Globe’s Alice Dembner does a fine job in today’s article outlining the contentious renegotiation between the Connector and the four Medicaid Managed Care Organizations (MMCOs) to manage coverage for the 177,000 enrollees in Commonwealth Care.

The Commonwealth wants to keep the cost of CommCare in FY09 as close to the $869 million projection in Gov. Patrick’s proposed budget as possible. Folks in the four plans think that’s not possible given the expected growth in enrollment and the projected costs of caring for this formerly uninsured population. Monthly costs per enrollee in CommCare now are in the range of $360.

A lot at stake. Negotiations such as this often get contentious. We hope both sides are able to work it out. And we hope they’ll take to heart Celia Wcislo’s comments at the conclusion of Alice Dembner’s piece:

“If the bids are high, extreme copay and premium increases for low-income families are not a morally or fiscally sound solution,” she said. “Massachusetts healthcare reform, which has been successful so far, was built on a foundation of shared responsibility.”

From today’s Washington Post, check out this story about the relationships between medical device makers and some/many surgeons who use their devices:

Four makers of artificial hips and knees paid doctors more than $800 million in royalties and fees in four years to influence their choice of implants, a U.S. investigator told Congress. The unidentified companies control about three-quarters of the $9.4 billion worldwide market for hips and knees, said Gregory E. Demske, an assistant inspector general at the Health and Human Services Department, at a hearing yesterday of the Senate Special Committee on Aging.

“Illegitimate” payments, the extent of which is unknown, influence orthopedic surgeons’ medical judgment and are so common that it will be difficult to eliminate the practice, Demske and other witnesses said. The fees have enriched doctors and distorted the market by bolstering sales of lower-quality devices, they said. “Industry and physicians are equally culpable,” said Sen. Herb Kohl (D-Wis.), chairman of the panel. “Some physicians make it known to the companies that they will be loyal to the highest bidder. Where does the patient’s well-being fit into the equation?”

Check out this from a doc who is committed to stopping these practices:

Efforts to curb questionable consulting fees have failed so far, said Charles Rosen, an Irvine, Calif., orthopedic surgeon, who started the Association for Ethics in Spine Surgery. He testified that he was vilified by leaders of his medical specialty, including medical journal editors, because of his opposition to company payments.

“I don’t believe the medical societies are capable of doing it, nor the industry,” he said. “It is so embedded now among most of the people running these societies, including the educational foundations, that I don’t think it’s possible to change that without something from the outside happening.”

It’s not just the inappropriate influence of pharmaceutical companies that needs to be addressed. It’s the medical device makers, too.

From today’s State House News Service, much anticipated:

Senate President Therese Murray, who has been working on legislation to control rising health care costs, will outline her proposal Monday in Worcester. In a media advisory, Murray’s office said her bill will “advance the next phase of health care reform in Massachusetts.” Murray will host a press conference at 11 am at UMass Medical School, where she will be joined by Health Care Financing Committee Co-chairman Sen. Richard Moore (D-Uxbridge), UMass President Jack Wilson, and UMass Medical School Chancellor Michael Collins. Critics of the current system say surging costs threaten to undermine the 2006 law expanding access to health insurance. There have also been increasing calls to promote transparency in health care in an effort to hold health care providers accountable and give consumers more information about choices.

The Connector issued the following statement today (Wednesday) after 5:00 p.m.:

Connector Board Chairwoman and Secretary of Administration and Finance Leslie Kirwan announced today that Thursday’s Connector Board meeting has been postponed. The following is a statement from Secretary Kirwan.

“As the Commonwealth Care bid process moves forward, it is apparent that more time is needed to not only analyze the premium bids for Commonwealth Care, but also to determine how they relate to proposed cost-sharing decisions.

“The postponement is a prudent course of action. The bids we received were not satisfactory. As we continue to accumulate information, we want to be deliberate about making key decisions.”

We agree that this was prudent, and appreciate the Connector’s willingness to take more time to get it right. Earlier today, ACT!! had sent a letter to the Governor, as did a majority of the Senate, organized by Senator Montigny. Community Partners released the valuable results of their survey showing widespread opposition to the proposal as formulated.

We look forward to a collaborative process with the Connector and stakeholders as all of us committed to expanded health coverage in Massachusetts confront the ongoing challenges.

