Here’s something new. Sen. Ron Wyden from Oregon last year championed the passage of legislation to create a Citizens Health Care Working Group to “provide for a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage” and to “provide for a vote by Congress on the recommendations that result from the debate.” Check out the official site for this new group by clicking here. The panel has 14 members, one of whom, Dr. Richard Frank at Harvard Medical School, is from Massachusetts.

The group is beginning public hearings around the nation, and one of them will be held in Boston on August 16, 2005 at a location yet to be determined, with a testimony focus on 1. quality; 2. evidence based practice; 3. the urban safety net; 4. the cost of health care; and 5. strategies to assist purchasers, including consumers, to lower the cost of care.

If we’re not mistaken, you read it here first.

This week will mark the official closing of eligibility for the part of MassHealth known as MassHealth Essential, which will reach its statutory enrollment cap of about 43,000 poor, long term unemployed individuals. The State will begin collecting names on a waiting list instead of opening the door to medically necessary services for a desperately low income and vulnerable population.

A little history: this program was originally called MassHealth Basic and began in the state’s major health reform period commencing in 1997. During the 2002 fiscal crisis, House Speaker Tom Finneran demanded and won the elimination of the program and coverage for 36,000 in the program. In the spring of 2003, Sen. Pres. Travaglini and Gov. Romney persuaded Finneran to accept a new program, with tighter eligibility and even less benefits, called MassHealth Essential to serve this population. Trav and Romney understood the state stood to lose hundreds of millions in federal dollars by not reinstating the program and convinced Finneran on that score. MassHealth Essential opened its doors on October 1, 2003, and re-enrollment at first was slow. It has since picked up and is now reaching its enrollment cap.

By the way, MH Essential is managed by the Mass. Behavioral Health Partnership which does an outstanding job managing all medical services for this needy population. Anyone eligible for Essential and put on the waiting list will still be eligible for the Free Care Pool. So they can use hospital emergency rooms, but may not get primary care.

Last year, Gov. Romney — as part of his health reform initiative — said he wanted to enroll about 106,000 persons who are “eligible and unenrolled” in MassHealth. His own administration estimates that at least 24,000 of those 106,000 would come in under Essential. Yet his House 1 budget proposal in January capped Essential’s enrollment at existing levels. The House also disappointed in its budget plan, keeping the Governor’s cap, and rejecting Rep. Deborah Blumer’s amendment to expand. The Senate budget plan would increase Essential’s enrollment cap by about 10,000 — not enough, but a good step forward. Thank you, Senate!

Just like last year, when the Children’s Medical Security Plan started a waiting list that totalled 15,000 kids by July, 2004, we’re starting a MassHealth Essential Waiting List watch, and we’ll let you know as it grows and grows.

Meanwhile, if you would like to help, please contact your Senator and Rep and ask them to support the Senate’s higher enrollment cap for MassHealth Essential. Yeah, it’s only about 10,000 out of 530,000 uninsured persons in Massachusetts. But it’s something YOU can do TODAY that will make a difference in the lives of 10,000 very low income uninsured persons. So how about it?

Back in March, bipartisan groups of US senators and reps called for a commission to study ways to achieve savings rather than cutting Medicaid by $16 billion over 5 years, as Pres. Bush and Republican leaders in the Senate and House wanted. Ultimately, both branches had recorded roll call majorities opposed to any cuts and calling for the commission solution. At the end of the budget process, Congressional leaders pushed through $10 billion in cuts and a commission to study ways to improve the program. (See article.)

In the hands of new Health and Human Services Secretary Michael Leavitt, the Commission will include four Democratic senators and reps as non-voting members, and the first charge for the Commission will be to develop a list of recommended ways to cut $10 billion from the program. Democrats are now refusing to participate in the panel.

Good for them! The same budget resolution approved by Congress cutting Medicaid by $10 billion also reduces taxes on millionaires by $32 billion. The same President who signed a law to prevent the removal of Terry Schiavo’s feeding tube signed a law as Governor of Texas to permit hospitals to remove life-saving support from patients with no ability to pay — and we’ll see a lot more of these if Congressional leaders have their way with Medicaid cuts.

