The Massachusetts Health Policy Forum and Health Care For All are co-sponsoring a public forum: “Universal Coverage and Individual Mandate in Switzerland: Lessons for Massachusetts” on Friday, June 22, 2007 from 9:45am-11:30am at Gardner Auditorium in the State House in Boston.

Featured speakers include the former President of the Swiss Confederation and former Domestic Affairs Minister, Ruth Dreifuss, and noted Swiss journalist, Beatrice Schaad Noble. Switzerland implemented an individual mandate for health insurance coverage 12 years ago.

Swiss health insurance is decentralized with private insurance and subsidies for families and individuals with low incomes. The Swiss have a plan very similar to what is being implemented in Massachusetts, but they have a big head start. This will be an opportunity to learn from the Swiss experience.

RSVP by June 18, 2007 to mhpf@brandeis.edu or register online.

Darn shame it requires a subscription, because today’s front page Wall Street Journal article on the Board of Directors of the Commonwealth Health Insurance Connector Authority is a gem. The article describes how ten individuals from a wide range of backgrounds and orientations came together to make the MA health reform law work. Nice details and a great set of board member profiles. A couple of excerpts:

Finding a consensus fell to a motley panel drawn from business, labor, academia and state government. On the liberal end was Celia Wcislo, a 55-year-old organizer with the Service Employees International Union who half-jokingly refers to insurers as “sleazeballs and bloodsuckers.” Her frequent adversary was Jonathan Gruber, a 41-year-old Massachusetts Institute of Technology economist who had helped then-Gov. Mitt Romney develop the plan. A Democrat, Dr. Gruber was surprised to find himself on the conservative wing of the board.

The Connector board offered, in microcosm, a look at the collision of interests — business, labor, medical professionals and needy patients — that has derailed decades of efforts to reform the U.S. health-care system. When it comes to health-care reform, everyone’s second choice, after their own plan, has been the status quo. …

Richard Lord, head of an employers trade group, was irate. Mandating such comprehensive plans would force many employers that already provided insurance to upgrade to more-expensive policies.

On March 14, Mr. Lord gathered some 30 lobbyists and industry representatives, including the Chamber of Commerce, health-plan officials and retailers. They denounced the proposal in a tense meeting. “We decided we needed to go public,” Mr. Lord says. On March 20, the day the board was slated to vote on the issue, businesses’ concerns turned up in an article published on the front page of the Boston Globe.

Operating behind the scenes was the board’s executive director, 58-year-old Jon Kingsdale. A former top executive at Tufts Health Plan, a health insurer, Mr. Kingsdale struggled to come up with a compromise, as he called board members to test various proposals. The board ultimately went along with his suggestion to require slimmed-down drug coverage but delay implementation of the new requirements. In a meeting, Ms. Wcislo dropped her opposition to the lifetime caps after receiving an email on her BlackBerry from another board member. He asked if she realized that her own union insurance had a lifetime cap. She hadn’t.

On March 20, the morning of the vote, Mr. Lord was still planning to cast his ballot against the compromise, but changed his mind on the way to the meeting. “I had gotten what I needed,” he says, adding that a unanimous vote “sent a strong message that we’re all trying to work this out together.” …

The night before the April 12 meeting, Mr. Joffe-Halpern began his three-hour drive to Boston, stopping for dinner at a Pizza Hut. There he got a call saying people on both sides had agreed to the deal. Tears filled Mr. Joffe-Halpern’s eyes as he realized that the state plan might actually work. “Thank you, at last,” he thought.

The next morning, Dr. Gruber walked into the meeting feeling some “buyer’s remorse.” Like Mr. Joffe-Halpern a couple days earlier, Dr. Gruber wondered whether he had gone too far in accepting a compromise. Still everyone voted for the deal; the board members would agree that the compromises were fair to all interests involved.

Well deserved credit for the entire board.

The Division of Insurance held a hearing today on its emergency Young Adult Plan (YAP) regulations. YAPs are private health plans to be offered through the Connector only to persons between ages 19 and 26. The Division worked with the Connector to design the benefit package these plans must include.