Nineteen health policy experts (one MA signer — MIT’s Jon Gruber) issue an open letter to presidential candidates complaining about the tone of the dialogue on health care, key excerpt:

Unfortunately, the Obama campaign is circulating in Ohio and elsewhere its “Harry and Louise” mailers that unfairly and unconstructively attack Senator Clinton’s universal health care reform plan. These mailers purposely revive “Harry and Louise,” the actors hired by the insurance industry to help destroy health reform in the first Clinton Administration. They make the inaccurate claim that the plan would force people to purchase unaffordable health insurance. Senator Clinton’s plan clearly recognizes that universal coverage cannot be achieved unless health coverage is affordable, and her plan provides subsidies to ensure it is affordable.

The “Harry and Louise” mailer literally takes a page from the playbook of the health insurance industry and other special interests which spent over $300 million to kill any meaningful healthcare reform in 1993-94. It undermines serious dialogue on needed changes to the health care system.

We call on all candidates for President to recommit to a civil, positive discourse that does not undermine the larger goal of quality, affordable healthcare for all Americans. To that end, we urge Senator Obama’s campaign to cease using a mailing that is clearly inconsistent with this goal.

Click here for the New Republic take on the issue, as well as the full letter and all signatories.

Click here for Gov. Deval Patrick’s testimony today before the House Energy and Commerce Committee in Washington DC on the State Children’s Health Insurance Program.

This morning, Governor Patrick was in DC to testify in support of overturning the Bush Administration’s August 17 2007 guidance on SCHIP. Last August, HHS issued new regulations on SCHIP implementation that will have hindered states’ ability to provide health coverage to children who would otherwise be uninsured. Governor Patrick joined the chief executives from Washington, Ohio, Mississippi, and Georgia in calling on Congress to roll back the Bush Administration’s actions.

Since its passage in 1997, SCHIP has been hugely successful in helping millions of kids across the country access health coverage. Here in Massachusetts, 90,000 children receive SCHIP benefits. If the August 17 regulations are not turned back, 4,500 of those kids who are in between 250-300% of the federal poverty level ($53,016-$63,612 for a family of four) may lose their coverage.

Here’s a bit of Patrick’s testimony:

So, I want to be as clear as I can be. Without continued federal support for and flexibility within the SCHIP program, Healthcare Reform in Massachusetts and elsewhere is in jeopardy. Given the benefits to children, to families and to our economy, and the many salient lessons to be learned from Massachusetts and other states on solutions that could work nationally, it is hard for me to understand why we would seriously consider limiting or reducing the reach of either the Commonwealth’s agreements with CMS or the SCHIP program as a whole.

This Thursday, 2/28, the Connector Board will vote on raising copays and premiums for CommCare. The Greater Boston Interfaith Organization (GBIO) has done an excellent job of gathering CommCare consumer stories and their real-life budgets. Read Yolanda’s letter to Gov. Patrick below to learn how raising copays and premiums will affect her life.

Community Partners created a two minute survey to poll opinions of CommCare enrollees, the outreach and enrollment community, and providers who service the CommCare population. Please take the survey if you are in one of these categories or pass it along to your network. The survey will close Tuesday at 12:00pm.

We will post more consumer stories on the ACT!! webpage and the Blog throughout the week. Check back here and the website for new updates!
***********************************
February 21, 2008
Dear Governor Patrick, Connector Board members and Legislators,

My name is Yolanda Pires and I live in Jamaica Plain. I am 52 years old. I work as a family day care provider in my home. I have been doing this work for 20 years.

I had free care for almost 10 years. I now have Commonwealth Care and I pay $74.98 each month. And I also pay $10 a month in co-pays for my medicines.

I am worried that the prices for Commonwealth Care are going up. My income fluctuates depending on how many children I am caring for. I have attached my budget to this letter.

As you can see, I don’t have a lot of extra money each month. I live alone and therefore I must pay for everything myself. While some months I can afford all of my bills, unfortunately, there are many months that I can’t so, I just wait to pay it. I would like to own a car, but I can’t afford it. I am glad to have a job and I know that I can pay the bills at some time. But I am not able to save.

It would be very hard for me to pay more for Commonwealth Care. I only see a doctor maybe 3-4 times a year. Thank goodness I am healthy. Please do not raise the prices.

