health reform law


Looking Back: What Really Happened At The Start Of Mass. Health Reform

A lot of Obamacare supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion.

But back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried.

Here’s why:

2006 Romneycare handshake

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state’s universal health coverage law at Faneuil Hall in Boston. (AP File)

1) It looked like the state had, by a lot, underestimated the number of people who would be eligible for free and subsidized coverage. (In 2006, the estimate was 140,000. By April 2008, the estimate rose to 225,000, based on early sign-ups. Enrollment plateaued at 177,000 in 2009.)

2) A dramatic increase in first enrollment put a strain on doctors and health care services at every level.

3) Patients, many of whom had not had insurance for years, had a lot of problems they hadn’t taken care of and were seeking more tests, surgery and other treatment that drove up costs.

4) State budget watchers started to panic. The governor’s office kept going back to the Legislature to ask for more money and a few top lawmakers began to question whether the state could afford to fund the coverage law.

5) Employers saw an increase in workers who, to avoid the individual mandate penalty, signed up for their employer’s coverage, which increased employers’ outlays for health insurance.

Of course we don’t know if people who’ve gone without insurance around the country will behave like Massachusetts residents.  Continue reading

How ‘The Berwick Report’ May Play Out In Massachusetts

Dr. Don Berwick, a candidate for governor of Mass.

Dr. Don Berwick, a candidate for governor of Mass.

Don Berwick, a Democrat, is running for Governor of Massachusetts. But yesterday, he issued a “Letter to the people of England.” The subject? Britain’s National Health Service (NHS) and Berwick’s recommendations for improving safety and restoring confidence after higher than expected death rates at one hospital rocked the country.

Berwick conducted his review and issued his report, pro bono, at the request of Prime Minister David Cameron. Today, he spoke with reporters in Boston about the health care and political lessons his work in the UK offers for Massachusetts.

Q: How do you think this report relates to people in Massachusetts. What do they take away from it?

A: Well…this report is not part of the campaign; I had agreed to do it prior to the announcement and getting people involved with the campaign, and the work does come to a close now, except for perhaps occasional advisory interactions. But this is about large system change, I mean, here you have a system with 1.4 million employees. That’s the size of the National Health Service, spending 100 billion pounds. And it’s a good example of how a very large system constantly needs the attention of leaders to the continual improvement of whatever it’s trying to accomplish. It’s an example of how the field I’ve been investigating for 30 years now, continuous improvement in quality, can be brought to scale. Continue reading

Bestselling Books: Surviving, Beating, And Hating On Obamacare

President Obama signing the health care bill into law

President Obama signing the health care bill into law

Hmmm. My odd compulsion to read every single entry on The New York Times bestseller list every Sunday has turned up an interesting phenomenon in the “Advice, How-To and Miscellaneous” category.

For two weeks in a row now, I’ve noticed that the paperback list has included these two books:

“ObamaCare Survival Guide,” by Nick Tate, described as “An explanation of and arguments against the Affordable Care Act.” That was at number three in the category this week. And:

“Beating Obamacare”  by Betsy McCaughey, described as “A handbook on the healthcare law from one of its critics.”

Clearly some great marketing minds have been at work. Much of the law kicks in beginning next year, and how can you not be concerned that its 800-plus pages might be studded with new rules that affect you, your insurance premiums, your medical bills?

But clearly so many great marketing minds are having the same idea that the field (perhaps it’s even a new genre? The “Surviving Obamacare” genre?) seems to be getting a bit crowded. On, I see that there are even two books with the same title: Tate’s, and another called “ObamaCare Survival Guide” with the subtitle, “The Affordable Care Act and What It Means for You and Your Healthcare.” It’s described as “a more objective and less partisan easy-to-read guideline to the law than the highly advertised Nick Tate’s ObamaCare Survival Guide.”

Readers, have you checked out any of these books? We’ll order them and take a look. We’ll also be shopping around for the best “What Will Obamacare Mean To Me?” material. Suggestions welcome. Harvard Professor John McDonough, himself the author of Inside National Health Reform, recommends MIT economist Jonathan Gruber’s health reform comic book as the easiest read for the lay public, but we’d note that it’s more of an overview than a guide to the nitty-gritty details.

Will The Debt Deal Hurt The Health Law?

Politico wonders whether the debt deal might profoundly undermine the federal health law?