Among those testifying were members of Affordable Care Today (ACT!!) Coalition (read our testimony here). HCFA’s Lisa Kaplan Howe opened our testimony by thanking the board for their hard work and highlighting coalition concerns. Top among ACT!!’s concerns is the inclusion of annual benefit caps. ACT!! believes these caps undermine the purpose of insurance and we worry they put young adults who have accidents or are diagnosed with serious illnesses at risk of financial ruin and barriers to care. The coalition asked that the regs be amended to exclude these caps no later than July of 2008.

Concerns about annual benefit caps, cost-sharing and deductibles were echoed by Mindy Cohen of the Children’s Health Access Coalition, Lorianne Sainsbury-Wong of Health Law Advocates, Kathy Bitteti of the Artists Foundation, Carol Pryor of the Access Project and Steve D’Amato. Speakers shared stories of devastating experiences of individuals with student health insurance plans that had annual caps similar to those allowed in YAPs. (The Access Project recently released a report on these plans entitled “Not Making the Grade” and Dr. Jay Himmelstein, who submitted written testimony, recently wrote an article about his niece’s problems with a student health plan)

Two young adults shared personal stories reflecting their concerns with annual benefit caps and other aspects of the regs. Ben Healy is 25 and looking for insurance. He told the Division he hopes to find insurance that provides him with preventive and catastrophic care. These are two things YAPs do not provide.

Vanessa Furtado shared her lesson about the importance of catastrophic coverage she recently learned. When she was a “healthy” 24 year-old she chose the least expensive health plan her employer offered. She ended up being diagnosed with a heart condition and a heart infection, resulting from complications of not being able to afford to go to the dentist for two years. By the time she was released from the hospital 12 days later, and after surgery, she had a $52K hospital bill. This did not include costs for months of follow up care she needed. Luckily, her plan did not have a benefit cap. The $50K permitted annual caps would have compromised her health and finances. She asked the Division to protect young adults from annual caps that can have severe long term consequences.

Also testifying were Tom Nyzio of the Massachusetts Association of Health Plans, who thanked the board for their hard work and offered MAHP’s support of the regulations and Bob Carey from the Connector.
Kayte Spector

Today the Connector Board held their third and last public hearing on draft regulations on “minimum creditable coverage” (MCC), affordability, and CommCare premiums at Gardner Auditorium in the State House. Taking testimony were Connector Executive Director Jon Kingsdale, Board Chair Leslie Kirwin, Board members Celia Wcislo, Chip Joffe-Halpern, Louis Malzone, and Rick Lord, and Jamie Katz, General Counsel. More than 160 people listened to presentations from community groups, employers, advocates, hospitals, and consumers.

ACT!! submitted written testimony, which is available here.

Philip Edmundson, Affordable Care Today!! Coalition Chair opened up a series of ACT!! panels with an overview of issues on affordability, prescription drugs, life-time caps, and cost-sharing.

Speakers from the National Alliance on Mental Illness of Massachusetts and the Mayor’s Helpline at the Boston Public Health Commission thanked the Connector for including prescription drugs in minimum creditable coverage, emphasizing the importance of access to drugs for basic health care. Dr. Stephen Soumerai added a research perspective on smart ways of designing drug coverage that promotes effective use.

They were opposed by several employer groups that urged the Board to remove the requirement that MCC plans include prescription coverage. The Massachusetts Association of Health Plans also opposed the drug requirement. The employer groups also supported the Connector’s aceptance of High Deductible Health Plans. John McDonough of HCFA testified that exempting these plans from MCC standards could harm health reform.

The Massachusetts Medical Society and AIDS Action Committee spoke in favor of setting at least a $1 million minimum for lifetime caps on plans. The proposed regulations do not restrict lifetime benefit caps. One parent shared a story of her child who was born with a congenital heart disease and has already reached over $1 million in treatment costs. Without a reasonable lifetime cap, HIV patients undergoing extremely costly drug therapy and procedures will also risk using up their coverage.