Sincerely,
Yolanda Pires

Yolanda Pires: my monthly budget
Income: varies from $1400-$1600.00 a month after taxes

Rent $574.00
Gas Heat: $167.45
Electricity: $84.69
Food: $250.00
Household supplies, prescription co-pays, : $50.00
Commonwealth Care: $74.98
Phone: $99.67
Paying for an assistant to help me with the kids at my daycare. (varies)$300.00
Bus/Train $10.00

Total spending: $1,610.79

Word is that Sen. President Therese Murray’s cost control legislative proposal is coming soon — maybe this week or next. As we kick off what we hope will be a vigorous cost control discussion, it may be helpful to start with a joint reading project. I have a book suggestion — Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer – by Shannon Brownlee of the New America Foundation.

Health policy specialists identify three categories of poor quality — underuse of necessary care, misuse of care, and overuse of unnecessary care. Overtreated is an entire volume devoted to understanding the third category. A lot of it is familiar terrain — prescription drugs, imaging, bone marrow transplants for breast cancer. Yet it’s powerful to read all these examples of overuse assembled in one volume.

Many prominent health thought leaders, such as Dr. Don Berwick at the Institute for Healthcare Improvement, have asserted for years that as much as one third of health spending is clinical waste. Overtreated is a great compendium to back up this assertion. And it’s an appropriate place to start the health cost control conversation.
John McDonough

From State House News Service:

The Massachusetts Health Care Quality and Cost Council will miss its March 1 deadline to make comparative health care information available on its website. “We’re not going to make it,” said Katharine London, executive director of the Massachusetts Health Care Quality and Cost Council. State law calls for the council to include comparative cost information by health care facility and by categories such as physician, diagnostic test, and therapeutic procedure. London told the News Service the council has conducted a phone survey and a focus group to get feedback on the the site’s design, which is complete. The council approved last week the hiring of Cambridge-based Medullan to build the site, she said. The council’s site does list cost and quality information by hospital and for specific medical procedures, but the data isn’t easy to get to, said London. “We want to make something that’s really user-friendly,” she said. “We’re just going to try to meet the spirit of the law as fast as we can.” The council is chaired by Health and Human Services Secretary JudyAnn Bigby. London said the council plans to have the site up in June.

Two noteworthy and worthy additions to the health blogging universe have come to our attention.

The Connecticut Health Policy Project has started the CT Health Notes Blog, a great new source of health policy information and analysis from the Nutmeg State (or is it the Constitution State?). Blogger-in-Chief Ellen Andrews says they were inspired by get rolling at a blogging workship in late January at the FamiliesUSA conference in DC. Great to have another state take advantage of this outlet, and welcome aboard!

Next, Michael D. Miller, a local MD consultant with lots of Washington and industry experience, has started the Health Policy and Communications blog with an emphasis on the intersection of clinical and economic factors in the US healthcare system – and comments on what is going on here in MA – particularly as it relates to national issues/initiatives. Worthy of a bookmark.

Welcome both!

The Affordable Care Today (ACT!!) Coalition has created a web page focused on the controversial proposals before the Connector Board to raise premiums as much as 14.3% and to double and triple many co-pays faced by program enrollees. Click here for the new page and learn how you can take action today. The vote is now scheduled for next Thursday’s Connector Board meeting.

Some of you will recall our earlier posts on the controversy over the use of “checklists” to improve quality — click here for the latest summary post. Briefly, Brigham & Women’s Surgeon Atul Gawande wrote a great essay in the New Yorker Magazine in December on how the use of a simple “checklist” has been proven a powerful clinical quality improvement tool. Turned out, though, the federal government wanted to submit use of the checklist to a cumbersome human subjects review process that would have strangled use of the checklist.

On February 15, the feds announced a new policy that will not require such review and process. Click here for the Office of Human Research Protection announcement. We hope this is the end of this controversy, though we’ll keep an eye on it.

Kudos to Dr. Gawande for making an issue of this. Oh yeah, and double kudos to Dr. Peter Pronovost of Johns Hopkins for pioneering the approach.

Now let’s hope folks in Massachusetts start joining the “checklist” bandwagon.

To include or not include cost information on the Quality and Cost Council’s forthcoming website by its first launching date – that was the big debate at Wednesday’s Quality & Cost Council’s bimonthly meeting.

The Council is mandated under MA Law “to disseminate, through a consumer-friendly website and other media, comparative health care cost, quality, and related information for consumers, health care providers, health plans, employers, policy-makers, and the general public.” While comparative quality data are at final stage and ready for the website, the Council may want to further massage the cost data.

