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

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

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

On January 1, the Medical Security Program (MSP) enacted a number of regulatory and programmatic changes (details). MSP provides health coverage, either through COBRA subsidies or a Blue Cross plan, to low-income workers on unemployment assistance.

On our HelpLine, we’ve heard from many MSP enrollees who can not afford needed care due to the changes. Today, Division of Unemployment Assistance (DUA) Assistant Chief Counsel Ed Santella presided over a hearing on the emergency revised MSP regulations which would:

1. Reduce presumptive hardship for enrollment in the direct coverage program from 200% fpl to 150% fpl; and
2. Deny MSP benefits to an individual eligible for but not enrolled in a spouse’s employer sponsored insurance.

Neil Cronin from the Mass Law Reform Institute and Kate Bicego from Health Care For All testified on behalf of the ACT!! Coalition, raising concerns that the regulatory changes would restrict MSP eligibility. Beyond the regulatory changes, Kate talked about HelpLine callers who are facing difficulties accessing care due to increased cost-sharing. Click on the links below to see testimony submitted by ACT!! and partner groups:

• ACT!! Coalition testimony
• Mass Law Reform Institute testimony
• Healthcare for Artists testimony

The DUA website has more information on the programmatic changes and on information sessions DUA is hosting regarding the changes.

We urge DUA to take the experiences of MSP members into consideration as they finalize the regulations.
-Suzanne Curry

We always knew that national health reform policy was going to be very dependent on Massachusetts. From the very beginning, we heard that Washington policy path was following “Massachusetts Avenue.” One Washington staffer said the goal was to do “Massachusetts, but better.” And so the bills passed by both the House and Senate owe their policy basics to chapter 58. People with experience here - John McDonough, Jon Gruber, and even us, to some extent, played an important role and passed on our knowledge.

Implementation, too, was always assumed to learn from our model. This Thursday and Friday, the Connector along with national partners are hosting officials from 42 states to talk about building exchanges. Next week HCFA’s Helpline Director is speaking at a national conference for consumer advocates.

But we didn’t expect that the politics of health reform would depend on Massachusetts as well. Isn’t that too much to put on one state? Why us?

Anyway - the intersection of the national media, repeating cliche (and often wrong) common wisdom about Massachusetts health reform, and the Senate race is getting harder to bear. One thing stuck out today.

Scott Brown repeated again today his “reason” for opposing national health reform, in a statement from his spokesman (and Romney spokesman during 2006 and today), Eric Fehrnstrom:

“In Massachusetts, 98 percent of residents are covered by insurance through our own state reforms. The plan is not perfect, and we need to get costs down, but we have already achieved near-universal coverage. There is nothing for us in a national plan except higher taxes and more spending to finance coverage expansions in other states. It’s a raw deal for Massachusetts,” he said.

On both policy and politics, this makes no sense.

Last week, Jack Sullivan at CommonWealth Magazine’s CW Unbound blog did a smart job responding on the substance. On a pure financial basis, the national bills would be a huge boost for Massachusetts. Federal tax credits could replace much state spending for Commonwealth Care, enhanced Medicaid reimbursements would relieve pressure on the MassHealth budget, and new Medicare drug assistance would allow us to save much of our Prescription Advantage budget. For the overall state economy, the effect is even more positive. The federal bills include new tax credits for small businesses, a large ramp-up in health research, and strengthened federal support for Community Health Centers, medical education, and other areas that play to Massachusetts’ strength.

While there is some uncertainty (we don’t have a final bill yet), we think Jon Kingsdale’s observation is on the mark: “I can say unequivocally, the long-term risk to Massachusetts would be immense should this go down to defeat. We’d be stuck with footing the entire bill.” Scott Brown’s claim is just wrong.

The New Republic’s Jon Cohn deals with the political angle. It’s the popularity of Massachusetts health reform that leads Brown to not call for its repeal, even as he opposes national reform that is in many ways more conservative than chapter 58. This validates the general understanding that once health reform is passed, and it starts providing real benefits to the population, support will rise.

While some national pundit bigfoots (we’re talking about you, Howard Fineman and Chuck Todd, for example) see tomorrow’s election as some kind of referendum on health reform, we think they have missed the point. Hardly any of the ads focus on health reform, and there’s way too much other stuff going on here.