The topic of controlling cost and preserving affordable plans brought out compelling consumer stories as well as an informative debate on the issue. Single payer groups such as MassCare, and Physicians for a National Health Program spoke against high deductible plans and bureaucratic inefficiencies of our current system. The American Cancer Society, Greater Boston Interfaith Organization, and Massachusetts Hospital Association, speaking on behalf of ACT!!, stressed that high deductibles inhibit use of medical care and that out of pocket maximums should include all co-pays and medical expenses.

The AARP and Health Law Advocates asserted the need to exempt from the mandate penalties families faced with premiums that exceed 10% of their income, and asked for a 500%-600% affordability income band for individuals.

GBIO, Mass Law Reform Institute, and a representative from the Children’s Health Access Coalition lauded the Connector for the family premium cap, which waive premiums for children’s coverage for parents with Commonwealth Care. While people under 100-150% fpl levels do not pay premiums, the groups would like to see this population shift to plan type 1, where dental coverage is available.

Artist groups highlighted the importance of using adjusted gross income as standards for self-employed people.

The Connector Board in turn expressed their appreciation for all the speakers and the effort put forth in the testimonies. The Board will vote on these regulations on June 5, at 3:00 pm, at the next board meeting at One Ashburton Place, 21st Floor, Boston.
Diana Ong

As we mentioned in a 5/24 blog entry, the Massachusetts Quality and Cost Council has issued a draft of its goals for FY ’08. They are inviting comments from members of the advisory committee, on which HCFA holds a seat. Send us your comments and we will consider them as we draft our response. Also, please note that the 5/24 blog entry now includes links to draft regulations for collecting claims data from third party payers. Look those over and post your comments.

PA Gov. Ed Rendell is getting quite active on health policy in a number of positive ways. His health access expansion initiative is getting beaten up in the Legislature, but it’s a good plan and a good starting point for a state that has never been active in this arena. Now he’s setting up an Office of Health Equity to develop a comprehensive approach to eliminate racial and ethnic (and other) health disparities. He’s also launching a statewide chronic illness initiative. Click here for the Governor’s two executive orders.

Here in Massachusetts, HCFA and other organizations part of the Disparities Action Network have proposed setting up an Office for Health Equity within the Executive Office of Health and Human Services to coordinate and lead MA activities to address disparities.

C’mon Massachusetts. Let’s not get shown up by Pennsylvania.

Yesterday the U.S. Congress acted to expand both funding for the Iraq war and children’s health insurance at the same time. Contained in the war funding bill signed by the President yesterday is approximately $650 million in emergency money for states to fund their SCHIP programs. Around $80 million will go to Massachusetts.

SCHIP, the State Children’s Health Insurance Program, is a highly successful initiative that provides quality, affordable health care coverage for children. In Massachusetts alone, almost 82,000 are covered by SCHIP (a good overview is here).

SCHIP has been facing a significant financial crisis across the nation and is due to be re-authorized this year. As of February, the federal Centers for Medicare & Medicaid Services projected over $624 million in shortfalls, including our $80 million shortfall. This funding should ensure that Massachusetts has enough federal support to cover our program through this federal fiscal year (which runs through September). Before today’s legislation passed Congress, Massachusetts anticipated running out of money for the SCHIP program by July. The administration was planning to cover our SCHIP program using regular Medicaid money, which would have hurt our budget neutrality calculations, in addition to costing more state funds.

Thanks to Senators Kennedy and Kerry and our entire House delegation, who fought hard to make sure the SCHIP funds for Massachusetts was included in the final bill.

The supplemental funding is a temporary band aid to a successful and cost-effective program that provides low-cost and comprehensive health care to children. The next step for SCHIP is reauthorization of the program. The Senate Finance Committee is tentatively scheduled to mark-up an SCHIP bill on Thursday, June 7th. Once the bill passes out of Committee, it will likely be heard on the Senate floor for debate within a week or so. As soon as this happens, it will be important to contact your Senators to voice your support and/or concerns about the bill. For more information, please visit the New England Alliance for Children’s Health.
Mindy Cohen

Physicians for a National Health Program, a single-payer support group, is gathering signatures in an online petition opposing Connector policies on Minimum Creditable Coverage and the individual mandate. You can read the letter, which as of this writing has around 350 signatures, by clicking here.