Some Council worried there is “no second chance at making first impression” and would rather wait to have more solid and meaningful cost data to post. The Council’s goal is to present useful and informative cost data to consumers and not just any data. Members voiced concerns that the data was not user-friendly and will require further work before it can be posted. The debate will continue on whether or not to publish the cost data on the Council’s website by its first launching date – now set for March.
Su Yoon

As debate begins on the Governor’s FY 09 budget, some have questioned Gov. Patrick’s proposal to create an Office of Health Equity at the Executive Office of Health & Human Services. The Disparities Action Network responds.

Why does Massachusetts need an Office of Health Equity?
People of color have worse health outcomes than the majority population on nearly every key health indicator in Massachusetts. Despite health access expansion, people of color bear an unequal burden of disease and death that is costly and unconscionable. The proposed Office creates a permanent central place in state government to spearhead efforts to eliminate disparities. There is currently no home for leadership and activity on disparities, despite the wealth of state and national research documenting the pervasiveness of disparities and solutions. The Office would coordinate efforts by state agencies to eliminate disparities, and oversee grant programs to demonstrate best practices. This office can provide direction, technical support and resources for public health commissions, state and local public health departments, and other agencies on disparities, while monitoring and evaluating our progress.

Why should the Office of Health Equity be located in EOHHS?
Health disparities involve many social, economic, and behavioral factors beyond access. Much research demonstrates relationships between social determinants (housing, education, transportation, employment etc.) and poor health. Locating an Office of Health Equity in the Secretariat allows the Office sufficient coordinating impact over a wide range of agencies to ensure that disparities elimination is integrated into all relevant initiatives of state government.

Aren’t there existing councils addressing health disparities issues?
The health care access law, Chapter 58, established two councils with relevance to disparities: the Quality and Cost Council and the Health Disparities Council. The Quality Council’s efforts focus on cost reduction and quality improvement. The reduction of disparities as a quality improvement effort has not been a major focus of the Council amidst a multitude of other quality and cost issues. The Disparities Council has met only once and is just beginning to outline a plan of action. This council can play an important role in advising state efforts, including a new Office of Health Equity, but cannot lead a major effort that coordinates state wide efforts, administers grant programs, and evaluates state progress.
Elmer Freeman, DAN Co-Chair

HCFA is pleased to announce this year’s recipients of our Community Leader Awards. These awards honor leaders make a difference in improving health and health care in their communities through outstanding advocacy, organizing and other means. The awards will be presented at this year’s Policy and Organizing Conference — click here for info and registration.

This year’s Community Leader Award recipients are…

Lisa Vinikoor, Community Organizer for the Greater Boston Interfaith Organization, for her tireless advocacy and organizing, constantly traveling the state to help individuals and families gain a voice in the health care system.

The Disparities Solutions Center for providing essential research, education, and training for the movement for health care equity and for the elimination of racial and ethnic health disparities.

And Lisa Nash, an invaluable and courageous leader in the Consumer Health Quality Council.

Hope you can join us on March 28th.

This morning, the Legislature’s Joint Committtee on Public Health reported favorably our health care quality bill, S. 1277, An Act Promoting Healthcare Transparency and Consumer Provider Partnerships. The bill includes the top priorities of our Consumer Health Quality Council, and members have been working hard all session to move it forward.

We worked closely with Public Health Committee staff to produce a redraft. Thanks to the offices of Chairmen, Rep. Peter Koutoujian and Sen. Susan Fargo. The bill would:

1. Require hospitals to establish Patient and Family Councils
2. Require use of Rapid Response Teams in hospitals
3. Establish public reporting of hospital-acquired infections and set a statutory goal of “zero” for all infections
4. Establish public reporting of “never events” such as wrong site and wrong person surgery
5. Permit providers to apologize for adverse events without the apology being used in malpractice actions

The Committee deleted one provision — requiring all providers to disclose “adverse events” to patients.

At last week’s Public Health Council meeting, DPH Commissioner John Auerbach presented Sen. Moore (the bill’s lead sponsor) and Rep. Koutoujian with “Recognitions of Appreciation for Leadership” for their “bold and effective leadership” in addressing hospital acquired infections and their work to improve quality. With the legislative activity,the DPH work, and the growing groundswell from consumers, providers, and payers, this may be a banner year for health care quality.

