Mass. Officials Say Most Have Yet To Pay For Health Plans

State officials say about 150,000 people have determined eligibility for insurance plans on the state’s overhauled Health Connector website. But less than 1 percent has paid for 2015 coverage with a deadline fast approaching.

The connector rolled out its new website on Nov. 15 to replace the one that was crippled by technical problems, forcing hundreds of thousands of people into temporary Medicaid coverage.

Residents eligible to buy insurance through the connector have until Dec. 23 to make their first payment. The Boston Globe reports that few have sent checks so far, but state officials aren’t worried because people historically wait until the last week to pay.

The head of the Massachusetts Association of Health Plans has expressed concern about the low enrollment and the prospect of many people going uninsured.


Put Back The Teeth? Why We Separate Dental And Medical Care

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr Creative Commons)

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr)

My colleague Stef Kotsonis stops me in the hall at work every few weeks with a new pearl of health care wisdom. Last week, it began with the story of three teeth that had to come out.

“I’m getting implants put in, dental implants,” Kotsonis explains, an index finger pulling back his lower lip. “Two down here, bottom left, and one up here.”

He pauses to grin.

“So when they tell you to chew on the other side, it’s a much more subtle dance than that.” Kotsonis is giggling now. “There’s a foxtrot going on at meal time.”

Paying to fix the problem is no laughing matter.

“Our dental plans are awful compared to our health plans,” Kotsonis says. “I’m paying thousands of dollars for these [implants]. It’s, boy, it’s breaking the family bank.”

Should dental health be treated separately from the rest of the body? (US Army Africa/Flickr Creative Commons)

Should dental health be treated separately from the rest of the body? (U.S. Army Africa/Flickr)

Kotsonis is also worried about the lack of coordination between his primary care physician and dentist.

“My own doctor has no idea what’s going on in my dentist’s office,” Kotsonis says. “She doesn’t know if I’m having implants, she doesn’t know if I’m being given these antibiotics, she doesn’t know if these antibiotics clash with anything else she’s doing. And it just seems to me that this is exactly the sort of thing, in this information age, that should be shared.”

How did this happen, this decision to treat the teeth and gums separate from the rest of the body? There is lots of proof that poor oral health is tied to heart disease, diabetes, HIV and can lead to death. So why, in this era of integrated medicine, do we continue to carve out the teeth? And is anyone trying to put them back?

Continue reading

Study: The Deadly Toll Of Opting Out Of The New Medicaid Expansion



Here are some serious numbers from Harvard researchers regarding the 25 states that have opted out of expanding Medicaid coverage under the Affordable Care Act:

We estimate that due to the opt-outs 7.78 million people who would have gained coverage will remain uninsured. This will result in between 7,115 and 17,104 more deaths than had all states opted-in.

Writing for the journal Health Affairs blog, researchers led by Samuel Dickman, a medical student at Harvard Medical School/Cambridge Health Alliance, estimate further severe health woes linked to states’ decisions to forgo expanded Medicaid, including:

•712,037 more persons diagnosed with depression
•240,700 more persons suffering catastrophic medical expenses
•422,533 fewer diabetics receiving medication
•195,492 fewer women receiving mammograms
•443,677 fewer women receiving pap smears


Here’s more from the Cambridge Health Alliance news release (and for full disclosure, all of the study authors are members of the national group, Physicians For a National Health Program, which advocates that the U.S. adopt a Canadian-style single payer health system. PNHP did not pay for any part of this research, according to a spokesperson):

Dickman and his colleagues, longtime health researchers at Harvard Medical School and the City University of New York drew on demographic data from the Census Bureau’s 2013 Current Population Survey and estimates on Medicaid take-up rates from the Congressional Budget Office and elsewhere to characterize those who would remain uninsured in states opting out of Medicaid expansion.

They developed estimates of the health effects of remaining uninsured based on previous studies that used state-level data on Medicaid expansions and death rates, the National Health and Nutrition Examination Survey Mortality Follow-up, and the Oregon Health Insurance Experiment.

In addition to arriving at national estimates, the researchers were able to break the findings down by state.

For example, in Texas, the largest state opting out of the Medicaid expansion, approximately 2 million people who would otherwise have been insured will remain uninsured as a result of the state’s action.

“Texas’ refusal to accept federal money to expand Medicaid will result in 184,192 more people experiencing depression, 62,610 more people suffering catastrophic medical expenses, and as many as 3,035 avoidable deaths,” said Dr. Steffie Woolhandler, a professor of public health at the City University of New York who is also on the faculty at Harvard Medical School. Continue reading

Report: U.S. Lags When It Comes To Preventable Deaths

(Health Affairs)

More bad news for the U.S. health care system. According to a new report by the Commonwealth Fund, America is worst among three other industrialized nations when it comes to preventing avoidable deaths through timely, effective medical care. The problem, once again, is the lack of health insurance, the report suggests. (Things were worse for folks under 65; presumably those over that age qualify for Medicare.)

