I know this may be hard for many to believe, but the $200K business campaign to smear the House health reform legislation in general — and the fair share employer assessment in particular — is full of distortions, half truths, and other bad stuff. In under 60 seconds no less! I know this is tough, especially for those who just learned the truth about Santa Claus, but it’s the honest truth.

Don’t believe us? View our evidence by clicking here. My favorite part — facts dug up by HCFA’s intrepid Brian Rosman: “The ad is funded by the Retailer’s Association of Massachusetts. A Romney administration study found that taxpayers spent over $20 million providing health care to employees of 36 large retail firms in Massachusetts, including Wal-Mart, Home Depot, CVS, Walgreens, Target and Cumberland Farms.”

As we prepared for the 1/1/06 launch of the Medicare Part D prescription drug benefit, there’s good news for 270,000 Mass. seniors because of passage of a new law yesterday (and its signing today). Here’s an update from our consumer health director Melissa Shannon:

Lt. Gov. Healey today signed our senior coalition’s bill providing emergency prescription drug access to people being switched to the Medicare Part D program on Jan 1. Yea!! While we’re going to have to push on the administration to implement this as soon as possible, this is good news for 270,000 people who are being switched overnight from state funded prescription drug coverage to Part D. Thanks to everyone in the coalition who worked so hard to get this done, especially Deb Thomson and Jessica Costantino! (Top thanks to Sen. Montigny and Dave Murphy, without whom this would not have been possible. Thanks also to several House members — Reps. DeLeo, Walrath, and Cabral and staff who worked hard to make this happen so late in the year.)

• The legislation means any dual eligible (a person receiving Medicare and Medicaid) or Prescription Advantage member who shows up at the pharmacy in the first 6 mos of 2006 and finds that their Part D plan will not pay for one or more of their medications can get a 30 day supply, paid for by the state.

• After that time, these people can get a 72 hour supply. These provisions allow the enrollee time to switch to another medication, appeal to their plan for coverage or switch plans.

• The bill requires the state to cover the difference between Medicaid co-pays and Medicare co-pays for dual eligibles to make sure co-pays don’t keep duals from getting the drugs they need.

• Finally the bill ensures that pharmacists will supply people in this situation with information on who to call to resolve coverage problems.

Great work by a great coalition and great legislative allies. You can see Melissa describing the issues on NECN’s video report titled “New Medicare Options,” here (the report isn’t 100% accurate).

Here’s an early Valentine we received from the Valley Advocate in Northampton as part of their:

“HALOS & HORNS Our annual roundup of the good and bad, the naughty and nice, the stupid and smart, and the laudable and laughable: …

“If the state is lurching toward a form of universal health care coverage, we can be thankful for the tireless advocates at Health Care For All and especially Director John McDonough. A halo goes to McDonough for being a beacon of sense on a complicated issue with entrenched interests on every side.”

After all the bricks and hockey pucks coming at us from many sides, we appreciate the bouquet.

And congrats to our unflinching allies at the Greater Boston Interfaith Organization who were the subjects of a great profile in today’s Globe, particularly Rev. Hurman Hamilton and Rabbi Jonah Pesner. GBIO has added an urgent moral dimension to a health care debate that all too often is only about dollars and cents. They add the sense, and we’re proud to have them as partners in the drive for real health reform.

OK, my vote for the most important book of 2005 — Collapse: How Societies Choose to Fail or Survive, Jared Diamond. If we don’t read and understood Diamond’s lessons, we’re screwed — not just US, but worldwide. Frightening, mind-bending, and important.

Most important health book of 2005: On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, by Dr. Jerome Kassirer. The title kinda gives away the punch line. Kassirer is no neophyte — he was editor of the New England Journal of Medicine, and let go for balking at new marketing schemes there. His book is far from the best read — the endless stream of outrages loses moral punch after so many of them are documented. His thesis — every aspect of medicine has been distorted and corrupted by commercial influence: medical schools, medical residency, continuing medical education, journals, professional medical societies, and the clinical research enterprise itself. Exhaustive details and documentation accompany every indictment.

And every example of corruption has a commercial entity lined up behind it, promoting drugs and medical devices. The head of the National Institutes of Health commented that if their review panels had to exclude clinical researchers with conflicts of interest, they would have no more juries. It’s not hard to draw the conclusion that some significant part of rampant medical inflation that is bankrupting our economy is tied to the explosion of this commercial orgy.

What’s surprising — having just finished the book — is that it was received with such a collective yawn. Perhaps it was deliberate benign neglect. Whatever, the commercially compromised portions of our medical-industrial complex succeeded in getting few folks to sit up and take notice of this vitally important and challenging book. Let’s spread the word…

Faithful Health Blog readers will not be surprised by the arguments — nonetheless, for those few who aren’t regular readers, here’s a link to my op-ed in today’s Boston Globe that outlines our best case for the House-approved payroll assessment on employers who don’t provide health insurance to their workers. Cooked it up on Thursday when we heard that business groups were readying a $200K campaign against the House plan. Best defense is a good offense, or is the other way around? Hmmmm….