Their letter gets it right and wrong at the same time. It’s too bad their serious critique of high deductible plans is marred by careless mistakes and false charges. Sloppy analysis is one reason single-payer groups are peripheral to health policy debates in Massachusetts. Here’s our take:

1. The criticism of “consumer driven”/high deductible plans is valid. By authorizing individual deductibles as high as $2000, and family deductibles up to $4000, the Connector is giving its seal of approval to plans that will unfairly saddle consumers with high out of pocket costs. A recent study by the Access Project, “The Illusion of Coverage,” shows the painful consequences of medical debt and substandard care due to inadequate coverage. We join the letter drafters in calling on the Connector to re-examine its definition of “minimum creditable coverage.”

2. Unfortunately, the letter demonstrates ignorance of the basics of MA health reform. The letter states: “The Connector is set to compel a 56 year old making $30,000 to spend $4,164 annually for the lowest cost policy. This coverage requires a patient to pay a $2,000 deductible before insurance kicks in, plus coinsurance of 20% for hospital bills and $25 for each office visit even after the deductible is met.”

Actually, an individual with that income is eligible for subsidized Commonwealth Care, which provides comprehensive coverage for an annual premium of $1260 ($105 per month), with no deductible, no coinsurance, and co-pays of $10 for an office visit. The letter gets a fundamental fact wrong in its rush to prove a point.

3. Even if the letter had specified a 56-year old with an income of 31,000 (who is ineligible for CommCare), that person would not be compelled to spend $4,000 for coverage. Under the Connector’s proposed affordability guidelines, an individual earning $30,631-$35,000 is only mandated to buy coverage if it’s available for less than $1800 a year, or $150 per month. So either way, the example isn’t real (The affordability schedule and other regulations are available by clicking here). No individual is expected to pay $4000 a year unless his or her income is over at least $50,000.

We are concerned that even over $50K, many older individuals will be unable to find affordable insurance. At this Tuesday’s Connector Board hearing, the ACT!! Coalition will urge the Board to add another “income bracket” to the affordability schedule so individuals earning between $50K and $60K yearly will not be mandated to purchase unaffordable insurance. We also will ask the board to exempt from the individual mandate any individual or family who would have to pay 10% or more of income for premiums, regardless of income. Also, the Connector is promising a robust and humane waiver process which will take into account other financial obligations.

4. Seems these errors don’t matter to the authors because their real point is to promote single payer health insurance as the only solution. If that’s really the case, the Connector is the wrong target, and the right target is the Legislature. Single payer legislation has been filed in every legislative session, to our knowledge, since 1986 (Sen. Sal Albano filed the first one), and has never received an up or down vote even in a legislative committee.

Regardless of one’s position on single payer – and HCFA is supportive – advocates, and especially physician advocates, should have a commitment to getting facts right and presenting them accurately and fairly.

The Quality and Cost Council met Wednesday with the new Executive Director, Katharine London, officially on board. Katharine announced that an initial website, with basic Council information, meeting locations and times, etc., will be up and running soon through mass.gov. We will notify you when the site is up.

Most of the meeting was a presentation about the new MassHealth Pay for Performance Initiative. Here are some excerpts on that conversation from State House News Service:

MassHealth officials on Wednesday unveiled their “pay for performance” initiative that is slated to start in October, when hospitals contracting with the program will be eligible for bonus rate increases by meeting new quality standards. The initiative is earmarked to cost $20 million during its first year … The new program seeks to “reward providers for excelling in or improving quality of care” delivered to MassHealth members, Acting Medicaid Director Tom Dehner said during a Health Care Quality and Cost Council meeting today. …

The new initiative is part of the health care reform law enacted a year ago, which calls for MassHealth hospital rate increases to be contingent on quality standards and performance measures, including the reduction of racial and ethnic disparities. “We are in this for the long-term. We’re excited about this work,” said Dehner.