What do you think?
-Brian Rosman

The Connector Board held their first meeting of the new year last week. Agenda items included quarterly program updates, the proposal to work with the Small Business Service Bureau to provide coverage to very small employers, the Connector’s administrative budget, and an Administration & Finance committee report. All Board members were present, with Nancy Schwartz representing the Commissioner of Insurance and Celia Wcislo on the phone.

Materials from the meeting are here; our full report is after the jump. (more…)

As we posted in late December, the Medical Security Program is changing, effective January 1. The changes include a tiered provider network and some increased cost-sharing.

The Division of Unemployment Assistance is hosting a number of information sessions to help MSP customers understand the changes to the program. The Administration is also interested in speaking with enrollees about their concerns. The sessions are meant to be a space for individuals to learn about their new coverage and also to talk to those administering the program about what those changes mean to them.

Click here for more information about the changes to the program as well as the dates and locations of the information sessions. There are eight sessions across the state, running from January 11th through the 26th.

On our HelpLine, we’ve heard from a number of MSP customers about the changes, many with anxiety regarding affordability problems with the new plan. We encourage all outreach workers to remind enrollees about the information sessions and to use them as a place to voice any of these questions or worries. These sessions are an excellent way for the state to collect information and interface with the individuals in the program.
-Lindsey Tucker and Kate Bicego

This is from today’s Letters to the Editor in the Springfield Republican (unedited):

My letter is in part a response to another letter writer’s advocating for single-payer health care and claiming that, like health reform in Massachusetts, congressional health care-reform is a sham.

I too agree that single-payer is the way to go. It is just apparent on every level that a for-profit insurance industry is concerned with profits and not health care.

That said, I am very fortunate to live in Massachusetts, the only state in the country that I know of where someone as poor as me can get complete medical coverage.

When I first heard Massachusetts was going to require everyone to have health insurance I laughed and thought “good luck with that.”

About two years ago I slipped on ice and broke a rib. I went to the hospital where they gave me x-rays, and pain killers. When I said I couldn’t afford to pay for the treatment they sent me to their offices where I applied for MassHealth Care.

I am fortunate because a few months ago I discovered I have a potentially fatal illness. Had I not had MassHealth Care I would not have been able to afford the tests that were taken, never mind treatments which are almost $3,500 a month. I am responding very well to the treatments but without health coverage I would not have had a chance of getting treated.

If recent health care reform is as effective in providing 30 million people with care as it has been for me what a blessing that will be.

Ironically, if I made enough money where I could afford health insurance I would be denied coverage on the basis that this is a 10-year-old preexisting condition.
–JAHFREE HARP
–Greenfield

Just one correction, Mr. Harp. You don’t have to worry about preexisting conditions in Massachusetts. Insurers may not ask you questions about your health status or medical history, and you can’t be denied coverage or charged more because of your health.

It’s only fair. Under the original Senate health reform bill, states will get substantial federal assistance for increasing their Medicaid eligibility to 133% of the federal poverty level. Except for states that already cover people up to that level, like … Massachusetts.

So Senator Kerry spoke today at Children’s Hospital Boston and announced that he has secured additional federal funds for Massachusetts in the Senate manager’s amendment, which was adopted this morning. CBO estimates the total amount at $500 million, although there is some uncertainty around the total. Also speaking at the event were HCFA Executive Director Amy Whitcomb Slemmer and MIT Economist Jonathan Gruber.

Senator Kerry listed a number of other benefits in the bill for Massachusetts, including increasing subsidies to 400% of poverty (CommCare now only goes to 300%), tax credits for small business, Medicare improvements like closing the drug doughnut hole, and support for comprehensive children’s coverage through CHIP. He pledged that he had secured assurances that the federal bill would not interfere with the success of Massachusetts health reform.

Maybe it’s just me, but we very much like the way they drafted the formal amendment language to boost the state’s federal reimbursement rate for three calendar years starting in 2014. In the amendment, it’s section 10201, starting on page 98. I’ve bolded the cool part; for those not familiar with legislative language this is somewhat unusual:

‘‘(z) EQUITABLE SUPPORT FOR CERTAIN STATES.—
…
‘‘(2)(A) During the period that begins on January
1, 2014, and ends on December 31, 2016, notwithstanding
subsection (b), the Federal medical assistance percentage
otherwise determined under subsection (b) with respect to
all or any portion of a fiscal year occurring during that
period shall be increased by .5 percentage point for a State
described in subparagraph (B) for amounts expended for
medical assistance under the State plan under this title
or under a waiver of that plan during that period.