Anyway, the new business coalition is on the radio with a constant stream of ads on august stations like oldies 103. Here’s a link to their website: http://www.unhealthyreform.com/
(At least someone in the coalition has a sense of humor.) Interesting that while they call themselves the coalition for real reform, all that’s really pushed on the site is their opposition to the House payroll assessment. “We’re for real health care reform. Not an unrealistic payroll tax.”

Also missing from their radio ad is any recognition that the assessment would only affect businesses that provide none or little coverage for their workers. Listening to the ad makes it seem the assessment would levy new costs on all employers.

Anyway, here’s your Latin phrase of the week:
Sentio aliquos togatos contra me conspirare.
(I think some people in togas are plotting against me.)

Mass. Taxpayers Foundation has weighed in (or should I say, “piled on”) with a new report on the MA health reform process. In brief: individual mandate — good; payroll tax on employers who don’t cover their workers — bad; expanding Medicaid — don’t go very far. I might express disappointment — but MTF has been the leading public critic of the House plan since its release in early November. Let’s examine their first two conclusions:

Individual Mandate: “…least expensive approach and the one most likely to extend coverage to all Massachusetts residents.” MTF credits the Urban Institute’s “Roadmap” report for the Blue Cross Foundation as validating this approach. But MTF ignores the Roadmap’s conclusion that $900 million in new dollars is needed to fully support this approach. Plus, MTF — and Gov. Romney — assume that anyone over 300% of the federal poverty line can easily afford to buy insurance with no financial support.

Hmmm. 300%fpl for an individual is $28,710, $38,490 for a couple. If you live in Greater Boston, you are living in one of the highest cost-of-living places in the nation — housing, transportation, food, insurance, you name it. What’s the standard to say this is the magic affordability threshold? There is none.

And like the Governor, MTF assumes there will be “new low cost health insurance products” — the same ones we have been promised by Romney since last fall and have yet to see.

It is remarkable to hear MTF and business leaders cry about the affordability of insurance for wealthy companies like Dunkin’ Donuts and McDonalds, and have not even a smidgen of concern about affordability for real people who will face tax penalties and loss of drivers license if they can’t afford coverage. Love to see any of these folks try to live in Greater Boston on $28K.

MTF assumes enforceability of an individual mandate is no problem because we have one now for university students. But that’s a simple enforcement challenge at registration time — the envisioned insurance mandate will require the Division of Insurance, the Department of Revenue, and the yet-to-be-created Insurance Connector to swap confidential data about millions of individuals to determine who gets punished. Mark our words — if this happens, it will be a costly administrative and political nightmare. This is the place where a word of caution from MTF would have been advised.

Payroll Tax: Not surprisingly, MTF only discusses the negative and ignores any evidence to the contrary: “… it is inevitable that some employers who can barely afford the health care expenses they currently face would opt to drop their coverage and pay the tax instead. And employers who do not currently provide health coverage would have no financial incentive to do so.”

Would some employers choose to drop coverage and pay. Probably. Would some not paying now choose to cover instead of pay. Probably yes. Why? Because when an employer buys coverage for workers, his or her workers are the direct beneficiaries. When he or she pays the tax, some of his lower income workers will qualify for MassHealth, some will qualify for sliding scale subsidies to buy coverage, and the rest (the higher income and more valuable workers) would be on their own with not a penny of support from the employer.

So the employer faces a conundrum — pay the assessment and get little direct benefit, or buy coverage and directly benefit my own workers. Chances are many employers will see the benefit, even if paying the assessment is marginally less. That’s why MIT economist Jon Gruber, using his own econometric model, concludes some employers would drop, others would pick up, and the net result would be a wash.

Does MTF even entertain this possibility? Nope. There’s only a downside to the payroll assessment in their universe, and only an upside to an individual mandate.

MTF normally produces balanced, on the level analysis that is helpful to public officials and the public. In this case, they are taking an advocacy position, and their analysis should be recognized as what it is, an advocacy document.

Business groups opposed to the House health reform plan that would require businesses that don’t provide health insurance to workers to pay a 5-7% payroll assessment are beginning a serious mobilization to undermine the House plan. Below are three communications that have come our way from some prominent business groups. Here’s your chance to see what they are saying to their own members (a few comments from me follow each one):

1. From the Mass. Retailers Assn. and others:
From: Jon Hurst [mailto:jhurst@retailersma.org] Sent: Monday, December 19, 2005 1:38 PM
Subject: MA Businesses for Real Health Care ReformImportance: High
TO: MA Chambers of Commerce & Certain Trade Associations

The Retailers Association of MA and other organizations are preparing a public media campaign to oppose the health care payroll tax and employer mandates. We are calling our coalition Massachusetts Businesses for Real Health Care Reform. We will also have a website (not up yet) which you will be able to access beginning next week at www.unhealthyreform.com.

Our campaign will consist of radio ads beginning next week, and continuing the first week of January. We will also present newspaper ads in “advertorial” style the first week of January. We hope to be able to list supporting organizations in the newspaper ads. The website will allow organizations and individuals to sign up, contact their legislator, and will contain information on the payroll tax and employer mandates. Other paid efforts (such as paid grassroots) will depend upon new contributions received over the next couple of weeks.

