As we move into our third year of health reform, Massachusetts has surpassed expectations when it comes to covering the uninsured. At the same time, Massachusetts tops the nation in overall health care spending per capita, and our medical trend far exceeds the national average. We will not be successful long-term unless we begin to control health care spending. Thanks to the leadership of Senate President Murray, we have an opportunity for a serious conversation about cost control. Senate President Murray’s bill offers a multi-pronged approach to controlling costs and improving the effectiveness of our health care system. Her bill contains many good ideas, and I applaud her efforts.

The conversation about controlling costs must begin with greater public disclosure of health care cost and quality information. Public hearings involving both insurers and providers can and should serve as the forum to provide this information.

For a number of reasons, the Massachusetts Association of Health Plans and Harvard Pilgrim believe that the Health Care Quality and Cost Council should conduct these public hearings. Read more…

At the legislature’s request, the Connector board is looking at ways to cover 30-to-40,000 low income residents many of whom can’t afford their share of employer sponsored health insurance. Anyone who is offered insurance at work, and doesn’t take it, is not eligible for Commonwealth Care. If the state lifts that restriction, those 40,000 plus roughly 670,000 more low income employees (most of whom currently buy into their company plan) and their children could switch to the cheaper state subsidized plan. Connector board chair Leslie Kirwan says that’s big concern.

That said, there’s clearly a sentiment that low income workers who may not be able to afford their employer sponsored insurance are a group that we should keep in mind for Commonwealth Care if we can figure out a way to do it responsibly.

But some Connector board members say it is not responsible to consider lifting limits on who qualifies for subsidized insurance right now. Read more…

The Department of Public Health is considering a statewide ban on trans fats to help control rising obesity rates. Commissioner John Auerbach says he is studying implementation of trans fat bans in New York City, Boston and Brookline. Auerbach says he is worried about how eliminating use of cheaper oils would affect small restaurants. The commissioner hopes to follow the smoking ban model with trans fats by building a broad coalition that supports the change.

At the State House, Rep. Peter Koutoujian has already filed a bill that would ban trans fats.

” When we ingest trans fat we are actively sabotaging our health, increasing our chances of developing serious life threatening illnesses such as heart disease.”

The bill is in committee.

The National Restaurant Association says local or state governments should not ban a product approved by the Food and Drug Administration. The association says many restaurants will go back to using oil that is high in saturated fats, which is at least as unhealthy, but is comparable in cost. Others opposed to a ban argue that government has no business limiting individual choices which, unlike smoking, pose no health risk to the general public.

THE NUMBER OF MASSACHUSETTS RESIDENTS WHO WOULD QUALIFY FOR SUBSIDIZED HEALTH INSURANCE…AND THE COST OF THAT COVERAGE IS RISING…AGAIN. ESTIMATES FOR THE NUMBER OF RESIDENTS WHO WOULD QUALIFY FOR COMMONWEALTH CARE HAVE RISEN FROM 140-THOUSAND TWO YEARS AGO TO 225-THOUSAND EARLIER THIS YEAR TO NOW…255-THOUSAND. THAT REVISION(PG.28) WOULD INCREASE THE COST OF SUBSIDIZED COVERAGE FROM 869-MILLION TO ONE-POINT-ONE BILLION DOLLARS NEXT YEAR. RICK LORD REPRESENTS BUSINESS INTERESTS ON THE CONNECTOR BOARD.

I’m hoping that state estimate is on the high side because if it’s not, that obviously presents a challenging budget situation in what is already a challenging budget year. Read more…

Transparency — the new moral imperative — has much to recommend it, but it is not a panacea. Giving people information about health care providers, or health plans, may or may not make them better “consumers” — whether the information is about price or quality. Indeed, a lot has been written in recent months about the unanticipated effects of price transparency — not all of it giving aid and comfort to those purchasers who are hoping that providing information will turn their enrollees into frugal, money saving consumers. “It ain’t necessarily so” — and not just because the information is complex and not easily transmitted. We have the price-placebo effect, — I personally like to call it, “The Neiman Marcus effect” — if the price tag is big enough, it has to be better — or, more academically put by behavioral economists, people tend to value stability more than change, and fear loss more than appreciate the potential benefits of change.