HCFA Board President Chip Joffe Halpern has written another keeper article in his series for the North Adams Transcript. Here’s how it starts:

Americans are consistently inconsistent when it comes to their attitudes toward health care. This observation, from a report written by the St. Luke’s Health Initiative of Arizona, is one of the reasons why Americans are stalemated when it comes to deciding how to expand health coverage to the uninsured. St. Luke’s observes that:

* Most Americans favor providing health coverage to the uninsured, financed by taxes.
* Most Americans don’t want to pay increased taxes themselves.
* Most Americans think the health care system is badly in need of reform.
* Most Americans express satisfaction with their personal use of the health care system.
* Most Americans don’t trust the government to do the right thing.
* Most Americans expect the government to do something.

What will it take to breakthrough the stalemate that has allowed 45 million Americans to go without health insurance?

ast night, about 1,000 persons attended a health care action rally organized by the Greater Boston Interfaith Organization, backed more than 65 churches, synagogues, temples and other organizations. The rally was held at Temple Israel in Boston and was noteworthy for many reasons, high among them the extraordinary energy, commitment, and diversity on display. Two state senators (Jarrett Barrios and Dianne Wilkerson) and six reps (Jim Marzilli, Ruth Balser, Debbie Blumer, Gloria Fox, Brian Wallace, Carl Sciortino) joined the event. Earlier yesterday, GBIO got a front page story in the Boston Globe on their work.

One of many highlights — each of the 65 participating congregations surveyed their own members on health insurance problems. In rapid succession, each of the 65 took the microphone to announce their community’s presence and tell a brief story about their own members’ difficulties with health care access. Also, Rev. Ray Hammond — JP’s Bethel AME Zion Church — blew the roof off the place with his stirring speech — “There can be no Commonwealth without common health — and their can be no common health without common wealth.” He gets it.

GBIO is a leading partner in the ACT! Coalition (Affordable Care Today) this is supporting the Health Access and Affordability Act sponsored by Sen. Richard Moore and Rep. Blumer along with more than 70 other legislators. The legislative hearing on this will be held on Wednesday June 8th at the State House — activities begin at 9am and the hearing starts at 10am. Check out the ACT! page for more information.

Spent yesterday in Washington DC catching up on health reform activities around in other states around the nation. Some tidbits:

In Maine, the Dirigo health reform plan is being implemented, though national conservative groups such as the Heritage Foundation and Americans for Tax Justice are setting up state operations to attack and undermine the plan. Dirigo is a voluntary plan that offers a lower cost option to small employers and uninsured persons, and has enrolled over 6,300 persons since early this year.

In Illinois, hearings are getting off the ground in each of the state’s congressional districts to develop a plan for universal coverage — a process that will take well over a year to result in a final plan, and one that is gaining momentum and attention across the state.

In Vermont, the House in April passed a planning process to develop a single payer system and the Senate has yet to pass their plan, though they are leaning toward a new tax on employers who don’t cover their workers. Senators are getting attacked from the left and the right.

In Maryland, the Assembly and Senate passed legislation requiring all employers with more than 10,000 workers to pay at least 8% of payroll for health insurance for workers — called the “Walmart” tax because the giant retailer is the only entity in the state that would be required to pay. Gov. Erlich has vetoed the bill, and it is expected the legislature will override his veto next January or in a special session earlier than that.

A new report on reforming the nation’s health care system projects savings as much as $182 billion annually within 10 years, according to an analysis released May 23 by a coalition of businesses, unions, consumer groups, and health care providers. The savings would be realized after reform was instituted at a cost of between $71 billion and $272 billion over four years, the analysis said.

The National Coalition on Health Care said the savings would be realized in any of four health reform options: mandating employer coverage for workers; expanding existing public health programs; creating a new public health program modeled after the Federal Employees Health Benefits Program; and establishing a universal, publicly financed health care system. In all four cases, the cost of a reformed health care system would be less than the price of continuing the current health care system, the analysis said.

The analysis shows “unambiguously” that, “done right, health care reform will save America a great deal of money–while at the same time assuring health coverage for all Americans and improving health care,” coalition President Henry E. Simmons said at a briefing. “In short, health care reform is a good investment–a crucial investment–for our nation and our people,” he added.