We are looking for associations and chambers of commerce to sign up for this coalition. Our messages will be anti-payroll tax and employer mandates, while urging lower health care costs for everyone, particularly small businesses. Obviously time is very short given the fact that the Health Care Conference Committee is meeting, and hopes to have a final bill to report in January. The holidays further complicate matters as we seek organizations to sign onto the effort, and to continue grassroots and free media (letters to the editor, op-ed’s, etc.) to influence the process.

Please consider signing on to this coalition this week. Please use the attached membership form, and fax it back today, or as soon as possible! We need you to be a part of an employer effort to prevent a payroll tax from becoming law in Massachusetts. Organizations signing on will be listed on the website, and perhaps (if space permits) on the advertorial. We would also be happy to supply you with draft letters to the editor and op-ed’s for your local newspaper use.

Thank you for your consideration, and feel free to contact me, Bill Rennie or Erin Trabucco of the RAM staff if you have any questions.

Jon
Jon B. Hurst, President
Retailers Association of Massachusetts
18 Tremont St., Suite 1040
Boston, MA 02108
617-523-1900, Ext. 12
617-523-4321 Fax
jhurst@retailersma.org
www.retailersma.org
The Voice of Retailing Since 1910

Comments: No surprise here — retailers are a key sector where health insurance for workers is inadequate or non-existent. The irony — calling their effort the “coalition for real health reform” when business has been missing in action on health reform since this discussion kicked off in November 2004. Also, by eliminating a $160 million current assessment on employers who cover their workers, the House health reform plan is the only one with guaranteed cost reductions in premiums for employers who cover their workers.

2. From Associated Industries of Mass:
AIM EMAIL
Subject: New Health Care Tax Opposed by Business Community
Call to Action

I write to you during this Holiday Season, however reluctantly, because I know health care reform is critical to you and we need your help.

Associated Industries of Massachusetts is participating in a multi-faceted public campaign to shape the final version of the pending health care bill and to ensure that any legislation adopted by the House and Senate does not harm the state’s fragile business climate. We are particularly concerned that the final version of the bill should not include an employer mandate to provide health insurance or a special “payroll tax” created to penalize employers who cannot afford to provide coverage for their employees.

Accordingly, we are asking every member of A.I.M. to contact selected elected officials to convey the business community’s concern about the final shape of the bill as well as our real concern for the overall business climate.

By accessing the link below, you will be directed to our website which contains additional background information about the status of the health insurance debate, the specific proposals that are of most concern as well as the principals of a plan that AIM does support. The website also provides you with the email address or fax number of the targeted officials central to the debate, as well as a proposed text that you can use when telling the targeted officials how you feel.

Associated Industries of Massachusetts has tried to achieve compromise on this issue using “diplomatic” means. Our success is not assured at this point and your help is most crucial.

Please call me if you have any questions or need further information at 617-262-1180.

Thank you for your willingness to join in this effort. We will reach out to you again as the campaign unfolds and keep you informed of our progress.

Click the link below to log in and send your message: http://votervoice.net/target.asp?id=aim:7461794

Comment: This is the most surprising and disappointing. AIM officials regularly disclose that more than 99% of their members provide health insurance to their workers, will owe nothing under the House assessment, and will save money via the elimination of the $160 million existing tax. AIM views itself as a convenor within the broader business community and needs to oppose the House plan to maintain that role. Their opposition also shows the extent to which ideology triumphs self-interest.

3. National Federal of Independent Businesses:
NFIB 12/20 Press Release
REPORTS OF INSURERS’ PROFITS SHOULD DERAIL BEACON HILL HEALTH CARE PROPOSAL (12-20-05)

The National Federation of Independent Business (NFIB)
Contact: Bill Vernon 617-482-1327
Jim Jennings (240) 645-4099

REPORTS OF INSURERS’ PROFITS SHOULD DERAIL BEACON HILL HEALTH CARE PROPOSAL

BOSTON, Dec. 20, 2005 – Media reports that several health insurers and health care providers in Massachusetts have enjoyed healthy profits and maintained sizeable reserves during 2005 brought an immediate reaction from members of the small-business community.

“Small-business owners’ first reaction is that the health care reform proposal on Beacon Hill is headed in the wrong direction,” said Bill Vernon, state director of the National Federation of Independent Business, the state’s largest small-business advocacy organization.

“The proposals before the conference committee include cost relief for providers and insurers and shift the costs onto the employers in the state. Employers already pay billions to cover their employees and have incurred double digit increases for health insurance premiums over the past several years,” he said.

“The year-end figures should give pause to conference committee members. It is outrageous – as is now apparent—that small-business owners on Main Street across the Commonwealth, and their employees who have been sharing the burden of increased costs, have been forced, in effect, to pad the bottom lines of a lot of insurers and hospitals. Is it any wonder that these increased costs have resulted in slower job growth here,” he added.

