reform 2012


When The Full Sticker Shock Of Health Coverage Hits Our Family

medical bill

(Attercop311/ Flickr Creative Commons)

As the new state Health Policy Commission begins its work to bring down health care costs, here’s one Massachusetts family’s reminder of why the issue is so urgent. The excruciatingly high prices of both insurance and care mean that some must choose between health insurance and a new furnace, or health insurance and a car. This is not an abstract policy issue; it is a daily burden with major effects. One mother’s story:

By Sara Cushing
Guest contributor

A few weeks ago I resigned from my job as a project manager at one of the largest health care delivery systems in the United States. I have worked in different capacities in the health care industry in the Boston area for the last eleven years, but decided to leave my career because I wanted a change — to follow my dream of becoming a writer.

Many things needed to be considered about such a family-life-altering decision, including one that hadn’t been a concern of mine in the past: what my family’s next steps would be in purchasing health insurance. I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer.

Sara Cushing

Writer Sara Cushing

The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher.

Try something closer to $1700. About the same as our monthly mortgage. About half of what my take-home pay used to be — money that was no longer coming in. And we see no way around it.

Because my husband is in a higher income bracket we’re not eligible for subsidized coverage though the state; and because my husband is a contract employee, his employer doesn’t provide subsidized health care coverage.

This means that we’re looking at the same cost for a family plan whether we buy through his employer; the Health Connector; or through my employer’s COBRA plan (which allows me to purchase the same health care coverage as offered by my employer for up to 18 months after ending employment, though I am responsible for 102% of the cost — the additional 2% is for administrative fees).

I live in Massachusetts, where legislation was passed a few years ago mandating health care coverage for all residents. The legislation helped to create the Health Connector agency so that people could purchase health insurance in larger risk-pools instead of directly from health insurance companies, to allow for more competitive pricing and coverage options for individuals and families.

This all sounds great, right? What many people do not understand, however, is just how steep the monthly premium cost gets, just how painful a $1700 bite out of a family budget can be. Continue reading

Health Cost Panel: Complex Challenges For A Ref Who Can Only Blow Whistle

health cost commission

The new Mass. commission on containing health costs (Martha Bebinger)

As WBUR’s Martha Bebinger was on her way back from today’s inaugural meeting of the board of the new state Health Policy Commission — a key instrument of the state’s health-cost-containment law — she kindly fielded my interrogation: “So what struck you most?” Her reply, edited:

I’d say what stood out to me was that they recognized that the main focus of the law, the key element of the law, is setting a health-care cost-containment goal, but that it is going to be a pretty complex process, both to figure out what that goal should be and to determine the best way to reach it.

Board chair Stuart Altman said he feels like he’s a referee who can blow the whistle but not issue a penalty.

In the area of what that goal should be, what’s at issue isn’t just what the state economic growth is, but what it is over time. So it’s looking more at a trend than at a fixed number, and that’s a difficult concept for many people to grasp, both patients and providers.

We do know what the target is going to be for 2013, 3.6 percent. But this is really a question about the next four years after that, when it’s supposed to be right at the potential Gross State Product.

And then if you start to ask, ‘Okay, so what will it mean to get there?’ that’s when it really gets complicated. Because in the process of figuring out whether providers are keeping costs under control, the state is at the same time trying to overhaul the health care system with a focus on prevention. Continue reading

New Mass. Health Cost-Cutting Law Takes Effect Today

Stuart Altman of Brandeis University, chair of the new state Health Policy Commission

WBUR’s Martha Bebinger reports:

A state law that aims to limit spending on health care takes effect today. 

The law makes Massachusetts the first state to say that health care costs must stop increasing faster than that of most other goods and services.  

A new board that will set a health care spending target and track progress towards that goal has a chairman, and a first meeting date, but the members have not yet been appointed.  

More than a dozen other boards and commissions designed to improve care also exist in name only so far.  

Several provisions in the law take effect immediately or as soon as the state puts new guidelines in place. They include new restrictions on mandatory overtime for nurses, a requirement that providers offer end of life planning to patients nearing death and rules for the use of telemedicine.

There’s a nice recent summary of the law and its rationale here: How a new Mass. law can show the future of health reform.

Study: Maybe Mass. Doesn’t Know It All On Health Reform

The Beacon monument on Beacon Hill

The Beacon monument on Beacon Hill (Swampyank on Wikimedia Commons)

Yes, we in Massachusetts can sometimes sound a bit know-it-all-ish about health reform, what with our early experience with near-universal coverage and all. Before he signed the latest health reform bill into law on Monday, Gov. Deval Patrick began with a proud litany of the many ways that residents of Massachusetts are ahead on health care — there’s just no place else like it, he said.

We here at CommonHealth are guilty, too. Our “About This Site” section below even begins, “Massachusetts is the leading laboratory for health care reform in the nation.” But a new report just out from the Beacon Hill Institute at Suffolk University suggests that perhaps we should be a bit less provincially, pridefully myopic. (The institute is “grounded in the principles of limited government and fiscal responsibility,” and judging by recent headlines of its studies, it tends to be quite critical of the Massachusetts reform model.)