We look forward to these reforms moving through the process. Next stop: Sen. Moore and Rep. Walrath’s Health Care Financing Committee.
James Madden

Folks are beginning to believe national health reform will be a real possibility beginning in 2009 with a new president and Congress. And reform proposals are starting to advance. Here’s a Lewin Group analysis of the “Health Care for America” plan to create a new national health insurance pool modeled after Medicare that calls for employers, individuals and the federal government to share responsibility, a national “pay-or-play” model developed by the Economic Policy Institute. From today’s Kaiser Report:

According to the report, the proposal would reduce the number of uninsured U.S. residents by 46.5 million people, or 97.3% of the uninsured. The report also finds the program would control health care spending by limiting provider payment increases, negotiating deeper prescription drug discounts and streamlining administration. The report estimates that under the proposal, total national health spending from 2008 through 2017 would be about $1.04 trillion less than under the current system.

It’s about health, and it’s not about health. Sometimes it’s hard to tell the difference. Anyway, click here for a site that provides the clearest, plainest explanation of social networking, social bookmarking, blogs and wikis you are ever going to see. These are some of the places the internet is going — what it means for health care and everything else — who knows. But enjoy the ride. Thanks to HealthBlawg for the heads up.

Lots and lots of interesting details from this State House News Service account of MA Health & Human Services Sect. JudyAnn Bigby’s testimony this past Friday on the Adminstration’s FY09 budget proposal for Health & Human Services:

FRANKLIN, FEB. 15, 2008…..Reprising Gov. Deval Patrick’s warning to lawmakers of the “cost of inaction,” Health and Human Service Secretary JudyAnn Bigby said on Friday the governor’s budget is a mix of cuts, reforms, efficiencies and targeted investments that lay the groundwork for economic growth.

“Failing to make these targeted investments will weaken the very assets that make Massachusetts a wonderful place to live, work and grow a business,” she told House and Senate budget chiefs at a hearing in Franklin.

Bigby is the overseer of 16 state agencies that take up nearly half of the $28.2 billion budget, at $13.54 billion. That’s a 4.5 percent increase over the allotment in the budget enacted last year, according to state officials. In testimony and prepared remarks, state officials touched on the state’s Medicaid waiver extension, which is pending before the federal government, efforts to curb prison suicides, and being patient in the face of rising health costs.

Highlights from Friday’s public hearing hosted by House and Senate Ways and Means committee members:

– A senator on the budget committee questioned the need to establish a $1 million Office of Health Equity within the health and human services secretariat, as the health care side of Patrick’s budget does. Sen. Karen Spilka (D-Ashland) pointed to the existing Health Care Quality and Cost Council and Health Disparities Council as already tackling the issue of ethnic and racial disparities. “Neither of those entities is responsible for day to day activities that would move us toward eliminating disparities,” said Bigby, who chairs the cost council. The office would coordinate efforts across the agencies and other secretariats, with a director providing staff support to the Health Disparities Council, and provide an annual report card that tracks progress and the effectiveness of programs across the state, according to her testimony. Rep. Byron Rushing (D-Boston) filed a bill last year, with 40 co-sponsors, creating a similar office.

–The state council involved with the cost control side of health care reform, the Health Care Quality and Cost Council, is getting its budget raised to $1.9 million under Gov. Patrick’s fiscal 2009 plan. But the figure falls below the $2.3 million request its executive director urged in December. Requesting specifics on the council, Sen. Karen Spilka noted that the council’s website for consumers has yet to go online, saying this “spring would be nice.” Secretary Bigby appeared reticent to set a firm date, with later this year as a better bet. Bigby said the legislation establishing the council requires it to collect every piece of health care claims data. “You have to realize, this represents millions and millions of pieces of data,” she said. The council has hired a company to go through that process and another company to do focus groups for the future website. Bigby said the council meets next week to discuss how they will contract with a vendor and figure out how to get the data, analyze it and post it on the website. Asked by Rep. Mary Grant (D-Beverly) if a person with a clinical background needs to be added to the council’s make-up, Bigby pointed to the council’s advisory board. “The number of people who can sit on that advisory committee are endless, quite frankly,” she said, adding that she recently made some suggestions to the governor on a few names that could be added.

