getting the insurance for free on the backs of those who could not afford it and/or who were unwilling to sign their assets over to the state. (btw, you, your staff and your buddies at the Connector can tell people from now until doomsday that estate recovery doesn’t apply to Commonwealth Care, but until we see this in black and white on the form, it does apply. There has been ample opportunity for this clause to be amended as the form appears to have been revised in other areas at least twice. Curious, isn’t it?)
Unfortunately, we penalty-payers are low-to-middle income people who can least afford to subsidize the freebie people while we take a financial hit with regard to our ability to keep up with our bills. And we still have no insurance.
One of the Connector board members, I believe it was Lou Malzone, stated that just to survive in MA requires a gross income of at least $30,000 to $40,000 – that was in 2007 – living costs have gone up considerably since then. Most of us don’t make that much and those of us who saw that we were eligible for Commonwealth Care could not afford the so-called “affordable” premiums much less the copays and uncovered annual services we require such as dental, progressive bifocals plus computer glasses, an eye exam during the year not paid for. For those eligible for Commonwealth Choice, the premiums are also too high and the coverage wouldn’t save patients from medical debt unless they are looking at a heart/lung transplant.
So to call this health insurance mandate a success is a rather large stretch when so many are being adversely affected. Keep in mind that as the Commonwealth Care and Choice premiums rise and many residents are forced to upgrade their plans to meet “minimum creditable coverage,” there will be more penalty-payers because the costs to pay for these increases will be prohibitive.
Furthermore, the requirement for residents of MA to carry “state-approved” coverage was really an added benefit to your friends in the health insurance industry. This waiver money was given with the stipulation that MA insure the uninsured, not make a grab for more money from those who were already insured. This is pure greed, plain and simple.
As for reigniting “the long-dormant national debate on universal coverage that’s now dominating the presidential campaign . . .”
It appears to me that as all eyes are on MA, the premise behind the 1115 waiver “experiment” was quite far-reaching; it was to ignite the takeover of the entire country by the medical industrial complex. The “M” word is being tossed around all over the media to get people used to the idea when, in fact, most citizens have no idea what a health insurance mandate really means and how adversely it can affect people.
You and your crowd manage to present half-truths to the media – 300,000 “newly” insured when, in fact:
a) many of these folks are not newly insured,
b) no one talks about the other half (I’m being generous here – it’s likely more than half) of the previously uninsured who are still uninsured and on top of that, paying and facing penalties, which makes them worse off than they were before,
c) Jon Kingsdale brags* about raising the unsubsidized premiums by a mere 5% but doesn’t mention the proposed 14.3% and double copay increases for the subsidized plans, not to mention removing the cap on RX in plan 4 (and maybe plan 3) *Chicago Tribune and a few other newspapers the names of which I don’t recall at this moment),
d) forcing at least 200,000 residents (probably more since the Connector underestimated all their figures from the get-go) to increase their coverage which means more money out of their pockets when most of these folks can barely afford what they currently have, and
e) the shortage of PCPs and specialists who will see Commonwealth Care patients – this problem soon to be (or already) exacerbated by the lowering of payments to them and talk of having less doctors in the networks to cut costs for the state.
We in the trenches:
a) don’t dare earn a dollar over the income bracket we are in per the Connector’s affordability schedule even though we need the money to pay the rising costs of living (and property taxes) because we could end up in the next income range which means double premiums and copays or, heaven forbid, Commonwealth Choice which would be about 3x more; 6x more for those 57 and older, and we will be worse off financially for having earned that extra money,
b) are not only penalized for not having insurance but also for taking a job that pays well and offers insurance because the monthly penalties are based on the 2008 gross income, so if we are, let’s say, 5 months with no insurance at a penalty of $35/month, a $40,000 job with health insurance is going to raise the penalty amount substantially for those 5 months without insurance, and
c) the stress caused by this state-enforced poverty is unhealthy and unproductive – it’s a living nightmare.
“The Governor is making a strong case for continued strong federal support for health reform, and I will be working right alongside him to make sure Massachusetts gets a fair deal.”
Deval Patrick ran on the campaign slogan “Together We Can.” I guess those who voted for him thought he meant him and them – now they know better. As for you working with him, I’m not surprised since you have yet to recognize and/or admit the harm this law has caused for far too many residents.
Intimidating people so they will purchase a specific product even though they cannot afford it and penalizing (hurting) people because they cannot afford to purchase a specific product are not actions that constitute a “fair deal.” The words that best describe this are coercion, extortion and collusion.
“The Romney Adminstration and Sen. Kennedy intereceded and convinced the Bush Administration to allow MA to keep the funds as long as the state approved and was ready to implement by 7/1/06 a near-universal coverage expansion similar to what became Chapter 58… So it’s not accurate to call it a “forced” arrangement because the State is a willing partner….There is no practical way the Commonwealth could proceed without the waiver that would not result in the loss of coverage for hundreds of thousands of MassHealth and CommCare enrollees.”
John, What I hear you saying is that in order to get the waiver money Massachusetts was forced to agree to what is Chap 58 and its individual mandate to purchase insurance in the private insurance market which is a very unprogressive policy that perpetuates wasteful spending and locks many out of needed coverage and care.
“Forced” is a matter of semantics, or privileged perspective, so it seems.