‘‘(B) For purposes of subparagraph (A), a State described
in this subparagraph is a State that—
‘‘(i) is described in clauses (i) and (ii) of paragraph (1)(B); and
‘‘(ii) is the State with the highest percentage of
its population insured during 2008, based on the
Current Population Survey.

The House bill also recognizes Massachusetts has going ahead of the rest of the country and provides substantially more federal reimbursements for people we are already covering.

We know Governor Patrick and his staff have been working hard with our Congressional delegation to provide them with the ammunition they need to advocate on behalf of Massachusetts. We thank Governor Patrick and the delegation for their ongoing work to give us our fair share, too.
- Brian Rosman

Yesterday President Obama signed the Defense Appropriations bill, which included a provision extending federal COBRA subsidies. Here’s how Phyllis Borzi, Assistant Secretary of the Employee Benefits Security Administration describes the provision:

The act extends the eligibility period for the ARRA premium reduction for an additional two months (through Feb. 28, 2010) and the maximum period for receiving the subsidy for an additional six months (from nine to 15 months). Millions of unemployed Americans and their families will be better able to afford and keep their health benefit coverage because of this new law.

Individuals who had reached the end of the reduced premium period before the legislation extended it to 15 months will have additional time to pay the reduced premiums related to the extension. To continue their coverage they must pay the 35% of premium costs by (60 days after date of enactment) or, if later, 30 days after notice of the extension is provided by their plan administrator.

We encourage you to subscribe to our COBRA Web site, www.dol.gov/cobra, to get information on new notice requirements, updated guidance, fact sheets, and frequently asked questions as they become available.

Individuals should contact their plan or health insurance provider for information regarding the extension under their health plan. If you need further assistance contact an EBSA Benefits Advisor toll-free at 1-866-444-3272.

This is particularly good new for low-income Massachusetts unemployed workers, who can add the federal 65% COBRA to their Medical Security Program (MSP) benefit, reducing their cost to just 7% of the premium. The funding will also save some costs in the MSP program. Three weeks ago we reported that our HelpLine has already received several calls from folks shocked to see their COBRA bill triple from last month.

We have recently blogged about the Medical Security Program (MSP): a plea to find state funding to save the program and a discussion of streamlining possibilities to prevent gaps in coverage. We’re pleased to report that the program is funded for another calendar year, thanks to creative thinking from the Administration. We can thank the Governor and legislature for a $30 million dollar appropriation. Additional funds will come from employers, though the employer assessment is still below the rate it would have been had it kept up with medical inflation, as called for in the statute (on this point, see law professor and bill language drafter Peter Enrich’s response to Mike Widmer’s claims to the contrary on the CommonHealth blog).

To cover the remainder of the shortfall, the Executive Office of Labor and Workforce Development, who runs the program, is making some administrative and programmatic changes. Yesterday, they sent updated information, posted on their website, to current enrollees.

Here’s what we know about the programmatic changes:

– Co-pays and deductibles will be tiered depending on provider and hospital, based on quality and cost measures

– Co-pays for primary care visits will move from $15 to $15/25/50

– Co-pays for specialist visits will increase from $30 to $50

– Co-pay for an emergency room visit will increase from $100 to $150

– Co-pays for prescription drugs will increase from $10/20/35 to $15/30/50

– Co-pays for inpatient/day surgery will change from $250 or $600 depending on the hospital to $150 with varying deductibles, depending on the hospital

– The out of pocket maximum will increase from $2,000 for an individual and $4,000 for a family to $5,000 and $10,000 (includes deductible, co-insurance and co-pays under $100)

More information on tiering:

– 8% of current enrollees live within 8 miles of 2 doctors at the $15 level, and 100% live within 8 miles of 2 doctors at the $25 level

– There are 39 hospitals statewide in the “enhanced” (cheapest) category; 14 in the “standard” (mid-level) category; and 23 in the “basic” (most expensive) category

Here’s what will stay the same:

– Income eligibility for the program is still to 400%

– Enrollee premiums are still $0

Here’s what we know about the administrative changes:

– Currently, an individual must be eligible for premium assistance for just one day of a month to receive coverage for that month. Now, one must be eligible for at least 10 days.

– Currently, those under 200% of the federal poverty level are given presumptive hardship waivers. Now, the presumptive level is 150%. (Anyone else may still apply for a hardship waiver.)