Jennifer Haberkorn reports:

The debt ceiling agreement could jeopardize millions of dollars, and perhaps billions, in initiatives from President Barack Obama’s health care reform law if the super committee can’t come up with required spending cuts.

Many of the pots of money in the law — one of the Democrats’ most prized pieces of legislation — could get trimmed by the debt deal’s sequestration, or triggered cuts. The funds for prevention programs and community health centers, grants to help states set up insurance exchanges and co-ops, and money to help states review insurance rates could be slashed across the board if the panel can’t find enough cuts this fall.

Funding for the temporary high-risk pools for pre-existing conditions could be sliced, too, as well as grants to improve maternal and child health. And as previously reported by POLITICO, the law’s cost-sharing subsidies — which are supposed to help low-income people pay their out-of-pocket expenses — could face the ax, too.

A Birthday Mitt Romney Would Like To Forget

After signing Massachusetts' universal health care coverage law on April 12, 2006, then-Gov. Mitt Romney shakes hands with state Health and Human Services Secretary Timothy Murphy as Sen. Edward Kennedy and others look on at Faneuil Hall in Boston.

Five years ago today, then Gov. Mitt Romney stood near Ted Kennedy and Democratic leaders of the state House and Senate and said: “Massachusetts once again, is taking a giant leap forward.” With that, he signed the state’s groundbreaking health reform bill into law.

Romney, inching ever-closer to becoming an official GOP presidential candidate, is probably not doing a lot of celebrating today.

But as WBUR’s Martha Bebinger and Bob Oakes report this morning, the state’s health law is still front and center politically: with near universal access to health insurance achieved, phase two of the law, trying to contain costs, is the top legislative priority of Gov. Deval Patrick. And on the law’s fifth birthday, experts continue to assess its impact:

There is little solid research that shows residents are healthier or are living longer as a result of the law, but there are lots of individual tributes.

Dennis Foley was 59 when he walked into an emergency room two years ago with a life-threatening foot infection. While treating that infection, doctors diagnosed diabetes, high blood pressure and a heart problem — and signed him on to the state’s health insurance plan. This was his first visit to a doctor in 30 years.

“I ended up with a severe foot infection, went to Good Samaritan Hospital,” Foley said. “It was an 18-day stay. They enrolled me in MassHealth and [I’m] doing good.”

Foley is among the 98 percent of the state’s residents who now have health insurance. Five years after enacting reform, Massachusetts has the lowest uninsured rate in the country.

Here’s an assessment findings from the Blue Cross Blue Shield of Massachusetts Foundation on the law after five years:

–401,000 more Massachusetts residents have health insurance coverage than did before reform.
–Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
–There has been no evidence of subsidized coverage “crowding out” employer- sponsored insurance, and employer offer rates have grown from 70 percent to 76 percent since implementation of reform. Continue reading

American Spectator: RomneyCare Support ‘Toxic’ To Republicans

Former Massachusetts Governor Mitt Romney

The conservative magazine The American Spectator is taking Tea-Partier and U.S. Senator Jim DeMint to task for sounding like he’s supporting the 2006 Massachusetts health reform enacted under then-governor Mitt Romney. The magazine’s Philip Klein warns here that any seeming support for the Massachusetts reform may be downright “toxic” for Republicans:

…Beyond being ignorant, DeMint’s comments are dangerous. I’ve long argued that the Massachusetts health care plan is not only toxic to Mitt Romney’s presidential candidacy, but it could prove toxic to the entire Republican Party. If Romney is excused for crafting and signing the Massachusetts health care plan, it significantly undermines the case against ObamaCare and weakens the effort to repeal it. The reason is that opposition to ObamaCare will start to look increasingly political and less about principle. It’s true that a state mandate doesn’t raise the same Constitutional questions as the federal mandate, but it still is government forcing an individual to purchase a product. These comments are especially dangerous coming from DeMint, who is known as a leading conservative and ObamaCare opponent. Let’s hope it’s an isolated incident and not part of a broader trend.

Navigating Health Care In The State Of The Union

How will health law politics figure into Obama's speech tonight?

Politico suggests that President Obama has two goals tonight, in his first State of the Union address following passage of the health reform law:

1. Win over a wary public
2. Be brief

David Nather writes:

…the public is still deeply divided over [Obama’s] biggest legislative accomplishment. Anything he says will be picked apart by groups on the left and the right – not to mention the entire health care industry – for clues about how strongly he’ll stand behind the law.

