“Health reform has been a wise investment, one we must do our best to keep alive even in the face of this very difficult fiscal environment.”
-House Speaker Robert DeLeo
Friday the Blue Cross Blue Shield Foundation of Massachusetts hosted their annual leadership summit, Care Beyond Coverage: The Next Generation of Health Reform at the John F. Kennedy library. The room was jam-packed with past, present and future leaders from the health care, business, labor and advocacy communities.
The audience heard special remarks from former Senate President Robert Travaglini and former Speaker of the House Sal DiMasi as well as comments from Senate President Therese Murray. The event marked the launch of the Foundation’s new initiative, Care Beyond Coverage, which is focused on ensuring Massachusetts residents have access to the right care, at the right place and delivered at the right time. The summit focused on delivering findings from the first-year Care Beyond Coverage evaluation and featured three panel discussions on moving health reform forward.
Dr. Sharon Long, Principal Research Associate at the Urban Institute presented an update on the Urban Institute’s report monitoring coverage and access in the first two years of health reform. Dr. Long provided data that demonstrates the successes and challenges of MA health reform. From 2006 to 2008 the number of adults with a usual source of care and access to preventive care visits, dental care visits and prescription drugs has continued to rise, with the low-income adults experiencing the greatest gains. However the report reveals the constraints in provider capacity; more adults had unmet health care needs because of difficulty getting to see a provider since the fall of 2006 especially low-income adults and those with public coverage.
A separate study on racial and geographic differences exposed geographical disparities as adults in the Southeast and Western regions of the state were shown to have more difficulty accessing and affording health care. She also found that Black and Hispanic adults in Massachusetts had less access to doctors, specialists and dental care and somewhat greater difficulty obtaining care than white residents in the Commonwealth.
Support for health reform continues to remain strong among working-age adults in Massachusetts.
Patricia Fairchild, Vice President of John Snow, Inc. provided valuable information on barriers to access with a focus on low and moderate-income residents and the newly insured. Her research included feedback from consumer focus groups and a pilot survey of HCFA Helpline callers, as well as the Mass. Medical Society’s Physician Workforce Study and a survey by the Mass. League of Community Health. The research found:
- 25% of newly insured adults experienced gaps in coverage during their first year of coverage.
- Newly insured, residents with limited English/literacy skills, immigrants and residents with job or income changes faced particular challenges enrolling in plans and maintaining coverage.
- High out of pocket costs especially for prescription drugs and the chronically ill, the affordability of premiums for people over 300% fpl, 55-65 years old and low-wage workers, and continuing medical debt pose significant cost barriers to MA residents.
- Community health centers face issues with provider supply and capacity especially physician vacancies.
- 71% of physicians reported difficulty making timely referrals and 11% of 30 day hospital re-admissions were potentially preventable.
- Other barriers to coordination of care were challenges in referrals to specialty care, poor communication during patient transitions, insufficient care coordination, management infrastructure and consumer behavior and preferences not well understood.
The keynote address was delivered by House Speaker Robert A. DeLeo (text here, Word), giving his first address on health reform.
Speaker DeLeo expressed his commitment to maintaining the gains of health reform despite the challenging economic climate:
Many of you know me as the former head of the Ways and Means Committee. You know that I take a rigorous approach to fiscal matters and examine the numbers carefully.
And, on that note, I would be remiss if I did not provide a word or two about the fiscal crisis we are currently facing. The climate is very, very grim – none of the economists or experts I spoke to last summer could have predicted these types of declines in revenue. What is worse is that these numbers continue to deteriorate.
That is the bad news. However, there is something else that is very much worth noting. Health reform has not caused this problem: In FY 2009, we allocated $869 million to pay for Commonwealth Care. Current projections show that we will actually spend less than that. For that reason, in our House budget, we left the Commonwealth Care program untouched, and we expect to see long term gains from this program and the expansion of coverage that it has provided.
The Speaker raised concerns with the growth of health care costs and said that he looks forward to recommendations from the Payment Reform Commission. Speaker DeLeo also addressed his concerns with the primary care provider shortage and the lack of coordination of care and highlighted the medical home demonstration model and health information technology.
He ended with a ringing declaration of support for the goal of reform: “As we move forward, I want to emphasize that high quality compassionate health care is not a privilege that belongs only to the wealthy – it is a right that should be accorded to all of us.”
-Catherine Hammons