With regards to not being able to “proceed” with Chapter 58 without the waiver money, well, maybe that’s what’s needed to get the MA public and the legislature to do the right thing and actually REFORM the health care system. And to do it with people’s and taxpayers interest front and center rather than the interests of Blue Cross Blue Shield, Partners Health Care, and the state’s HMOs that seem to be the big winners with Chapter 58.
What value are Massachusetts taxpayers and the average person in this state getting out of Chapter 58??? Don’t we all count?
Fair questions, Ann. Let me attempt to offer some clarification.
Under the terms of the original 1115 waiver issued in 1997 by the Clinton Administration to Massachusetts, the state received a set of payments directed to the Massachusetts health care safety net; these payments were called “supplemental payments to Medicaid managed care organizations” and the lion’s share of them went to support Boston Medical Center’s Health Net, and Cambridge Health Alliance’s Network Health — both managed care plans exclusively serving MassHealth enrollees.
By 2004, these payments had reached $385 million annually. The original waiver was renewed in 2002 for a three year period with minimal changes. When the waiver came up for its renewal in 2005, the Bush Administration informed Massachusetts officials that the MCCO supp payments would not be included in any renewal (Congress has no direct role in approving or disapproving waivers). The Romney Adminstration and Sen. Kennedy intereceded and convinced the Bush Administration to allow MA to keep the funds as long as the state approved and was ready to implement by 7/1/06 a near-universal coverage expansion similar to what became Chapter 58, with lots of details to be determined by the Legislature. If the State does not follow the terms agreed to in the 1115 waiver, the Bush Administration pulls back the agreed upon funding. So it’s not accurate to call it a “forced” arrangement because the State is a willing partner.
The current (third) waiver expires on 6/30/08 and the State is seeking a fourth that they hope will include more federal funds to support MassHealth and the C.58 expansions, especially Commonwealth Care. While the Bush Administration (and its successor next January) have unfettered authority in granting or refusing waivers, in Massachusetts the Legislature retains significant oversight authority and can reject any waiver the Patrick Administration may negotiate if they do not like it.
The loss of the waiver and associated funds would result in the loss of many hundreds of millions (could be over a billion depending on what gets counted) all directed toward the state’s health care safety net. There is no practical way the Commonwealth could proceed without the waiver that would not result in the loss of coverage for hundreds of thousands of MassHealth and CommCare enrollees.
Hope this is helpful.
John McDonough
Isn’t there a phrase about sunshine that applies to situations such as this? The public – and the taxpayers who’re footing the tab for this waiver and for the state spending on the new health insurance law – should not be kept in the dark. See comments below made in response to Sen. Kennedy’s post on the waiver renewal, cross-posted from NPR/wbur’s site CommonHealth:
Would either the Senator or Governor Patrick or their staff be so kind as to help constituents to better understand these two points:
1. “After very difficult negotiations, we were able to retain strong federal support through the waiver, but with the stipulation that we move [to] enact health reform in Massachusetts.”
What was the specific stipulation that had to be met in order to receive the waiver money?
I recall hearing at a public forum a comment from John McDonough, the director of health care for all MA around the time that Gov Romney signed CHap 58 into law, that the federal administrators at HHS had issued an ultimatum to Massachusetts politicians that we had to expand coverage and it had to be done using private insurance companies.
Is it true then that the feds (in concert with Gov. Romney and the Heritage Foundation) forced a privatization scheme on the Commonwealth that forbade our state to expand coverage primarily through public programs that have less admin. overhead spending than private insurance companies? Were we in essence blackmailed into this approach because we desperately needed the waiver money?
I am trying to understand the implications of the federal control over the waiver funds. Are the stipulations that came with the waiver the reason that Massachusetts is spending huge sums of public dollars to purchase private insurance policies for the newly insured (except for the 93k newly covered under expansion of MassHealth, a reform I fully support)? Is this waiver the reason our state had to create and fund a new bureaucracy called the COnnector and to enact a punitive individual mandate law to force people with threats of tax fines to buy private insurance even if they won’t be able to pay their other bills?
It does seem very strange that Sen. Kennedy and Gov. Patrick support the harsh and unfair individual mandate when Senator Obama, whom they both strongly support, understands that it is harming many people here in Massachusetts and has stated this fact on national television during the presidential debates.
This leads to the second point that many constituents do not understand:
2. “…working right alongside him [Gov. Patrick] to make sure Massachusetts gets a fair deal.”
Could you be more specific? What people or parties in Massachusetts are getting a fair deal under the current and future implementation of the Chapter 58 health insurance law, and how do you determine what is a fair deal and what is not?
Thank you in advance for responding to these sincere questions. I hope you can appreciate how important it is that your constituents are fully informed about this vital area of public policymaking. Only when we are included in the process will we be able to fully engage and contribute to urgently needed health reform both here in Massachusetts and on the national level.
# Norma posted:
Comment posted March 7th, 2008 at 7:02 pm
Citizens of Massachusetts are being forced to buy into bad insurance products with the federal governments blessing.I don’t understand the reasoning behind this unless it’s big insurance lobbyist in washington.The citizens can’t afford the insurance if anything Senator Kennedy should be strongly against this mean law.The uninsured in Massachusetts are being discriminated against.