“True health care reform means cost containment, not cost shifting, so that small employers – the backbone of the Massachusetts economy—and their employees can afford quality health care.”

Comment: No surprise here. NFIB is the business group that played a crucial role in killing the Clinton health plan in 1994, and is the most reliable Republican oriented business organization. Their MA head, Bill Vernon, was the head of the Mass. Republican Party and a Republican member of the MA House of Reps. Interesting to see how they are taking direct shots at health insurers and providers.

To prepare for the January 1 start of the Medicare Drug Benefit (Part D), the City of Baltimore is readying their emergency surveillance and response systems. That’s right - they’re treating this as a public health threat. Click here for details. Their worry is that the “dual eligibles” (people who are dually eligible for Medicare and Medicaid), who will be switched overnight from their current Medicaid drug coverage to a new privately-administered Medicare program, will not be able to get their medications because their new plans don’t cover all their medications, because they cannot afford the higher co-pays, or because they’ve slipped through a crack in the “system.”

In Massachusetts, we have the same worries — for the duals and for our Prescription Advantage members. That’s why HCFA, in coalition with other groups including AARP, Mass. Law Reform Institute and Greater Boston Legal Services, are working to pass legislation to require Massachusetts to protect people who don’t have access to the drugs they need. The bill will help duals with higher co-pays and will supply Prescription Advantage members and duals with an emergency supply of drugs if their Part D plans won’t pay.

The legislation passed the State Senate in November as part of a supplemental budget, where it got held up in conference. The Senate passed the legislation again this week and it’s now working its way through the House. We only have three more sessions before Jan 1 to get this done. Please call your House member TODAY to ask them to support Senate Bill 2310.

Check out Chip Joffe Halpern’s new column on health reform in today’s North Adams Daily Transcript. Chip runs Ecu-Care which helps uninsured persons in Berkshire County get medical care and he’s the President of HCFA’s Board. Here’s a tidbit:

“We who work with the uninsured on a daily basis cannot shield ourselves from seeing the effect that lacking health coverage has on individuals and families. I am currently working with two uninsured women who are both cancer patients. Besides the trauma of the diagnosis and their uncertain futures, they are both facing the potential of overwhelming medical debt. So not only are they being challenged by their illnesses, but they are also being stripped of their dignity by the financial consequences of being uninsured.

“Both women would have health coverage under the bill passed by the House. Under the Senate bill, they would still be left uninsured.

“I cannot, in good conscience, tell these women they should wait for some mythical future, before we develop a “perfect” health care system that will satisfy all the health care stakeholders in the United States. That health care system never will exist, there will always be trade-offs. But Massachusetts lawmakers now have the potential of passing legislation that will bring relief to these two cancer patients, and to provide health coverage to the vast majority of the other 500,000 uninsured residents in Massachusetts.”

And a correction:

I stated in a previous post on MassHealth dental coverage for pregnant women and mothers with children up to age three that the Romney Administration had failed to respond to our letter we sent before Thanksgiving asking for a timeline for implementation of this service. I was incorrect. Deputy Medicaid Director Tom Dehner sent a reply letter on December 5th. My apology to Tom.

From Our Friends at FamiliesUSA:

As of last week, it looked as if the US House and Senate would agree on a budget that would be far less harmful to Medicaid beneficiaries than the House’s version. All that changed for the worse last night.

Early this morning, House and Senate negotiators reached a deal on a budget conference that closely resembles the House’s budget. This budget cuts Medicaid by $22.8 billion over 10 years, directly harming low-income beneficiaries. Fearing the disinfectant effect of sunlight and public scrutiny, the House passed this budget at 5:45 AM this morning. In a way, this makes sense: Such an immoral deed can only be done in the cover of darkness.

Once again, our best hope for stopping this unusually cruel piece of legislation lies in the Senate. Specifically, our best hopes lie with four Senators: Norm Coleman (R-MN), Arlen Specter (R-PA), Mary Landrieu (D-LA) and Ben Nelson (D-NE). If you know anyone in one of these four states —Minnesota, Pennsylvania, Louisiana, and Nebraska— we urge to contact them to call their Senator as soon as possible and urge him or her to vote NO on the budget conference report. Please forward this e-mail to them and urge them to call their Senator.

You’ve probably memorized this number already, but here it is again:
Call Your Senators, Toll-Free:1-800-828-0498

This is it: our last chance to stop these deeply harmful and immoral Medicaid cuts from becoming a reality. Your calls have moved Senators to do the right thing in the past, and they can have the same effect again. If you live in one of these four states—Minnesota, Pennsylvania, Louisiana, and Nebraska—please call Senators Coleman, Specter, Landrieu, or Nelson and urge him or her to vote NO on the budget conference report.

Early this week, Health Law Advocates (HCFA’s law firm) and Mass. Law Reform Institute filed suit against the Romney Administration for failing to restore dental coverage for pregnant women and moms with kids up to age 3 who are on MassHealth — as mandated by the FY06 state budget approved last July. We had a court hearing scheduled for today (Friday) at 2pm in Suffolk Superior Court. Prior to today’s hearing, we were informed by the Attorney General’s Office that the Romney Adminstration has now agreed to restore these benefits “no later than January 15, 2006.”