The point of these cautionary notes is not to criticize or denigrate transparency. Read more…

I am a officer manager for a small family owned company. I had health insurance through the company until last May when I went part time so I could be home more to care for my mother who has Alzheimers. As a part-time employee, I was no longer covered and had to paid the whole insurance bill, which at the time was 500.00 dollars. That was a hardship considering I no longer was getting a full paycheck.

I tried a few insurance companies before finding out about Commonwealth Care. There plans were not that good and costly. But with the help of Health Care for All I found about Commonwealth Care and they helped me to enroll and get started on the plan.

I have gone for my yearly physical blood work, mammogram. It is great coverage I have not had any out of pocket expenses just my co-payments which are very good. It’s a really good plan and a big price difference from 500.00 to 35.00 a month. If not for this I would not have been able to go part time. With every thing else that is going on I am glad I have good health insurance. It makes things easier for me.

Kathy Riley, Wilmington

Our state – this Commonwealth – is founded upon one of the great themes of religious faith – the responsibility to care for each other and for those less fortunate. The very meaning of the term “commonwealth” reflects a concern and caring for the public good – a covenant among members of the community for the welfare of the least among us.

In his noteworthy sermon aboard the Arbella entitled, “A Modell of Christian Charity,” our first Governor – John Winthrop – admonished the first citizens of the Province of Massachusetts Bay with a clear statement of our civic responsibility as a reflection of our actions as people of faith. No document better exemplifies the spirit behind the Puritan migration to the New World, effectively summarizing the goals of these first American Puritans.

Winthrop said that “to do justly, to love mercy, to walk humbly with our God,… we must be knit together in this work [of building a new society] as one man, we must entertain each other in brotherly affection, we must be willing to abridge ourselves of our superfluities for the supply of others’ necessities, we must uphold a familiar commerce together in all meekness, gentleness, patience, and liberality, we must delight in each other, make others’ conditions our own, rejoice together, mourn together, labor and suffer together, always having before our eyes our commission and community in the work, our community as members of the same body.”

A Modell of Christian Charity, 1630 Read more…

The Congressional Budget Office says a bill that would establish health coverage for all Americans would be budget neutral once fully implemented. Here’s the letter from the CBO and the Joint Committee on Taxation to Sens. Ron Wyden and Robert Bennett. The legislation:

1) gets rid of employer based insurance (employers that contribute to coverage would give employees that money at first, and eventually shift to a federal health coverage tax)
2) requires all Americans to have health insurance
3) offers subsidized coverage up to 400% FPL (Mass is up to 300%)
4) sets up purchasing pools (like the Connector) Read more…

It is time to make the MassHealth/Commonwealth Care outreach and enrollment grants permanent. With the passage of health reform, these grants have been essential to help facilitate enrollments in the new public health insurance plans.

With the implementation of health reform and the health insurance mandate, it is essential that individuals in each community have local access to needed information and to be able to enroll in all public health programs in their own communities.

An historical perspective here may be helpful: Prior to October 1995, Massachusetts residents enrolled in public health insurance programs through local Department of Public Welfare offices, where individuals had designated workers. At the time there were only six categories of MassHealth, but still, individuals found that having relationships with workers helped facilitate successful enrollments. Read more…

Connector Board member and former First Deputy Commissioner of Insurance, Nancy Turnbull has written often about how health insurance companies are doing under Massachusetts’ healthcare reform.

In a nutshell, they have done well, very well indeed. 2007 data shows hefty profits for the state’s “non-profit” health insurance companies. More importantly, the data shows these companies are well positioned to contribute more towards the rising costs of healthcare reform. Over the last five years, the major health insurers in the state have earned more than $2 billion in profits, and at year-end 2007 had combined reserves of nearly $3 billion. The majority of profits and surplus have been accrued by BCBS, the state’s largest health plan, but most other carriers have done well also.

Since 2006, close to 100,000 people have privately bought health plans (which based on an average annual premium of $3,000-$4.000 a year means an estimated $ $300-$400 million in new revenue). Read more…