– Regulations will preclude those with access to spousal coverage to be eligible for MSP.
-Lindsey Tucker

Last week, the Division of Health Care Finance and Policy released two more reports. The FY 2009 Health Safety Net Annual Report (ppt) summarizes the activities of the HSN program (formerly the Uncompensated Care Pool) from October 2008-September 2009. The latest edition of the quarterly Key Indicators (pdf), was also released, covering up to June 30, 2009.

The reports show that health reform has entered a relatively stable period, without much change in one direction or another.

Highlights from the reports include:

• While total HSN volume and payments decreased dramatically from FY07-FY08, they were virtually unchanged from 08 to 09. However, HSN payments to community health centers increased by 13% from FY08-FY09. This is mainly attributable to increased dental and other medical visits.
• More than 408,000 additional people have enrolled in health insurance since the implementation of health reform. This is down from the peak of 425,000 at the end of June, 2008. From December 2008 to June 2009 private group enrollment declined by 1.3% as the unemployment rate rose from 6.4% to 8.6% and individuals lost their employer-sponsored insurance.
• Fewer health plans reported two or more months of days in reserve during the first half of 2009.
• Hospital operating margins improved while non-operating margins continued to decline during the first three quarters of hospital fiscal year 2009.

Also worth checking out is the new report by former Medicaid director Beth Waldman, looking how the Massachusetts model was successful in covering children and familes.

The report is an important consideration in the ongoing issue in Washington regarding whether or not to fold the CHIP program into the private insurance exchanges. The study finds that Massachusetts achieved family coverage by building on existing coverage systems, including CHIP, and streamlining enrollment processes. The most important component is that every family member has coverage, not that the coverage is provided by the same insurer.

This is another example of how the Massachusetts experience informs national reform.
- Suzanne Curry

Suzanne Curry

Michael Widmer of the Mass Taxpayers Foundation posted this week on WBUR’s Commonhealth calling for immediately moving unemployed people in the Medical Security Program (MSP) to Commonwealth Care, the Connector’s subsidized coverage program. He also called for ending the assessment on employers that pays for the MSP.

Here at the Health Care for All HelpLine, we hear from lots of folks stuck in between MSP and Commonwealth Care. While federal requirements currently preclude the state from making immediate changes to programs like MSP that receive federal funds, we support looking at harmonizing and rationalizing these programs.

Low and medium income adults that can’t get insurance through their employers are able to get it through Commonwealth Care. The Medical Security Plan covers unemployment insurance beneficiaries by either subsidizing COBRA or offering basic direct coverage with no monthly premiums. These programs work independently of one another and do not share information. This is where the problem lies.

Once a Commonwealth Care member begins collecting unemployment benefits, or even fills out a new application for the program, they are no longer eligible because they are assumed to be eligible for another government subsidized program – the MSP. So the person is terminated from coverage and told to go and apply through the other agency.

This is when our HelpLine Counselors’ phones start ringing. People are understandably upset when they lose access to a health care coverage program that is vital to their lives. It often takes several weeks to get people reenrolled into a plan after there is a termination from one of these two plans.

We know that there’s a better way and we thank the Patrick administration, the Connector, and the hard working folks at the Medical Security Program for committing to work on this issue. The health care coverage options in the state have changed dramatically since the Medical Security Program was created in 1988. We would not want to lose some of the good features of the MSP that make it work well from those on unemployment insurance. The funding that currently brings in federal revenue will need to stay in the mix. But with the maturity of CommCare and the fiscal challenges hitting MSP, now is a great time for us all to think creatively about program simplification.

We would ask the administration to convene a broad group of interested stakeholders to discuss and find a consensus for recommendations on program changes.

And one other thing on this topic — MSP has been helped by the 65% federal subsidy for COBRA beneficiaries that was part of the ARRA stimulus bill. Eligibility is expiring unless Congress and the President act to extend subsidy past the current 9 month limit. As of December 1st. the subsidy ended for the group of folks that have been unemployed and receiving the discount since March 1st.