– State and federal officials are working on an extension to the state’s Medicaid waiver, health care reform’s core financing mechanism, Medicaid officials said Friday. The current three-year, $11 billion waiver ends on June 30, and state officials are seeking an additional three years and upping the number to $13 billion. “I think it’s fair to say we’re solidly in the fact-finding stage with CMS [federal Centers for Medicaid and Medicare Services] about what exactly’s happening in Massachusetts, what we think is going to happen with health care reform moving forward,” Tom Dehner, the state’s Medicaid director, told lawmakers. Gov. Patrick’s budget includes $8.6 billion for MassHealth, the state’s Medicaid program, a 4.4 percent increase over last year’s budget.

– Some members of the state’s business community can breathe a sigh of relief, for now at least: Health officials say they haven’t yet decided whether to increase the $295 per employee charge upon employers that do not make a “fair and reasonable” contribution to their employees’ health plans. “We’re doing a bunch of analyses, looking at that issue,” said Secretary Bigby. “We need more data. I wouldn’t specifically say it’s on the table.” Added Sarah Iselin, commissioner
of the Division of Health Care Finance and Policy: “It’s still early.” Lawmakers pushed health officials to use the reports they’ve been developing. The division is expected to put out a number of important reports in the next few months, including a cost-and-benefit analysis of the health care reform’s various mandates, a biennial survey of Massachusetts employers and their health insurance policies and practices, and the division’s legislatively-mandated list of employers with 50 or more employees using public health assistance each year. The division has reconfigured the methodology for the latter, and it “will support a more accurate count of employees and expenditures than we have been able to capture in prior years,” Iselin said. Lawmakers also voiced concerns that while some businesses are struggling under the weight of the health care law, there are others that have more employees using public health assistance than they’d like to see. Rep. Paul Loscocco (R-Holliston) asked if they were finding any evidence of corporate employers restructuring, possibly setting up two corporations with 10 employees each in a bid to get around the health care law, which applies to employers with 11 employees and over. Bigby said she had spoken with Labor Secretary Suzanne Bump, who can monitor that kind of information and had said that the restructuring costs would amount to too much.

–As lawmakers pressed her and her top aides on rising health care costs in the headlines, Secretary Bigby pleaded for them and others to wait and see the results of the state’s massive health care reform effort. “Massachusetts has to
be patient and make sure we don’t say it’s too expensive before we allow it to work,” she said. Costs will eventually trend downward, she and other health care officials said, pointing to an announcement, reported by the News Service Wednesday, showing that state’s six largest non-profit health plans will hold average premium increases in the Commonwealth Choice program to five percent, rate limits that were accompanied by some benefit changes. “It’s certainly better than 8, 9, 10, percent,” Bigby said.

The Connector Board met today for the first of three meetings during which they will set new affordability standards, and premiums and cost-sharing for Commonwealth Care and Commonwealth Choice (see materials here).

Affordability and cost control generated intense debate. Staff proposals on the affordability schedule and CommCare copays were scrutinized – Board members debated state cost, financial impact on consumers, and the crowd-out threat. The task is tough, and the debate is healthy - it leads to greater transparency and more informed decisions. We look forward to the next six weeks!

Executive Director’s Report
Jon Kingsdale began by emphasizing achievements realized in implementing Health Reform. There have been numerous tests and challenges. And, the Connector implemented a successful CommCare program and prices for non-group coverage have seen a marked decrease, to name a few. The biggest challenge ahead is cost. There are signs of success, such as CommChoice bids that produced below-market premium increases.

CommChoice Seal of Approval
The first issue was CommChoice renewals. Bob Carey presented staff recommendations on FY09 CommChoice plans. The staff evaluated renewal bids on four factors:
• Percent and dollar amount of premium increases
• Affect of proposed benefit changes on out-of-pocket costs
• Affect of proposed benefit changes on the relative plan value
• Potential member disruption created by modifying plans

The average premium increase was 5.1% (from a low of -2.7% to a high of 9.9%, both in the YAP level). This is good news because the average increase in Massachusetts premiums has been double-digit for the last eight years. However, the “savings” won’t be free for consumers. To achieve lower premium increases, two-thirds of the plans changed benefits (including all 6 Gold plans, 5 of 12 Silver plans, 4 of 6 Bronze plans, and 5 of 7 YAPs). The staff didn’t detail changes, saying the majority of changes involved adjustments to cost-sharing, particularly prescription drug cost-sharing, and/or the drug formulary (people now in plans being adjusted can keep coverage as is or move to a new plan). Carey said many plans that include drug deductibles exclude “Tier 1” drugs from the deductible, as the Connector requested. No plans that previously had not offered a select-network Bronze plan opted to offer one in addition to their broad-network plan in the Bronze level, as the Connector requested. Fallon currently offers only a select-network Bronze plan and has opted to offer both that plan and a broad-network Bronze next year.