Now that wasn’t so hard, was it?

You can read the actual “stipulation of the parties on plaintiff’s emergency motion for preliminary injunction” by clicking here.

Hey, do we get things done, or what? Special thanks to MLRI’s Vicky Pulos and HLA’s Leslie Storm (and to Assistant AG Daniel Hammond — we bet the AG’s folks told the Administration they had no case. Muchas gracias!)

And to the Romney Administration, what can we say but: “Utinam logica falsa tuam philosophiam totam suffodiant!” (”May faulty logic undermine your entire philosophy!”)

Nada. Zippo. Zero.

Why? Two reasons.

One: Romney’s choice not to seek re-election was one of the worst kept secrets in modern state political history. Every one on Beacon Hill with any political sense (and there are a lot of them)has understood for a long time that he would not be in the ‘06 gubernatorial race and has already factored that knowledge into their decision making.

Two: The real driver of MA health reform is this — the potential loss of up to $700 million in federal Medicaid dollars if the Legislature can’t agree on a new law to re-arrange the use of these dollars to satisfy the Bush Administration. There are disagreements on the necessary date for action, and differences of opinion on how far the state needs to go — but no one denies the need for substantive legislative action early next year.

And here’s the irony: lame duck or not, the Legislature, the state’s health care system, and the Commonwealth badly need Romney’s help to sell a final plan to officials in the US Department of Health and Human Services (specifically: Health & Human Services Secretary Mike Leavitt, Centers for Medicare and Medicaid Services Administrator Mark McClellan, and Medicaid Division Director Dennis Smith). That — and his veto pen — are his two chief assets that make him a player in the final innings of this long-running game.

Today, on behalf of about 45,000 poor pregnant women and poor mothers with children under age 3, we filed a class action lawsuit to compel the Romney Administration to restore dental benefits to these women. Last July, the Legislature included renewed coverage for these two groups of women in their final FY06 state budget. Gov. Romney vetoed the expansion for women with kids under 3, and the House and Senate overwhelmingly overrode the veto.

The lawsuit was filed by HCFA’s crack law firm, Health Law Advocates, and the ever vigilant Mass. Health Law Reform Institute. We’re all lucky in Massachusetts to have these two fabulous groups of legal advocates.

Every two weeks, a group of health care advocates meets with representatives from the Office of Medicaid to discuss what’s happening in the program. Since July, we have been asking when the Administration would restore coverage. We have not received any response. The day before Thanksgiving, we sent a letter to Gov. Romney asking them to restore coverage or else we would file suit. No response. We filed suit today.

India Bulgar is one of our plaintiffs. Six months pregnant, she is from New Bedford and has a child under three. Bulgar, a bus driver with a medical history of high-risk pregnancy who makes $270 a week, suffers from severe dental and periodontal disease which causes her chronic pain. Since July 1, she has lost two teeth because she can’t afford adequate dental care.

Sometime in 2004, we remember Gov. Romney stating that he “can’t pick and choose which laws to enforce.” Of course, that comments was about gay marriage — and a 1913 law about cross state recognition of marriages. So how come he can choose not to enforce a law to provide dental care to poor pregnant women and moms?

About 20 people crowded into the office of Health Care Financing Committee chair Patricia Walrath Monday afternoon. The conference committee to resolve the differences between the House and Senate health care reform bills was meeting for the first time.

No one there could remember the last time a conference committee had posted the time and place of its meeting. While some 15 years ago, conference committee meetings were open to the public, since the late 1980s all meaningful debate has been behind closed doors. Everyone was speculating what would happen now — bland opening speeches? serious work in the public eye? or was this just a feint?

Representative Walrath was at the head of the table, the host and clearly in charge. The other House members of the committee - Representatives Mariano and Hargraves - were sitting on one side of the table, waiting for their Senate counterparts. The observers, mostly health industry lobbyists, along with a few members of the press, crowded around the office desk and squeezed behind the small sofa.

About 10 minutes late, Republican Senator Brian Lees arrived. Two minutes later, the other Democratic conference committee members, Senators Moore and Murray arrived with their staffs, along with Senator Nuciforo, Senate chair of the Financial Services Committee but not a member of the conference. Everyone was surprised to see Senator Nuciforo there, and people wondered what his role will be. Representative Walrath showed the Senators to their assigned seats, seating Senator Moore opposite herself.

The House staff then came in, bearing thick sheafs of charts and notes comparing the two bills.

Representative Walrath called the meeting to order, and announced that the first order of business would be to vote on closing the meeting. A motion was promptly made and seconded, and the vote was unanimous. Rep. Walrath annouced that “everybody who is not a member of conference or staff has to leave.” As everyone left, a reporter stepped back into the room, and told the group that while they had every right under the legislative rules to close the meeting, the public had an interest in the health care debate and that it was wrong for them to deny access to the public and press. As he turned and left, an aide closed the door and the real work of deciding the fate of health reform in Massachusetts began.