Under MassHealth’s proposal, Dehner said all acute care hospitals contracting with MassHealth will be asked to provide information relative to five measures: maternity, pediatric/asthma, pneumonia, health disparities and surgical infection/prevention. Hospitals will also be required to participate in at least one public reporting initiative, which discloses basic safety practices. After the data is assessed, MassHealth would then reward “bonus points” to hospitals based on their ability to meet industry benchmarks, minimum thresholds and improvement markers.
Because MassHealth has not collected data on some of the measures, Dehner said during the initiative’s first year, hospitals will be compensated for improvement in some comparative areas and for reporting only in new areas.

Some council members expressed disapproval about rewarding hospitals for reporting only.

Referring to language under the new health care reform law, Gregory Sullivan, a council member and the state’s inspector general, said he wanted “strong mandates” to set clear improvement standards for hospitals. “This is a very important initiative,” said Sullivan.

Dehner said he wanted to give hospitals a chance to understand all the new requirements in the first year. He also said MassHealth needed to collect data first on new measures before holding hospitals accountable for performance. “I think this is an area where it’s important that we design a way that is understandable so the measures are clearly determined and understood and margins can be tracked,” said Dehner. “I don’t think the way for us to approach this . . . is for us to say ‘here are the standards, if you don’t meet them you don’t get it.’ ”

Council member Dolores Mitchell spoke in favor of a more stringent approach. “I think we have to be willing to accept a certain degree of risk,” said Mitchell, who said Dehner should take advantage of the attention the new health law has received so far and hold hospitals accountable for quality standards. “I think you have to go to a high level of expectation. To miss the opportunity is a mistake.”

“This is not a one-year deal,” said Dehner. “I think this is a small minor first step in terms of where we need to be.” Other council members expressed support for Dehner’s incremental approach. “We are doing the right thing now based on where we are,” said council member David Friedman. When council members asked Dehner if the initiative would receive more than $20 million after the first year, he said it would, but did not provide a figure. For the next fiscal year, MassHealth estimates it will spend $1.18 billion in acute hospital care costs.

Under the new health reform law, MassHealth must consult with the council and the MassHealth Payment Advisory Board in developing quality standards and performance benchmarks.

The Council discussed an outline of overall goals for FY08. An updated version will be available soon. We will post them when we receive them. The goals included some HCFA priorities, such as infection reporting and elimination of infections, never events reporting, reduction of health disparities, chronic disease management, and promotion of preventive care.

The Council discussed draft regs for collecting claims data from third party payers. The data would be used to develop info about quality and cost to be posted on a website. The Council will vote on these regs at a future meeting, and after public comment and hearings. Many advisory committee members submitted comments with concerns about privacy. Read the overview and the actual draft regulations here. Tell us your comments.

Upcoming meetings:
June 6: Council and advisory committee meet. Dr. Elliot Fisher will speak about regional variations in care. He is an expert on this topic. 1-3pm at 1 Ashburton Place, 21st floor.

June 20: Council Meeting, 1-3pm, 1 Ashburton Place, 21st floor.

September 19: The Council’s first annual meeting. This may be a longer session (full or half day) with a number of speakers.

Julie Jette, the first-rate health reporter for the Quincy Patriot Ledger, kicks the tires on Commonwealth Choice non-subsidized plans and finds significant variations in premiums by occupation and zip code (click here for her article):

“For example, the cheapest policy available for a 45-year-old telemarketer living in Quincy will cost $2,340 a year, about $600 cheaper than for a 45-year-old janitor living in Quincy.

Where you live will also count for a lot under the new plans; A 45-year-old telemarketer in Plymouth will pay $972 a year more for the cheapest policy than his or her counterpart in Quincy.”

Simple question — is this variation really necessary? Lots of folks have complained about the awkwardness of the occupational categories on the CommChoice website. What would be so awful about getting rid of these designations? Should we really charge more or less in premiums to someone based on his or her occupation?