Our HelpLine has already received several calls this week from folks shocked to see their COBRA bill triple from last month. The budgets of unemployment beneficiaries are already stretched to the limit and finding hundreds of dollars each month for health insurance is not feasible for the majority. We urge Congress and the President to act to extend the federal COBRA subsidy now.
- Kate Bicego

The Connector Board met yesterday to discuss revised MCC regulations, an opportunity for the Connector to become more involved in the small group market, and an operational review of the CommCare MCOs. Materials from the meeting can be found here. Full details below the fold. (more…)

The Department of Revenue released its data on the 2008 tax-filing season today(the first full year of Individual Mandate implementation and the second year of mandate enforcement), and the news builds on last year’s positive results. The summary is in DOR’s press release and the details, complete with graphs are in the preliminary report (pdf). Also, there’s Globe blog coverage.

The headline is that the number paying penalties for being uninsured despite being able to afford coverage is down 25%. Like other surveys have shown, 96% of tax-filers were insured, and the implementation of the Individual Mandate remains smooth—thanks largely to Commissioner Bal and her team at the Department of Revenue. Other key findings:

• Fully 98.3 % of tax-filers complied with filing health insurance information with their taxes. The 2008 filing required month-by-month determinations, as opposed to 2007’s requirement of Dec. 31 only.
• Over 96% of tax-filing adults who completed the Schedule HC had coverage at some point during calendar year 2008; almost 96% had coverage for the full year.
• 45,000 filers, uninsured and deemed able to afford insurance, were subject to a penalty—down 25% from last year’s 60,000 penalized.
• Insurance was unaffordable for about 21,000 (plus 88,000 under 150% fpl) individuals for the full year of 2008 and 24,000 individuals (plus 47,000 under 150% fpl) for part of the year.
• To date, the State has assessed $16.4 million in penalties, which will be deposited in the Commonwealth Care Trust Fund.

Coming this spring will be a detailed demographic breakdowns of this data.

DOR also released today draft penalty guidelines for 2010; the process will be very similar to this year. Penalties will be no more than half the premium of the lowest cost plan in a person’s demographic, and they will accrue monthly. There will be no penalty for those under 150% of the federal poverty level. The main difference in 2010 will be a reduction in permitted lapse time, down from three months this year to the statute’s minimum grace period of 63 days.

DOR will be accepting comments on the penalties through next Friday, December 18.

-Lindsey Tucker

Is the individual mandate unconstitutional? Experts say no, but the far right keeps claiming the mandate goes beyond the power of Congress to regulate interstate commerce. The Senate health reform bill includes a section to make the case that the mandate is allowed, and cites the experience of Massachusetts to prove the point.

The Senate health reform bill (pdf) includes a 3-page preamble (section 1501, starting on page 320) of Congressional findings before the legal language setting up the individual mandate. The findings are essentially an advance brief to the Supreme Court in case a constitutional challenge is ever raised on the issue. The findings declare that health care is an economic activity that affects interstate commerce, and that the individual mandate furthers economic goals. The section includes the following:

(D) The requirement achieves near-universal coverage by building upon and strengthening the private employer-based health insurance system, which covers 176,000,000 Americans nationwide. In Massachusetts, a similar requirement has strengthened private employer based coverage: despite the economic downturn, the number of workers offered employer-based coverage has actually increased.

This is yet another, unexpected example of how Massachusetts health reform has paved the way for national reform.
-Brian Rosman

Also on today’s legislative agenda is the Patrick administration’s request for a $30 million stopgap appropriation for the Medical Security Program (MSP). We urge the legislature to approve the funds. The alternative would be loss of coverage to thousands, and the loss of hundreds of millions in federal funds.

MSP provides affordable health coverage to 34,000 low-income workers on unemployment assistance. The program, which is funded by dedicated revenue from an employer assessment, will run out of money next month. Because the program receives federal reimbursement under our MassHealth waiver, it’s covered by the federal requirement that states not make eligibility changes in Medicaid programs. The penalty for making changes would be the loss of hundreds of million dollars in federal Medicaid reimbursements.

Any solution to the MSP funding problem will have to include an increase in the employer assessment. As pointed out in a cogent Mass Budget and Policy Center report issued yesterday, state law directs an administrative board to increase the assessment to keep pace with inflation. Yet the assessment, set initially in 1988 at $16.80 per worker annually, has never been increased.

Adjusting the assessment should not be seen as increase, but rather as making up for the real decreases that employers have enjoyed, as inflation whittled away at the value of the amount over time. Yesterday’s report estimates that for the assessment to be reset at its intended real value, it should now be at $56.41 per employee. Last month, a broad coalition of groups sent a letter to the Governor, urging him to bring the assessment rate in line with legislative intent (and see this blog post on the MSP, too).