Senator Nuciforo, however, remained in the room. Afterwards, staffers said he was present as a guest to provide expertise on insurance matters. The committee will meet again, in private, on Thursday.

It’s a rarity — an open meeting for a legislative conference committee. It seems the health reform conference committee will hold an open meeting on Monday at 1pm in State House room 236. They could immediately vote to go into executive session, and that’s the last we’ll see or hear from them until they’re done. But you never know.

Here’s a State House News Service account:
Lawmakers officially convene this week to work on final legislation many expect will change the face of how health care is delivered in Massachusetts. The six-member conference committee appointed to work out the differences between House and Senate bills passed earlier this fall holds its first meeting on Monday, although staff members for the appointees have been holding informal conversations and working behind the scenes for the last several weeks.

The two bills include much overlap, but major differences in how the state can ensure that many more of its residents have health insurance, with the House looking to reach roughly 95 percent of the state’s population in three years by taxing employers and imposing an individual mandate for all residents to purchase health insurance. Senators take a more layered approach, looking to reduce the number of uninsured residents by half within two years by dipping into the state’s reserve funds and establishing their own version of a requirement for employers to offer health insurance. There is pressure to act soon, as some lawmakers and administration officials fear the state risks losing $385 million in aid tied to the state’s federal waiver.

Under the rules, conference committee meetings are open to the press and the public, but conferees may vote to close such meetings. The health care conference committee, in a rare move on Beacon Hill, posted a public notice of its Monday meeting. (Monday, 1 pm, Room 236)

Also…

Later this week, Secretary of State William Galvin will announce which initiative petitions and constitutional amendments are still on track for the statewide ballot. Signatures certified as valid by local clerks were turned into Galvin’s elections division last week. Sponsors of petitions to protect dogs from harm, allow food stores to sell wine, lift a ban on cross-endorsement voting, and empower personal care attendants say they have gathered more than the 65,825 necessary certified signatures, as well as more high-profile campaigns to expand health insurance access and ban gay marriage under the constitution.

Last fall, Boston-based Local 2020 of the Service Employees International Union merged with the New York giant, Local 1199, to form a major new labor organizing force in Massachusetts, and in the MA health sector generally. Their influence will in no way be limited to organizing, as this story from this past week’s State House News Service makes clear:

UNION JOINS HEALTH CARE FRAY WITH CAMPAIGN IN SUPPORT OF HOUSE PLAN
By Jim O’Sullivan, DEC. 6, 2005….

The state’s largest health care workers union is throwing its support behind the House health insurance reform proposal with a campaign that includes direct mail, recorded phone calls, and newspaper advertisements costing more than $75,000, union officials said. Starting Tuesday with phone calls that prime voters for literature expected to hit mailboxes later in the week, the SEIU drive asks for pressure on legislators to support the controversial House plan to expand health insurance to approximately 95 percent of the population, in part by imposing “payroll assessments” on certain employers that don’t presently offer insurance.

While both Gov. Romney and the Senate have pushed their own competing schemes and earned support from various sectors, the House version has drawn praise from advocates of universal health coverage and criticism from business groups who say the levy will discourage business investment in the state. With the federal government pressing the state to settle this winter on a major insurance expansion policy, members of a House-Senate conference committee are trying to hash out a compromise bill.

SEIU 1199 opted for the House plan, a spokeswoman said, because it spreads the cost of insurance among employers and helps the medical institutions that employ union members to receive more adequate reimbursements for the care they provide.”If people are insured, then our workers are working in centers of care that are not being financially drained through Medicaid reimbursement rates and by a system that’s built, right now, on folks who don’t have insurance coming in to access it,” said Meghan Finegan, communications director for SEIU 1199.

Health care workers account for about 10,000 of the union’s 12,000 members, including patient access representatives, radiologists, nurses, and switchboard operators, Finegan said. “I think our concern is, while hospital workers are behind this, we’re reaching out to voters because it’s certainly a very difficult issue to understand and we don’t want it to fall off their radars, and we want them to weigh in with their representatives,” she said.

Some of the state’s largest hospital systems, including Boston Medical Center and the Cambridge Health Alliance, prefer the Senate plan, which they say is less drastic and more feasible than the other two. But the union’s full-throated backing of the House’s more ambitious blueprint jibes with its support for universal coverage. An initiative petition to create a law expanding health care registered with enough signatures to advance another step toward the 2006 ballot, and SEIU 1199 collected 12,000 of them, Finegan said.

Another SEIU-supported initiative petition, establishing a “personal care attendant quality home care workforce council,” notched a sufficient number of validated signatures, with delivery to Secretary of State William F. Galvin’s office scheduled for Wednesday morning, SEIU 1199 spokesman Jeff Hall said.

Approximately 80,000 “robo calls” started going out to home phones Tuesday, Finegan said, featuring the voice of a nurse from Union Hospital in Lynn alerting residents to mailings targeted to the same 80,000 addresses.The direct mail literature includes detachable postcards that residents are encouraged to send to their Beacon Hill representatives urging support for the House plan. Full-page newspaper ads will splash later this week into local papers with a focus on Cape Cod, southeastern Massachusetts, North Adams and other parts of Berkshire County, Finegan said.Finegan declined to disclose the exact cost of the campaign, but said it exceeded $75,000.