Somebody please explain and defend this practice or let’s chuck it…

The Prescription Access Litigation Project (PAL) (a project of HCFA’s national partner, Community Catalyst) recently announced the settlement of three nationwide class action lawsuits against three pharmaceutical companies and is now working to make sure consumers and third party payors who paid for part or all of the cost of these drugs get payments for which they are eligible. The deadline to submit claims is fast approaching!

Information about each of the lawsuits is included below. If you think that you may be eligible to collect under any of these lawsuits, call the phone numbers provided below or contact PAL directly at 617-275-2931. Please help spread the word about these settlements!

GlaxoSmithKline: $70 Million settlement
In re Pharmaceutical Industry Average Wholesale Price Litigation (D. Mass.)
• Drugs at issue:
Alkeran Imitrex Kytril (injectable and oral)
Lanoxin Myleran Navelbine
Retrovir Ventolin (Albuterol) Zantac
Zofran (injectable and oral) Zovirax (Acyclovir)
• Deadline to submit claims: May 28, 2007
• More info: www.gsksettlement.com or 1-888-568-7645

Paxil Pediatric: $63.8 Million settlement Hoorman v. SmithKlineBeecham (Illinois)
• Drug for depression and anxiety disorders, prescribed to children & adolescents
• Deadline to submit claims: August 31, 2007
• More info: www.paxilpediatricsettlement.com or 1-866-494-8404

Serostim: $29 Million settlement
Gov’t Employees Hospital Assoc. v. Serono Int’l, et. al (D. Mass.)
• Drug for AIDS Wasting
• Deadline to submit claims: July 19, 2007
• More info: www.serostimsettlement.com or 1-800-378-3615

Today the Connector Board held their second public hearing on draft regs on “minimum creditable coverage,” affordability, and CommCare premiums at American International College, Springfield, MA. Jon Kingsdale, Connector Executive Director, Celia Wcislo, Connector Board member, Chip Joffe-Halpern, Connector Board member and Jamie Katz, General Counsel, were in attendance. Several organizations, including Neighbor to Neighbor and Community Partners, thanked the Board on the positive impact of lower premiums and the forward direction of policies so far, and highlighted other hardships of low-income groups under the mandate.

Groups and individuals shared opinions and experience related to the regs. Frank Robinson, from the Oral Health Advocacy Task Force, with Rev. Bernard Penn from Partners for a Healthy Community, emphasized the need to extend dental coverage to more income groups and the need for cost-benefit analysis.

One consumer expressed appreciation for having CommCare, and for not having to choose between child care and health care. Another consumer mentioned difficulty finding eye care in Western Mass in his network and the high cost of lenses even for those in type 1 plans. Reps from community health centers talked about cases where CommChoice plans were too expensive for families, and many might take the hit from the penalty simply it was less expensive. Translating outreach materials to different languages will help communities.

Self-employed persons advocated for an adjusted gross income standard for self-employed to take into account business expenses.

Community leaders raised other issues such as monitoring plan affordability, providing easy payment and appeal processes for transient groups, and preventing a “locked out” population who have unaffordable employer insurance and are exempt from the mandate, but will remain uninsured.

Connector Board members listened and asked for additional details on obstacles consumers have encountered. They reiterated the significance of hearing individual stories and promoting public dialogue. Speakers thanked the Connector board for having a hearing in Western Mass.

The next Connector Hearing will be held next Tuesday, May 29, 2007, at 10am in Gardner Auditorium at the State House.