This Thursday evening from 7-9pm at Temple Israel in Boston (Riverway and Longwood Avenue) the Greater Boston Interfaith Organization (GBIO) hosts a public meeting on health reform in Massachusetts. GBIO is a grassroots, church/synagogue/temple based social justice organization with a deserved reputation for effective action. About 1,000 persons are expected to attend — and you’re welcome to be one of them. GBIO is an active part of the Affordable Care Today! (ACT!) Coalition which is sponsoring the Health Access and Affordability Act.

For an amusing take on the Romney Administration’s “tough love” on hospital billing, check out Blue Mass Group by clicking here.

Here’s the text of a letter published in today’s Boston Globe in response to comments by Gov. Romney’s aide on hospital billing practices (see May 18 post):

TIM MURPHY, Governor Romney’s policy director, has said that hospitals should be more aggressive in their billing practices and use all legal options to collect from ”recalcitrants” (”Romney aide targets debt at hospitals,” Page A1, May 18.)

There are four flaws in the administration’s claims:

The administration does not take into account the patients’ ability to pay. Punishing patients who need healthcare and cannot afford to pay for it by placing liens on their homes and garnishing their wages is not the answer.

It fails to recognize that hospitals charge the uninsured, who have the least ability to pay, the highest rates for medical care, often two to three times what insurers have to pay.

The administration’s comments let employers off the hook. Employers have to take responsibility for failing to offer coverage to their employees or only offering coverage with unaffordable deductibles.

And, most important, the comments fail to recognize what every patient knows — that healthcare is not a luxury. Hospitals should not take a more aggressive tactic with debtors than other industries because patients do not choose to need healthcare.

If the governor wants the confidence of consumers as he pursues a healthcare reform agenda, he should disassociate himself from Murphy’s comments.
JOHN McDONOUGH, Executive Director Health Care for All Boston

Let us know your thoughts and reactions.

Stupid: The trend in health care is clear — make consumers pay more for everything everywhere. Copayments, deductibles, premiums and more. A new study from the Center for Studying Health System Change provides a good window into the way this cost shifting hurts. In 2003, more than 14 million adults with chronic conditions — half low income — could not afford their prescriptions; African Americans were twice as likely to forego needed medications. The numbers facing this problem are growing because of increasing co-payments and other cost sharing. Short term savings, long term higher costs.

Smart: An alternative: in 2003, Pitney Bowes ended co-payments for prescription drugs for their employees and families with asthma, diabetes, and other chronic conditions. After the change, PB found their overall health spending went DOWN as more workers and family members complied with their recommended treatments and medications. This was described in the Wall Street Journal in a May 19, 2004 article: “Higher Co-Pays May Take Toll on Health.”

Governor Romney’s chief health policy advisor, Tim Murphy is quoted in a front page Boston Globe story as berating hospitals for not pursuing more aggressively patients with unpaid medical bills. Murphy describes hospital practices as “passive” and suggests the Governor will address this deficiency in yet to be filed legislation.

Do we need any more evidence why consumers should be cautious about Governor Romney’s “reform” intentions in health care?

If Gov. Romney wants to delve into this issue, we hope he will also address hospitals who bill uninsured patients at two to four times the amount they bill private insurers for the same services.

We hope he will address the issue of ability to pay. Right now, co-pays, deductibles, and other cost sharing are imposed on consumers with zero regard for ability to pay. So that $2000 deductible hits families with incomes over $100,000 and under $20,000 equally, but with no regard to their economic circumstances.

We hope the Governor will address employers who are hitting their workers with deductibles now rising as high as $10,000 per year before a penny of insurance coverage kids in, as well as employers who provide not a penny of health coverage to their workers.

As the Globe article mentions, a 1999 study shows that over 90 percent of bad debt was connected with patients who qualify for support from the state’s Free Care Pool. These are families struggling to make ends meet, not the “bad actors” Tim Murphy likes to complain about.

Bottom line: medical debt is one of the two largest factors in all personal bankruptcies in the United States. For information on the consequences of medical debt, see this report from the Access Project.

If Governor Romney wants consumers to believe he has a clue what real families are facing, he needs to disassociate himself from these remarks, and fast.

This blog was the first to break the news (eee May 5 posting) that State Health & Human Services Secretary Ron Preston would be leaving his post in the summer. Now we’re the first (as far as I’ve seen) to report that his acting replacement will be current Undersecretary Steve Kadish. This is good news. Kadish is smart, talented, and respected. He’s taking over at a critical time for state health reform and the reorganization of the EOHHS. It would be good news if he were the permanent replacement — and I hope that doesn’t jinx him.