Commonwealth Fund President Karen Davis is quoted in the news release saying: “Despite spending about twice as much per person each year on health care as France, Germany or the U.K.— $8,400 in 2010—the U.S. is increasingly falling behind these countries in terms of progress in lowering the potentially preventable death rate. The good news is that the Affordable Care Act is already beginning to close the gaps in access to care. When fully implemented, it will cover nearly all Americans, with the potential to put our country on track to improve to levels seen in the best-performing countries.” Continue reading

Health Payment Reform Can Bring Big Savings For Employers, Report Finds

Projected impact of growth scenarios on total employer savings on employer-sponsored health insurance. From "Benefits of Slower Health Care Cost Growth for Massachusetts Employees and Employers" by Jonathan Gruber and Ian Perry. (Courtesy)

Projected impact of growth scenarios on total employer savings on employer-sponsored health insurance. From "Benefits of Slower Health Care Cost Growth for Massachusetts Employees and Employers" by Jonathan Gruber and Ian Perry. (Courtesy)

WBUR’s Martha Bebinger reports that under new health payment reform (read cost-containment) plans currently underway in the state legislature, employers could save between $8 and $35 billion over nine years, according to a new analysis by MIT economist Jonathan Gruber.

That translates into direct financial benefits for workers, writes Bebinger:

Gruber says there’s a direct trade off between health care costs and wages. When premiums go up, wages don’t rise as quickly.

“What we’re saying here, by that same logic, is if we can control health care costs workers get more,” Gruber said.

In what Gruber calls a modest proposal, health care costs would increase 5 percent per year, just one point less than the expected 6 percent increase. The savings for employers would be $8 billion over nine years.

Under a more aggressive approach, health care costs would still rise, but only 2 percent per year. Employers would save almost $35 billion or about $1,000 per worker, per year. Continue reading

Dropping Co-Pays Boosts Adherence, Health After Heart Attack

Can free medications help solve the problem of poor adherence among heart attack patients?

A new study by researchers at Brigham & Women’s Hospital (and funded, in part, by the insurer Aetna) concludes that eliminating co-pays for drugs prescribed after a heart attack improves patients’ medication adherence rates and health outcomes without increasing overall costs.

The research, published online in The New England Journal of Medicine, split heart attack patients into two groups: one with full insurance coverage — including all prescription drugs routinely prescribed after a heart attack, including statins, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors, and angiotensin-receptor blockers — and another with usual insurance coverage, including co-pays.

While adherence rates were incredibly low in both groups, study authors write: “Rates of adherence ranged from 35.9 to 49.0% in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group.” Continue reading

Poorer Patients Help Subsidize Health Care For The Rich, Coakley Report Finds

Tucked into Attorney General Martha Coakley’s exhaustive investigation of the drivers behind escalating health care costs in the state is a startling, new and counterintuitive finding: the richer you are, the more your insurer is probably spending on your health care. And the poor are helping to foot the bill.

Indeed, the report says, it appears that lower-income people are subsidizing the higher-cost care of the wealthy — the Chelseas of the state lending a hand to the Wellesleys, in effect.

As far as the attorney general’s office knows, this is the first such analysis in the nation.

In what counts as a glimmer of irony in an otherwise serious document, the report says:

While we did not uncover any relationship between TME (total medical expense) and payment method, we did uncover a relationship between TME and patient income.

The relationship is this: “More money is being spent on the patients from higher income zip codes” and “those with lower TME may be
subsidizing the higher cost of care of those with higher TME in the same risk pool.”

To come to that conclusion, the attorney general gathered information from the state’s top three health insurers — Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim HealthCare and Tufts Health Plan — on their members’ spending by zip code, and compared it to data from the IRS on average income. They found that the higher income zip codes had higher total medical spending, which includes what insurers spend on care plus the patients co-pays and deductibles. This spending, the report notes is “not explained by the member being sicker or older” and it doesn’t include services such as purely cosmetic surgery.

The attorney general found the same pattern among the commercial members of all three big insurers: the total medical spending for higher-income patients tends to be far higher than the total medical spending for lower-income patients. For instance, a Blue Cross member living in a tonier area like Wellesley with a six figure income is spending $437 per member per month on health care. That’s compared to a member living in a neighborhood like Chelsea, where incomes are considerably lower, who is spending $320 per member per month, according to the report. And both consumers, the richer and the poorer, are likely paying comparable premiums.

Interestingly, when investigators examined the data by region, they found the relationship between level of health care spending and patient income to be strongest in three areas: Metrowest, Northeastern Massachusetts, and Boston and its surrounding towns.

So what’s going on here? While there’s a stereotypical notion floating around that poor people burden the health care system with overuse, and therefore cost more, it turns out in Massachusetts at least, the opposite seems to be true.

The report says that in general, two factors drive differences in spending: price (richer people are using pricier providers) and use (the wealthier are using more health care services.) Continue reading

Pennsylvania Slashes State Health Insurance, In Contrast To Mass.