Lots of folks around the nation — and in MA — swallow the line that “consumer driven health care” is the fair and right answer to our health system problems. Gov. Romney, our health plans, and business leaders see these high deductible, high cost sharing plans as the best approach. A new study released today by the Commonwealth Fund puts these plans into proper perspective… Here are a few excerpts:

“Promoting consumerism in health care is the latest big idea in health insurance in the US. One leading manifestations is the use of high-deductible health plans (HDHPs) with savings accounts, such as health savings accounts (HSAs) and health reimbursement arrangements (HRAs), collectively known as consumer-driven health plans (CDHPs).

“The first EBRI/Commonwealth Fund Consumerism in Health Care Survey was conducted to provide reliable national data on the growth of high deductible plans and their impact on the behavior and attitudes of health care consumers. The study defines high-deductible plans as those that would qualify for federal HSA tax preferences: with deductibles of $1,000 or more for individual plans and $2,000 or more for family plans.

Findings indicate:

Lower satisfaction with consumer-driven plans. … Individuals with more comprehensive health insurance were more satisfied with their health plan than individuals in high deductible plans … 63% of individuals with comprehensive health insurance were extremely or very satisfied with their health plan, compared with 42 percent of CDHP enrollees and 33 percent of HDHP participants. 60% of individuals with comprehensive insurance reported they were extremely or very likely to stay with their current health plan if they had the opportunity to switch, compared with 46 per-cent of CDHP enrollees and 30 percent of HDHP enrollees.

Higher out-of-pocket costs. Despite similar rates of health care use, individuals with CDHPs and HDHPs are significantly more likely to spend a large share of their income on out-of-pocket health care expenses than those in comprehensive health plans. Two-fifths (42% ) of those in HDHPs and 31% of those in CDHPs spent 5% or more of their income on out-of pocket costs and premiums in the last year, compared with 12% of those in more comprehensive health plans.

More missed health care. Individuals with CDHPs and HDHPs were significantly more likely to avoid, skip, or delay health care because of costs than were those with more comprehensive health insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. About one-third of individuals in CHDPs (35%) and HDHPs (31%) reported delaying or avoiding care, compared with 17% of those in comprehensive health plans.

More cost-conscious consumers. Among people in the plans who did receive care, there is evidence they are more cost-conscious. People in the CDHPs and HDHPs were significantly more likely to say that the terms of their health plans made them consider costs when deciding to see a doctor when sick or fill a prescription, to report that they had checked whether their health plan would cover their costs as well as the price of a service prior to receiving care, and to discuss treatment options and the cost of care with their doctors. Nevertheless, they were also more likely to go without care.

Lack of information. Few health plans of any type provide cost and quality information about providers to help people make informed decisions about their health care. The study also found very low levels of trust in information provided by health plans.

From State House News Service:

TRAVAGLINI: NO PREDICTIONS ON HEALTH CARE, GOING “DAY BY DAY” With the conference committee working out health care reform details set to hold its first meeting next Monday, Senate President Robert Travaglini today declined to make a prediction about whether the Legislature would return for a special session to consider an accord before January. “I’ve never indicated that that was likely to occur,” Travaglini said today following an unrelated event. “In the event that we make significant progress, it will occur. But right now I’m not going to make any predictions. I’m just going to go day by day and try to get it right.”

Formal negotiations are currently on hold while the lead House and Senate conferees, Sen. Richard Moore (D-Uxbridge) and Rep. Patricia Walrath (D-Stow), attend the National Conference of State Legislatures’ Fall Forum in Chicago, legislative aides said. Last week, House conferee Rep. Ronald Mariano (D-Quincy) was on vacation. Legislative aides say they have been doing work behind the scenes in preparation for the full conference committee’s first meeting, which is scheduled for Monday afternoon in Walrath’s office.

Travaglini also downplayed the role US Sen. Edward Kennedy has played in the advancement of a plan to expand affordable access to health insurance, but said the topic is one of conversation between them. “Senator Kennedy talks to me on a variety of issues,” Travaglini said, noting that it’s “not unusual” for Kennedy to call his home and talk with his wife and daughters. “Don’t read anything into that. Obviously he would be very pleased if would could continue the momentum on this issue and lead the nation into the direction of universal health care. And that’s the goal.”

Business leaders are also working on a proposal that merges the House and Senate legislation into a plan fully supported by the employer community. How and when that proposal will be released is still unknown, business leaders said. Employers are opposed to the payroll assessment included in the House plan and supported an individual mandate on residents to purchase insurance.

You’ve never heard of Glenn Kingsbury. He runs a business association — the electrical contractors association of Great Boston. He’s no radical or leftie, he’s just fed up representing employers who provide decent health care to their workers and then have to subsidize medical care for workers whose employers don’t provide coverage. He had some strong reactions to Scot Lehigh’s “swallow the business line” column on Tuesday. He sent this letter to the Globe — don’t know if they will run it, but you can read it below:

The Burden of Unfunded Healthcare

Scott Lehigh was right to take aim at the burden rising healthcare costs place on businesses, but he missed the target by a mile (“The burden of mandated healthcare,” op ed, Dec. 6). In fact, there is already an employer mandate in the Commonwealth called the Uncompensated Care Pool that is killing responsible employers.