So, the best strategy, he says, will be to concisely reiterate the health law benefits that have already kicked in — no insurance bans on pre-existing conditions, more coverage for preventative care, tax credits for small businesses — and then move on, leaving Republicans, who voted in the House last week to repeal the law, to bicker and fret over the details — at their own peril.

This time, Obama will talk about the benefits of the law and may make a case that it will help the economy in the long run, “but it will be brief,” said Neera Tanden, chief operating officer at the liberal Center for American Progress and a former top official at the Department of Health and Human Services during the health care debate.

Keeping the health care discussion short would set up a “nice contrast” with Republican efforts to repeal or withhold funding from the law, which could consume so much time on Capitol Hill that the Republicans themselves could face demands to spend more time on the economy, Tanden said.

And here’s Kaiser Health News with advice for the President from nine health policy experts on what to say about about health reform in the speech.

Warning: Since none of these unofficial advisees seem to have a sense of humor on this topic, here’s an older post from The Onion on some alternative health reform proposals. My favorites include:

Melancon-Cooper Bill: Would create a low-cost government-administered health insurance plan, but would prohibit anyone from buying into it

Griffith-Cantor Bill: Low-income families would be allowed to huddle outside hospital windows in the cold and look at wealthier families receiving care

Hutchinson-Snowe Bill: Children insured on a cuteness scale

Grayson Bill: Rep. Alan Grayson will personally punch in the face any insurance executive who turns down a valid claim

Blookross-Feiser Bill: Although no one is exactly sure who these two shadowy congressmen are, their bill would mandate a twofold increase in insurance premiums and force patients to buy name-brand drugs

Three Reasons To Worry About The Virginia Decision

Fallout from a judge's ruling that part of the national health law is unconstitutional

Ok, so this morning, to calm health reformers, I linked to a piece in The Atlantic called “Why The Health Care Ruling Doesn’t Worry Me.”

This afternoon, however, I spoke with Michael Doonan, an assistant professor of health policy at Brandeis, who says reformers, in fact, have a lot to worry about. Here are his top three concerns about the national health reform law following yesterday’s Virginia decision that the insurance mandate is unconstitutional.
1. Implementation Slow-Down

Even if ultimately found constitutional, the immediate danger for supporters of reform is that the decision will slow state implementation.  And it is not like the states are going gangbusters. Twenty states have brought suit against the individual mandate. In the most recent elections 11 governorships switched from Democrats to Republican governors.  In 29 states Republicans — most of whom oppose or ran against reform — are now responsible for implementation. How enthusiastically do you think they are the preparing for reform? The Virginia decision and media coverage add an element of doubt and bolster those who want to roll back or put the breaks on reform.  This decision will provide further “evidence” for these unenthusiastic states to sit on their hands.

2. Without The Mandate, Things Fall Apart

While the Obama Administration is confident that they will ultimately win this fight, they also declare that things like the Medicaid expansions and tax subsidies are not contingent on the individual mandate.  Actually these expansions are far less valuable without a mandate. Continue reading

NPR: Health Industry Not So Hot To Repeal Health Law

Some are still calling for the repeal of health care reform -- but not the health industry

Julie Rovner makes and important point on Morning Edition today: the health care industry, for all its grumbling, is not terribly keen on completely abandoning the new health reform law.

Republicans continue to talk about repealing the law (though experts say that scenario is pretty much impossible), but Rovner reports that industry has already invested a lot, and at this point, going back to square one on health reform would cause major headaches:

…while a large majority of GOP voters told exit pollsters they strongly support the idea of starting from scratch on the health overhaul issue, major players in the health care industry — usually strong Republican allies — are a lot less enthused about the idea.

“No one has said what this bill would be replaced with,” said Richard Umbdenstock, president and CEO of the American Hospital Association. “But doing away with this would certainly be the wrong thing. … People have been gearing up for some time, well before this actual bill got passed, to make these changes locally, and have invested a lot.”

It’s not just hospitals. Employers, particularly large employers, have already put considerable time, effort and money into implementing the parts of the law that have already taken effect. And just the possibility that the law will be repealed or substantially changed could present a serious problem.