John Auerbach, the new and dynamic Commissioner of the MA Dept. of Public Health, is hosting a series of “regional dialogues” on public health priorities for the new Administration. Click here for the letter of invitation. Here’s the list:

CENTRAL Regional Dialogue
Wednesday, May 30, 2007, 4:00 PM to 6:00 PM
Quinsigamond Community College, Hebert Auditorium
670 West Boylston St., Worcester

CAPE & ISLANDS Regional Dialogue
Thursday, June 7, 2007, 4:00 to 6:00 PM
Barnstable High School, Knight Auditorium,
744 West Main St., Hyannis

METROWEST Regional Dialogue
Thursday, June 21, 2007, 4:00 to 6:00 PM
MetroWest YMCA, Hayes Lodge
45 East Street, Hopkinton

NORTHEAST Regional Dialogue
Monday, June 4, 2007, 4:00 to 6:00 PM
Greater Lawrence Technical School, 57 River Road, Andover

BERKSHIRES Regional Dialogue
Wednesday, June 13, 2007, 5:00 to 7:00 PM
Ralph J. Froio Senior Center, Main Meeting Room, 2nd floor
330 North Street, Pittsfield

BOSTON Regional Dialogue
Tuesday, June 26, 2007, 4:00 to 6:00 PM
Boston Public Health Commission, Carter Auditorium, 4th Floor
35 Northampton St, Boston

SOUTHEAST Regional Dialogue
Thursday, June 7, 2007, 9:00 to 11:00 AM
Bristol Community College
Fine Arts Building, Room H209, 777 Elsbree St., Fall River

WESTERN Regional Dialogue
Thursday, June 14, 2007, 4:00 to 6:00 PM
Springfield Technical Community, College, Building 2 Theater
One Armory Square, Springfield

Health Law Advocates and Holland & Knight LLP are sponsoring a Legal Training on insurance coverage issues for consumers on Thursday, June 14, 8 – 11 a.m. at 10 St. James Avenue, 11th Floor in Boston. This training is designed as a primer on health law issues impacting consumers. It will provide attorneys with the basic legal knowledge and practice tips needed to represent a health care consumer with health care access issues, and will provide up to the minute updates on the new Mass. Health Care Reform Law.

Topic Include:
– Public and Private Insurance Coverage Options
– New Coverage Options Under Health Care Reform
– Appealing Coverage Denials: MassHealth & Private Insurance

Presenters will include:
Melissa Boudreault, Director of Commonwealth Care, Commonwealth Health Insurance Connector Authority
Charlene DeLoach, Assistant General Counsel, Commonwealth Health Insurance Connector Authority
Georgia Maheras, Staff Attorney, Health Law Advocates
Clare D. McGorrian, Esq., Clare D. McGorrian Health Law Consulting and Counseling
Vicky Pulos, Esq., Health Law Attorney, Massachusetts Law Reform Institute
Lorianne M. Sainsbury-Wong, Senior Staff Attorney, Health Law Advocates
Elizabeth Sanghavi, Esq., Associate, Holland & Knight

To pre-register, please call or E-mail Matt Selig at HLA: (617-338-5241 x2986; selig@hla-inc.org) by June 8th.

Click here to view HCFA’s May Quality newsletter, produced by our new Consumer Health Quality Project. We’re proud of this effort — pretty unique if we do say so ourselves. Each edition includes a profile of one member of the new Council, describing their own circumstances that led to their involvement. It also includes lots of other news about quality improvement activities around town.

Click here for www.hcfama.org/signup if you would like to receive the Quality e-newsletter (or any of HCFA’s other newsletters) via email each month.

Today’s Globe included a mag supp: The Globe 100 — The Best of Massachusetts Business. One article reported on a survey of the CEOs of the top 100, along with a comparison group of 1,000 Boston.com visitors, Bullish on Themselves. One question and results caught our attention:

What impact will the state’s new healthcare mandate have on the economic climate?
100 CEOs: Positive — 18%; Negative — 27%; No Effect — 55%
B-com visitors: Positive — 24%; Negative — 42%; No Effect — 34%

Not a scientific survey, by any means, as writer Peter Howe concludes. And the Boston.com visitors survey is particularly impossible to evaluate. The CEO results beg for some interpretation. The 55% “no effect” is the least surprising. Can’t help wondering what thoughts are behind the other two numbers, 18 and 27%. Where do they see the negatives and the positives? Leaves us hungry for more.