This year, employers that are already struggling to provide healthcare for their employees will pay an additional $160 million surcharge into the Uncompensated Healthcare Pool to pay the healthcare costs of people without insurance. Seventy percent of these people are employed, so, in effect, responsible employers are subsidizing employers that do not provide healthcare coverage to their workers.

Mr. Lehigh cites the example of a small contractor that won’t be able to compete against moonlighters or out-of-staters. Well, what about contractors that provide coverage competing against those that don’t. The vast majority of the contractors in our Association have less than 10 employees, but they all provide healthcare coverage to their workers. This year, just our share of the Uncompensated Pool will be over $730,000. How can we continue to survive if, on top of the burden of the rising premiums for our own employees, we are also required to pay the healthcare bills of our competitors?

If we’re going to have a healthcare system that ties insurance coverage to employment but then lets employers shirk their responsibility to gain a competitive advantage, then we’ve got a system that’s nothing but a race to the bottom. Fewer employers provide healthcare coverage for their employees and more people are without insurance. Without an employer mandate, that trend will continue. The House’s proposed healthcare plan is the only one that even begins to address the problem.

Glenn Kingsbury, Executive Manager
Electrical Contractors Assn. of Greater Boston, Inc.

Don’t you just love regular folks who see through the BS?

Geesh, Joe Klein yesterday, Scot Lehigh in the Globe today. The argument, business doesn’t like the House-approved payroll assessment on employers who don’t insure their workers, ergo it must be baaad! Whatever happened to columnists engaging in at least a smitten of critical examination of the pro-business line? Those were the days, my friends. Anyway, a few reacs:

First, Scot adoringly quotes AIM’s Rick Lord: ”There are $350 million in new business taxes in the bill,” says Rick Lord, president of Associated Industries of Massachusetts. ”It’s not realistic to say that that won’t have any effect.” What he leaves out is that the House bill also repeals an existing $160 million tax on employers who now provide health insurance to their workers. Feel welcome to challenge my math — $350 - 160 = $190 — or am I missing something? Seems more to me like Scot’s missing something, and the missing something takes air out of his tires.

Second, here’s Scot: “And as for firms that don’t offer health coverage? McDonough contends that those employers can offset the new costs by raising prices some. Using Dunkin’ Donuts as an analogy, he says that the price of a cup of coffee will simply go up a few pennies.
But that’s a problematic paradigm, for several reasons. For one, the state’s principal business associations remain adamantly opposed to the policy prescription House leaders insist will prove salubrious for many of their members. They worry both about future increases if such a payroll levy is established and about putting small firms at a competitive disadvantage by adding more burdens in a state where the costs of doing business are already among the nation’s highest.”

The firms that don’t offer coverage are service, retail, food and construction — companies that can’t move across state borders or to Taiwan because they can’t take their business with them. A February state survey of businesses that have workers on MassHealth or the Free Care Pool showed these businesses on the top of the list: Dunkin’ Donuts, Stop & Shop, Walmart, McDonald’s, and Unico (janitorial services). If we stop these business from ripping off taxpayers, guess what, none of them can move out of state. If they do, good riddance, and let another firm take their place that provides decent health coverage to workers and stops ripping off taxpayers to boot.

When I buy the Boston Globe — every day, by the way — I assume the price of my paper includes the cost of providing health insurance to Scot. And I don’t mind, and I wish the price of DD cup of coffee also covered health care for those workers. No sweat.

Third, go Scot go: “…it’s important to note that leading liberal economic thinkers also regularly cite the high cost of healthcare as one reason US companies like General Motors have become less competitive vis-a-vis international rivals.” Yes, and that’s why the House bill will lower health insurance costs for companies that provide coverage — like the GMs — while creating an affordable assessment on employers that don’t. Overwhelmingly, the companies in the US that compete against the China’s and Taiwan’s provide affordable coverage — and are at a competitive disadvantage because they cross-subsidize Dunkin’ Donuts.

Fourth, stop him before he hurts someone: “Paul Guzzi, president of the Greater Boston Chamber of Commerce, says the chamber, AIM, the Massachusetts Taxpayers Foundation, and the Massachusetts Business Roundtable will shortly unveil their own proposal to get the state to full coverage in three to five years. Guzzi wouldn’t disclose details, but others say the plan is likely to endorse an individual mandate.” Sorry, Paul, you’re eight months too late. Proposals have been coming forward since November 2004 — now the process is down to two, the House and Senate plans before a conference committee. Sorry you just decided to take this process seriously now, but you’re too late.

By the way, I’ve heard all the business groups talk about how an employer assessment is unaffordable — even for profitable firms like Dunkin’ Donuts. I’ve yet to hear a single business leader suggest that an individual mandate has to meet an equivalent affordability test.