In response, Lou Malzone expressed concern with the increasing complexity of the offerings, which may result in confusion and administrative costs. He and Dolores Mitchell asked staff to study having all carriers offer a limited set of identical plans. Nancy Turnbull asked staff to report on the premium impact of getting rid of the annual benefit caps in YAPs and how many enrollees are hitting the caps. The board will vote on the final CommChoice contracts with carriers on March 20th.

MMCO Contracts
Next the Board turned to MMCO Contracts. Jamie Katz wasn’t joking when he said he would talk a lot without saying much. Aside from noting a “frank and vigorous” discussion, he gave no details. He offered to take questions and no one took up his offer. The staff anticipates providing information at the next Board meeting (February 28th).

CommCare Enrollee Contributions and the Affordability Schedule
The Board took on proposed changes to the Affordability Schedule and proposals for CommCare enrollee contributions together since the first few tiers of the Affordability Schedule (0-300%FPL) mirror the CommCare premiums. Secretary Kirwan set the stage, emphasizing the goal of balancing affordability and fairness and turned the mike to Patrick Holland and Melissa Boudreault, who presented the goals and data.

A few data sets informed proposed changes. The staff looked at the level of contribution for typical ESI plans, median incomes for Massachusetts residents and premium trends for the CommChoice Bronze plans. Celia Wcislo questioned underlying assumptions with this approach. Wcislo asked why staff hadn’t looked at rates of increases in salaries and cost of living. Turnbull pointed out that the CommCare rungs (up to 300%fpl) experienced an average increase of 14% (the staff proposed raising CommCare contributions from $35 to $40, $70 to $80 and $105 to $120), while the upper end of the schedule increased by 5-10%, making the changes regressive.

Wcislo argued they shouldn’t base what is affordable for low-income groups on small group market rates. She emphasized the new premium and cost-sharing proposal is a significant jump for consumers. Turnbull echoed that, reminding the Board that what we’re talking about is an “affordability” schedule, and coverage offered by employers may not be affordable. The affordability schedule should not be led by an “unaffordable” standard. Wcislo argued the Board should look at all stakeholders to share the financial burden, including insurers and providers.

Boudreault emphasized that the premium payment rate in CommCare is high and demonstrates that current premium levels are indeed affordable.

Kingsdale agreed they need to be mindful of individual situations but reiterated the dangers of crowd-out. He said that 625,000 low-income individuals are taking employer coverage. Enrolling even 1-2% of that population would jeopardize the sustainability of the program.

CommCare Copays
Holland turned to the staff recommendations for new copay structures for CommCare. He outlined next steps in the MMCO bid process, explaining that no vote would be taken today. Delaying the vote allowed time for a robust discussion on these critical decisions. We thank the Connector for continuing to value transparency and process!

Copays in the plans have been raised to move closer to (and sometimes above) small group market standards (detailed info included in the materials). The Board debated this and proposed out-of-pocket maximums, which increased along with the copays in the proposal for plan types II and III. In plan type III, out-of-pocket maximums for drugs were eliminated altogether. Members felt that copays for generics should be maintained as low as possible and that out-of-pocket protections are essential for members.

Similar to concerns raised during the affordability debate, the question of why small group standards were used as benchmarks came up again and Turnbull suggested it is more appropriate to look at cost-sharing in large group plans because most individuals in employer plans are in large groups. Board members requested more data and information to compare the value of the current plans to proposed plans, and several members asked about the amount of savings gained through these changes. The staff will work to gather this data for the next meeting.

Emergency Regulations Approval
Before closing, the Board approved final regulations on Eligibility and Hearing Process for CommCare and Affordability for the Individual Mandate. Katz provided a summary of the changes, most of which were technical clarifications reflecting current practice.

Mr. Katz stated the Connector received testimony and comments from a number of organizations and adopted a few recommendations. He stressed that the majority of requests were substantive and CommCare and the Affordability regulations needs more time and consistency under current standards before major changes can be contemplated.

The excitement continues in two short weeks on February 28th. We’ll be there!
Diana Ong and Lisa Kaplan Howe