With 2010 dawning, we thought we’d look back over the year and highlight some of our top stories of 2009. While we had only 5 entries in our “health care humor” category (including lots of late-night Comedy Central fake news clips), this was a momentous year for us. With over 530 blog entries last year there was much to choose from. Below is what made our list of some of the biggest and brightest moments for Massachusetts and Health Care For All.
All eyes on Massachusetts
The biggest story of the year was the passage by both the House and Senate of comprehensive national health reform modeled substantially on the Massachusetts health reform plan. We spent the year with one eye on Washington, as Washington kept a close eye on us.
HCFA was featured in a January national NBC News story, and our Helpline was mentioned twice by Senator Kirk in Senate debate in December. Speaker Pelosi featured a Massachusetts cancer survivor and CommCare enrollee at a July press conference, while Republicans made up the nonsense that Massachusetts was rationing care (real facts: medical visits and preventive care are up).
Here, we marked the third birthday of health reform with cool posters at the State House celebrating the 432,000 people added to insurance coverage. Reports found that Massachusetts has the lowest uninsurance rate in the country, that barriers to care due to costs are below half the national average , and that employer coverage is improving.
Health reform continued to change and adapt, for good and bad. Federal rules forced MassHealth to retreat from an attempt to reduce by 50% the time people had to return redetermination forms, Commonwealth Care added CeltiCare, its first for-profit plan, average CommCare premiums declined, and changes were made to auto-enrollment, and the Commonwealth Choice plans.
But the most important (and regrettable) change was the elimination of Commonwealth Care coverage for 28,000 legal immigrants, called AWSS in Mass-speak, and their placement in the new reduced-benefit, reduced-network Bridge program. We organized a major campaign on behalf of immigrant coverage with a broad coalition supporting full restoration that included powerful videos.
While we labored in the policy arena, a Washington Post reporter, diagnosed with leukemia at age 26, personalized the issue for all of us, writing, “But perhaps the greatest miracle of all was that shortly before I found out I was sick, I had moved to Cape Cod, Mass., to intern at a radio station and work as a coffee shop barista. I had no medical insurance when I received my diagnosis, but miraculously the state’s watershed universal health-care law had recently gone into effect.”
Money Money Money
How and how much we pay for health care dominated our work. Despite Mass Taxpayer’s Foundation Mike Widmer’s conclusion that the cost to the state for Massachusetts health reform is modest and in line with initial estimates, revenue declines properly focused us on finding revenue and reducing the cost of care.
In February, the federal government approved the stimulus bill, that included an increase in the federal Medicaid match rate. Over $3.1 billion came to the state, with the increased match rate expected to end in January 2011. Governor Patrick used the new revenue to secure jobs and maintain health reform.
Another victory in 2009 was the ending of the sales tax exemption on alcohol. HCFA supported the measure which would bring in an estimated $80 million, earmarked for substance abuse treatment and prevention programs, as well as other public health programs. Yet another reprieve in November, when the Governor used an unexpected $82 million tax settlement to reverse plans to limit services and increase co-payments in the MassHealth program.
State leaders understand that long-term cost control will require fundamental changes in the delivery and payment system. Last year, payment reform began to build real momentum. The special commission began work in January, including several meetings we hosted with consumers, and HCFA weighed in with our principles. The Commission released its unanimous report in July, recommending Massachusetts transition to a patient-centered global payment system within five years. The Health Care Quality and Cost Council released its complimentary roadmap to cost containment in October.
Improving Our Health All Year
Early in January, Governor Patrick signed the omnibus oral health bill, making major improvements in oral health. HCFA brought together the Oral Health Advocacy Taskforce, the Massachusetts Dental Hygienists’ Association and the Massachusetts Dental Society to find common ground and pass the bill.
In March, DPH adopted its pharmaceutical and medical device conflict of interest regulations, effective on July 1. Opponents of the law and the regulations claimed industry would leave the state in droves. Didn’t happen. What did happen? Other states followed Massachusetts’ lead, and federal law is likely to follow, too.
In July, we trumpeted the little-noticed provision in the state’s new transportation bill creating a “healthy transportation compact,” which requires a health impact assessment for use by planners, transportation administrators, and developers. These provisions have great potential for helping Massachusetts build healthier and more equitable communities.
In August, the Attorney General’s Office and the Division of Insurance announced a settlement in the case brought against MEGA Life and Health Insurance. MEGA Life had been misleading consumers by selling inadequate insurance masquerading as meetings state standards. HCFA had blogged about MEGA Life’s misbehavior since 2006. The AG’s settlement bans them from selling coverage in MA for at least 5 years and fines them $17 million.
In October, all hospitals in Massachusetts were to have plans in place for Patient and Family Advisory Councils, as called for in HCFA-sponsored legislation. Hospital infections decreased in 2009, too, probably due in part to HCFA-sponsored disclosure legislation.
In November we reported on the success of the MassHealth smoking cessation program, instituted by a provision in health reform. To date, 33,000 individuals have quit smoking thanks to this program, reducing heart attacks, asthma-related hospital visits and birth complications among MassHealth members.
HCFA Pride
In October, HCFA was honored to receive a highly competitive federal CHIPRA outreach grant. HCFA will partner with the state, Mass Medicaid Policy Institute and community organizations to identify and enroll the hardest to reach kids throughout the state. Roughly 1.7% of children in Massachusetts do not have health insurance and HCFA is determined to get those children insured.
In January, the Robert Wood Johnson Foundation released a list of the 10 most influential RWJF-funded research articles of the year. On the list was Massachusetts Health Reform Implementation: Major Progress and Future Challenges, written by 5 HCFA staffers.
Goodbyes for 2009
Many state health policy officials said goodbye to their positions in 2009. Among those who helped shape Massachusetts health reform were Melissa Boudreault, Nonnie Burnes, Tom Dehner, Sarah Iselin, Leslie Kirwan and Quentin Palfrey.
We end with our reflection on the tragic loss of Senator Kennedy in August. One of the memories of 2009 we’ll carry forever was the outpouring of heartfelt tributes. We were uplifted when, standing by the State House holding our “Health Care For All” banner, the funeral motorcade went by and family members acknowledged our sign, the Senator’s cause. We pray that 2010 will bring a national health reform law that honors his memory.
-Brian Rosman and Mehreen Butt