The Globe reported yesterday that the administrative committee empowered to increase the assessment will meet on November 30. We renew our call for the committee to follow the directive in the MSP statute and adjust the assessment as required.

But because of timing and cash flow issues, the program will run dry if it doesn’t get an immediate cash infusion. Any assessment increase will not provide funds quick enough to enable benefits to continue. Thus the administration has asked for a $30 appropriation from the General Fund, which may be paid back if program finances permit. It’s only fair for the General Fund to bail out the MSP; back in 2001-2003, some $194 million was diverted from the MSP Fund to make up for shortfalls in other programs.

We urge the legislature to approve the MSP funds today.
-Brian Rosman

The Massachusetts Artists Foundation recently released a report assessing the impact of state health reform on professional artists.

The report, Stand Up and Be Counted: A Survey of Massachusetts Artists on Their Work Lives, Socioeconomic Status, Access to Healthcare, and Medical and Non-Medical Debt (pdf) compiles extensive survey data from 3,145 full- and part-time Massachusetts artists. It was inspired by and modeled largely after Minnesota’s 2007 Artists Count survey, which convinced the Commonwealth Connector to calculate income based on Adjusted Gross Income instead of Gross Income by highlighting the significant costs artists incur. The Massachusetts study shows how high costs of work and high rates of self-employment have left many artists behind even as state-wide health care access has improved.

Here are some key findings:

• Nearly half of the artists surveyed have combination incomes (both self-employed and as employees), which can be an obstacle to receiving subsidized health care.
• The uninsurance rate for Massachusetts artists surveyed is twice that of all Massachusetts residents. This is due mostly to lack of affordability for self-employed artists, earning just too much to qualify for subsidized health care, or having no insurance available through employers.
• Of those artists who do have health insurance, about a quarter fear losing it in the near future because of rising costs or losing government subsidy eligibility.
• Artists fall behind the general population with access to primary care, with only 82.5% reporting that they see a primary care doctor or provider regularly. Meanwhile, the state average is 92.1% of all residents and 87.3% of low-income residents.
• A disproportionately large percentage of artists face debt for medical or dental bills, nearly 24% compared to the 17.4% national average.

These statistics stress the importance of continued policy work to ensure fair implementation of health care reform in Massachusetts. Further, in conjunction with other similar studies such as Artists Count, the report draws attention to the healthcare obstacles artists face around the country today. As national health care reform materializes, it will remain extremely important to keep these challenges in mind.
-Christa Frintner

Connector Board member and MIT economist Jon Gruber was interviewed today by Washington Post blogger Ezra Klein.

In addition to the mention of Health Care For All, the interview shines lots of lights on how expanding coverage is the first step to getting serious about cost control:

Klein: One of the peculiarities of the [national health reform] bill is that it actually “does” coverage. If the bill succeeds, then pretty much every American will have insurance. But it really only starts cost control. Coverage is more of an event. Cost control seems more like a process.

Gruber: That’s exactly right. We know what happens if we don’t do this. The science of coverage is ahead of the science of cost control. We know how to do coverage. But we don’t know how to bend the curve with research yet. Are we going to hold 46 million uninsured Americans hostage to figuring that out?

My view is, even if the bill did no cost control it would be an incredible thing for this country. But politically, it sets the stage for cost control in two senses. First, it puts in place all the things we can do now. It does comparative effectiveness and pilots and all the rest. But second, once you get coverage off the table, the conversation gets more focused on cost control.

That’s also because the people who mainly care about coverage now have something they need to protect from health-care costs, right? If costs aren’t controlled, you can’t keep the coverage.

The same thing happened in Massachusetts. We passed our bill. The lobbying group Health Care for All was incredibly important in that. But they were primarily about coverage. But then they realized that they would lose all this coverage they’d gained if it didn’t control costs. So they got behind real cost-control measures. A global budget, even.

People say you can’t do coverage without cost control. I think it’s the opposite. You can’t do cost control before coverage. We would do a huge amount for the cause of cost control just by covering people.

On Jay Gonzalez’s first Connector Board meeting as Secretary of Administration & Finance and the chair of the Connector Board, there was plenty to discuss. Materials from the meeting are posted here.

The meeting discussed the plans for next year’s Commonwealth Care program, and examined the small business Commonwealth Choice program. Read on for our detailed report. (more…)