State Senator Jarrett Barrios, a Cambridge Democrat who has served in the State Senate since 2003, and in the House of Representatives between 1999 and 2002, will be the new President of the Blue Cross Blue Shield of Massachusetts Foundation. Barrios will replace Nancy Turnbull who has returned full time to the Harvard School of Public Health as a Dean; Turnbull, in turn, replaced Andrew Dreyfuss, the Foundation’s first President, who instigated the “Roadmap to Coverage” Initiative which played a central role in the Massachusetts health reform process.

Throughout his years in the State House, Jarrett Barrios has been a strong and reliable voice for quality and affordable health care for everyone. He has played leading roles in environmental justice issues and elimination of racial and ethnic health disparities. Disparities has been as special issue focus for the Foundation. We will miss Jarrett’s voice in the State Senate, and welcome his new role at the Foundation. Over the past six years, the Foundation has provided significant support to a large number of organizations working to improve health care access and quality, including HCFA.

Today, the Connector Authority hosted a Fenway Park ceremony which brought out the Governor, Senate President Murray and Speaker DiMasi as well as Red Sox officials and Connector EC Jon Kingsdale. The purpose was to showcase new advertisements on Connector coverage options and the individual mandate. Click here for the Connector’s release on the Red Sox partnership.

At the event, the Connector previewed their new TV ads on the Jumbotron, you can see them by clicking here.

Also premiering today is the new website from the Massachusetts Healthcare Reform Coalition, www.masshealthreform.org. The Coalition brings together business, labor, providers, insurers, advocates and consumers to promote the successful implementation of Chapter 58. Their initial activities include a a public education campaign and recruiting a grassroots network of volunteers who will promote health insurance enrollment. The campaign will include TV, radio, newspaper and transit ads.

Kudos to the Massachusetts Dental Society. At its Annual House of Delegates meeting on 5/11/07, the Society officially approved a resolution encouraging all its 4,000+ active members to enroll in the MassHealth (Medicaid) dental program.

“Today, the Massachusetts Dental Society has taken the important step of approving a resolution encouraging member dentists to participate in the MassHealth dental program,” says Dr. Andrea Richman, president of the MDS. “Reducing some of the barriers in obtaining dental care is critical to the overall health of every citizen. The MDS remains committed to working with all interested parties as we look for ways to increase access to care.”

To attract more dentists and to improve the program, MassHealth has made changes to its dental program, including permitting dentists to limit the number of MassHealth patients they accept into their practice and hiring Doral Dental as the program’s new third-party administrator.

“The Massachusetts Dental Society has always been at the forefront of the access to care issue. These initiatives demonstrate that we, as an organization, are committed to helping those in need obtain care that they may otherwise never receive,” says Dr. Robert Boose, MDS executive director.

This step would have been inconceivable as recently as one or two years ago. It reflects positive work by MDS, and a lot of positive work by MassHealth, the Legislature (led by the Legislative Oral Health Caucus), and HCFA’s unbeatable Oral Health Advocacy Task Force which — since June 2004 — has brought all major parties together to work collaboratively to improve oral health for disadvantaged groups.

Congrats to the Massachusetts Dental Society.

At Healthy Blog, we monitor officials documents the Commonwealth sends to Wall Street for any insights and intelligence regarding health care and health reform. Prior to now, these documents were available only to Wall Street analysts and other financial wizards, and not the public (we had a squirrel who helped us get them). Last January, we suggested the Patrick Administration could strike a blow for “transparency” by releasing these documents to the public as well. And they did. You can obtain the latest Commonwealth “Information Statement” (5/9/07) by clicking below:
http://www.dacbond.com/GetContent?dctm_r_object_id=0900bbc7800b3f50

The sections on Medicaid and health reform run from pages A-22 to A-26, and the financials reflect the information we posted last week — click here. No surprises we could see — post a reply if you notice anything. Lots of good detail, numbers, and helpful analysis.

Kudos to A&F Sect. Leslie Kirwan for making these documents available, for the first time, to the public, and not just to Wall Street.