Tom and Paula Michele Boyle, Pennsylvania residents who are about to lose their state-funded insurance

File under “Reasons to be glad we live in Massachusetts.”

NPR reports today that Pennsylvania’s entire state-funded health insurance program for low-income adults is about to be cut, leaving 42,000 members uninsured. Nearly 500,000 people had been on the waiting list, hoping to join the program.

States around the country are facing similar cuts in this season of exploding budget crises. In California, Gov. Jerry Brown is proposing to slash more than a billion-dollar swath out of state health programs, as reported here.

Not here in Massachusetts. As WBUR’s Martha Bebinger reported earlier this month:

In a tough budget year, the Patrick administration is out with a strategy to maintain subsidized coverage for 174,000 low to moderate income residents. While states around the country are trimming government health insurance, Secretary for Administration and Finance Jay Gonzalez says Massachusetts will preserve near universal coverage. Continue reading

Prediction: Not Just Carrots But Sticks Coming To Wellness

Of these eleven sage predictions for health care in 2011 just posted by Evan Falchuk, president of Best Doctors, Inc., the one that grabbed me most was #5:

5. More employers will start charging employees surcharges for being overweight, smoking, or otherwise not taking care of themselves. Among self-insured employers, who pay for a huge proportion of American health care costs, this is becoming increasingly mainstream. These employers are saying to their employees: it’s your business if you don’t take good care of yourself, but it’s mine to pay for the consequences of it. So, employees are being told they need to pay extra for their health coverage, unless they participate in programs the employer makes available to help them quit smoking, lose weight and manage their chronic illnesses.

I’d just been thinking that even though I post a daily reason to exercise and I’m afloat in health information, it’s stunning how hard I find it to do the right thing in terms of diet and exercise every day. “I need coercion,” I thought. “I need a workplace where they make everyone go to gym class at noon.”

That won’t be happening soon, but I did ask Evan about this trend he’d identified — let’s call it the “wellness stick.”

It began two or three years ago, he said, and so far it’s happening mainly outside of Massachusetts, perhaps because we tend to be healthier already than other states.

One of the first companies doing this was PepsiCo, he said. The company’s head of benefits told him that their employees who smoke had been informed: “If you smoke, we’re going to charge you $600 a year extra in your health premium — unless you participate in a smoking cessation program. You don’t have to quit, you just have to participate.” They had huge success with people signing up — though the tactic is still playing out; many people quit, but many people have said they’ll just pay the $600.

Another example: The supermarket firm Safeway and obesity.
Starting about two years ago, Evan said, Safeway plotted its employees’ Body Mass Index scores on a chart, and found the expected bell curve but there was “a big lump on the right hand side of people with really high BMI,” to the point of clear health risks. Safeway said in effect, “We’ll have surcharges for those people because they’re costing everybody more money, but also create a very supportive environment to help them lose weight.”

“It’s the carrot and stick approach. It’s not enough just to dangle the carrot out there. A lot of companies are putting in these stick-like approaches,” Evan said, and he knows of several Massachusetts employers who are contemplating adding sticks to their wellness plans. (Though WBUR’s Martha Bebinger tells me that she’s been looking and looking for wellness sticks among state employers, and found none so far.)

Readers, does your company use a stick? Do you think that it should?

Daily Rounds: Health Insurance Profits Soar; Fosamax Questions; Probiotics For Diarrhea; Public Against Obamacare Repeal; Menino Fights For Insurance Flexibility

Health Insurance Profits Soar, Dem Calls For Rebates “Health insurance profits are skyrocketing in 2010 compared to last year’s returns and the outgoing chairman of the House subcommittee that oversees the companies is calling on them to return the profits to consumers in the form of premium reductions.” (Huffington Post)

Fosamax Lawsuits Question Wide Use of Osteoporosis Drugs – “The trial is providing a palpable backdrop for a broadening debate among many doctors and researchers who are rethinking Fosamax and similar bone medications known as oral bisphosphonates, particularly as a treatment for women who have not yet developed osteoporosis.” (The New York Times)

Medical News: Probiotics May Help Treat Acute Diarrhea – in Infectious Disease, General Infectious Disease from MedPage Today “One way to battle diarrhea-causing gut bugs is to introduce even more gut bugs, two major reviews found.” (

Poll: Public mixed on GOP tax, health plans – “When it comes to the health care law Obama signed in March, just 39 percent back the GOP effort to repeal it or scale it back. Fifty-eight percent would rather make even more changes in the health care system or leave the measure alone.” (Boston Herald)

Menino seeks more control over health insurance costs – The Boston Globe “Mayor Thomas M. Menino vowed yesterday to go to Beacon Hill to fight for a state law that would allow the city of Boston to save millions of dollar on health care insurance. Tweet Be the first to Tweet this! Yahoo! BuzzShareThis Menino said he could save at least $12 million a year if he gained the authority to shift a larger share of the city’s insurance costs from taxpayers to teachers, police, firefighters, and other city employees, retirees, and elected officials.” (Boston Globe)