Meanwhile, Senate Ways and Means released their FY06 budget plan today and did a solid and commendable job on key health issues, including:

* Full funding for MassHealth HIV, Breast and Cervical Cancer, and Insurance Partnership;
* Funding to allow 26,000 more enrollees in MassHealth, icnouding 10,000 more in MassHealth Essential for very low income long term unemployed persons;
* Full restoration for 3,500 senior and disabled legal immigrants;
* Full funding (and affordable premiums) for Children’s Medical Security Plan and Healthy Start;
* Restoration of smoking cessation and dental benefits for pregnant women and new moms (we will continue our push for full dental restoration for all 560,000 adults);
* Full funding for the hospital Uncompensated Care Pool;
* Full funding for Prescription Advantage including an open enrollment period.

Sincere thanks to Senate President Bob Travaglini and Ways and Means Chair Therese Murray for a great job!

On Tuesday, State Senate Ways and Means Chair Therese Murray will release the Senate leadership’s version of the FY06 state budget. It will be debated in the Senate beginning next Monday, going for two, three or four days most likely. After the House produced a fiscally restrained budget that left advocates across the board disappointed, expectations are higher for the Senate version.

On health matters, we’re waiting to see items such as: funding for MassHealth, especially for programs such as MassHealth Essential which is facing an enrollment cap, restoration of benefits such as adult dental, funding for the uncompensated care pool, public health, children’s health access programs, and the Prescription Advantage program for seniors and disabled. Amendments, which can only be filed by Senators, will be due on Thursday.

The most convincing explanation for horrendous annual increases in health costs and premiums is the relentless pace of new tests and technologies used by all of us. Today I was part of this as I celebrated my first colonoscopy. In truth, it wasn’t an eager embrace. My doc told me to do it two years ago and I avoided it like the plague; only later did he take away my choice in the matter and schedule it for me. And like a good boy, I did it.

My insurer is Harvard Pilgrim and I use Harvard Vanguard’s Kenmore Center which has a spanking new endoscopy/colonoscopy center on the first floor. And are they busy! 50 a day, 250 a week, 13,000 a year! 13 docs and several dozen nurses. I don’t know the charge, but it’s got to be a pretty penny, especially times 13,000.

Is all this really necessary? Yes. Colon cancer is the second most common cancer after lung (breast cancer is second among women, prostate second among men — but colon cancer is third among both genders so it’s the second most common overall). And it’s totally preventable. So an expensive procedure that prevents many cancers also adds many dollars marbled into our health insurance premiums. Five years ago, hardly any one was getting this procedure. Yes, the cost effectiveness of this procedure has been verified in numerous studies (click here to see a few), but those savings offsets occur years into the future while the cost of testing happens today.

The event itself? The prep the day before is nasty. The procedure is, well, kind of groovy. If you want enough drugs, you won’t remember a thing except a blissful feeling; if you take a little less, you can see and recall a televised “fantastic journey” into your you-know-where in dazed marvel. (Guess which I chose.) It’s worth the trip, for all of us.

By the way, I asked the doc to check if he could find any sign of my head up there, since so many folks have wondered over the years if that’s where it’s most often located. No sign of it, he told me.

Thanks to FamiliesUSA founder, Phil Villers, I just found out about a first-rate exploration of the options for state health reform prepared by the savvy folks at the Frameworkers Institute. This analysis was done with the state of Arizona in mind — though its findings and insights are applicable in any one of the 50 states. It’s a thoughtful and carefully done exploration of the four major options for state health access reform: 1. public utility model (aka — single payer); 2. employer mandate; 3. expansion and opening up of public programs; and 4. tax credits. No slam dunk for any option — just a well done exploration of the possibilities and problems with each.

I suppose I should add a big “wonk” alert here. But, heck, these issues are tough and demand serious and thoughtful exploration. Let us know what you think.

Yesterday, in a back room in the Massachusetts State House, eight senators and reps along with about ten legislative aides, met with oral health advocates to establish the first state legislative oral health caucus in the nation.

Oral health? You mean teeth? Yes, and a lot more. Oral health, good dental care, is intimately tied to one’s overall health. Yet medicine and public policy have encouraged a separation which leads to awful policy choices such as the elimination of adult dental services from the Mass. Medicaid program in late 2002. So here’s how it works now — MassHealth will only pay for dental services for adults when teeth get so rotten they need to be pulled — aka, extractions. After they’re pulled, the state no longer pays for dentures to replace them. Blenders and straws become essential items of daily living.

That’s why we tip our hats to: Chairs — Sen. Harriette Chandler and Rep. Kathy Teahan, and Co-Chairs — Sen. Bruce Tarr (R!) and Rep. Cheryl Rivera. These folks get it, and we appreciate their leadership. We’re making a big push right now (right now!) to restore adult dental benefits in MassHealth. Please help us by taking 53 seconds to send an email to your state senator to support this. Click here, and thanks!!

American journalism’s prince of darkness, Robert D. Novak, wrote on Sunday’s Boston Herald that Gov. Mitt Romney “in a recent secret Washington meeting with national political operatives, signaled he probably will forgo seeking re-election in 2006 in order to pursue the 2008 Republican presidential nomination. Romney did not flatly reveal his future intentions, according to sources who were present. but he did say a presidential race would be difficult if he were concentrating on a 2006 campaign for governor and were still in that office in 2007-08.”

Tied with other recent Administration moves — Health & Human Services Chief Ron Preston departure this summer, Romney’s Admin & Finance Secretary Eric Kriss leaving this fall — we wonder, what effect will all this have on the prospects for comprehensive health reform between now and the end of 2006?

The Administration needs to develop major health access legislation to propose to the House and Senate or risk losing hundreds of millions of dollars tied to the new federal Medicaid waiver. The brain drain, potential lame duck status, and potential loss of a state focus do not auger well for such a high intensity/high profile initiative. This would leave legislative leaders in a much stronger position to direct a reform agenda — and leave the Governor with only a veto to make his mark.

In some ways this resembles the last major health reform drive in 1996 when Gov. Bill Weld, seeking to win Sen. John Kerry’s seat, was a passive observer of that year’s health reform, and his veto was easily overridden by the House and Senate in July 1996. It’s impossible to predict how this will play out. The one certainty, if Gov. Romney becom

It’s feast or famine time for health reform. Vermont, Maryland, Maine among others push the limits to expand coverage while Tennessee, Missouri and others push backwards. Last Thursday, California rejoined the former set when a Senate Committee voted 7 to 4 to approve a single payer tax-financed health reform bill. This same committee approved a similar bill in 2003 which passed the full Senate in scaled down form. Ultimate, both branches passed an employer insurance mandate which was repealed narrowly by voters in November 2004.

Click here to read details from Associated Press. Little trivia — lead sponsor is State Senator Sheila Kuehl who, in an earlier life, played Zelda Gilroy on the 50s TV show, Dobie Gillis. California has a curious history on health reform, especially when it comes to ballot initiatives. In 1992, the voters rejected an employer mandate; in 1994, they rejected a single payer plan, 73-27%; and in 2004, they again rejected an employer mandate, 51-49%. That’s a tough crowd to please out there!

INDEPENDENCE, Mo. — A state senator from Independence is going to extremes to protect Missouri’s new budget, KMBC’s Bev Chapman reported Friday. Sen. Victor Callahan announced he is giving up his state-funded health insurance to draw attention to the thousands of people without medical insurance.

The Democratic senator said that lawmakers shouldn’t ignore the growing number of uninsured people. “I’m doing this today because I don’t want to be a hypocrite. I intend to join the other 74,000 Missourians without health care,” Callahan said. Changes in Medicaid eligibility in this year’s budget will eliminate between 70,000 and 100,000 people from the program.

Callahan, who represents Independence and Raytown, estimates more than 30,000 people in his district will be affected by Medicaid cutbacks. A spokesman for Gov. Matt Blunt’s office said the program has grown beyond the taxpayers’ ability to support it. He said the program provides coverage for one out of five Missourians.

Callahan wants the governor to join him in quitting health care. “I’m calling on Gov. (Matt) Blunt today to lead by example — to join with me coming off state health care until we resolve the issue,” Callahan said. In addition to giving up his state coverage, Callahan has also stopped receiving benefits from his regular employer.

Check it out here if you don’t believe me.