The report reviewed several health-reform policies in other states and concludes that there is much worth emulating, particularly when it comes to better serving consumers. From the press release:

BHI reviewed several consumer driven policies from others states. These include establishing Health Savings Accounts (Indiana and Georgia), eliminating the tax bias in favor of employer sponsored health plans (Missouri) and reforming guaranteed issue and community rating (Maine). The paper, entitled “Lessons for Massachusetts from State Health Care Reforms in Other States: What Chapter 58 Missed” also suggested that following Medicaid Reform in Florida and tort reform along the lines of Mississippi and Texas.

The study also examined Utah Exchange, that state’s private alternative to the Massachusetts Connector. The Utah Exchange offers high deductible plan choices which lowered overall premium costs rather than the more stringent ‘seal of approval’ plans vetted by the Connector.

The full study will be available on the Beacon Hill Institute’s Website. I just tried the link in the upper right of the homepage but it doesn’t seem to be live yet.

Mass. Med Society Chief: Reform Means Patients Have To Change, Too

Massachusetts Medical Society President Richard Aghababian (Courtesy of MMS)

Massachusetts Medical Society President Richard Aghababian (Courtesy of MMS)

There was no time to really talk in the State House hubbub before Gov. Deval Patrick signed the new health cost control plan into law on Monday. But the president of the Massachusetts Medical Society, Dr. Richard Aghababian, shared a quick line that intrigued me, something about how health reform means that patients have to change, too. We continued the conversation today; here it is, lightly edited:

So what did you mean at the State House, that the cost-control era will involve new responsibilities on the part of the patient?

My thoughts are that if the citizens of Massachusetts want to control the costs of health care, not only do we have to change doctor-hospital-nurse behavior but we also have to change patient behavior. If we want to be leaders in this movement toward getting more people covered and improving the quality of health care outcomes, we as individuals all have to participate.

I would think, in particular, that under this next phase of health reform, doctors will be bearing more financial responsibility for their patients’ health, but so much of their patients’ behavior is out of their control…

What could undermine this undertaking is if doctors and all health care workers work very hard at improving their efficiency and trying to obtain the best outcomes possible for their patients, and the patients don’t cooperate. And cooperation involves taking the best care possible of themselves, and if they have an illness, taking the medications as prescribed for them, exercising or eating properly as prescribed and, very importantly, reporting their progress accurately to aphysician.

If people don’t do what they should, don’t take responsibility for their own health, should they be penalized?

For example, if you’re a diabetic and you’re monitoring your blood sugar with a home device, or if you’re hypertensive and you should be monitoring your blood pressure, write down what the numbers are when you take the measurements and bring that in to the doctor to review with you. If the doctor gives you instructions about Physical Therapy or eating properly, either ask for written instructions or write something down that you can use to remind yourself. Or bring a friend to help you understand and remember your instructions. And lastly, keep a log of what you are doing when it relates to whatever treatment has been suggested; write down what you’ve done.

Are you planning a guide on how to be a better patient? Continue reading

‘Next Big Step:’ Mass. Health Cost Control Bill Signed Into Law

patrick signs health cost bill

Mass. Gov. Deval Patrick signs the bill aimed at controlling health care costs into law. (Jesse Costa/WBUR)

Today, amid cheers and applause echoing against the marble walls and floor of the Nurses Hall in the Massachusetts State House, Gov. Deval Patrick signed into law a groundbreaking bill aimed at controlling health costs. “Today, we take our next big step forward,” he proclaimed.

But I write this just for the historical record. The signing was so expected that it isn’t really news. So I exploited my Nurses Hall visit to pose a forward-looking question to some of the state health care players assembled for the signing. To wit:

‘This is an incredibly significant and important step but it’s going to be a journey.’

Two or five or ten years from now, what do you think people will be saying about this health cost bill? Their replies:

Len Fishman of Hebrew SeniorLife: “Five years from now people are going to see this as a giant step forward — though not the last one. And I think we’ll realize this is every bit as important as the coverage legislation, because if you don’t get costs under control, you can’t afford universal coverage. (I asked: Any criticism?) I think it’ll be the same criticism as now: Some saying it’s too little, some saying it’s too much. But the emphasis will be on finally tackling the other big issue in health care in this country. I think people will be proud that Massachusetts took the lead on both these issues.”

Sarah Iselin of the Blue Cross Blue Shield of Massachusetts Foundation:
I think looking out two years from now, people are going to say, ‘We were leading again.’ This is a critical but in many ways more challenging problem to solve.” It took decades of work to reach a solution to the coverage problem, she noted, and “this is an incredibly significant and important step but it’s going to be a journey.” The lawmakers wrestled with “the role of the market and how far it would go on its own, and the role of government,” she said. “We’ve set really ambitious goals;” now the future will show: “Are the enforcement mechanisms strong enough?”

‘The state wasn’t ready for the tougher regulatory aspects, but it would have been a shame to do nothing.’

Prof. Stuart Altman: “I think it was an initial, interim step. Ultimately…Either it will turn out that we didn’t hit the goals, or hitting the goals was really tough. Some groups could feel the losers. You can’t control health care costs without there being some parts of the industry who feel like they’d be better off without it.” As national experience has shown, “Ultimately, what you find is the losers scream and the political system gives in. We have to decide, as a state and as a society, the relative worth of controlling spending. But do I feel this is important legislation? Yes. It’s exactly where we should be. The state wasn’t ready for the tougher regulatory aspects, but it would have been a shame to do nothing.”

Dr. Richard V. Aghababian of the Massachusetts Medical Society: “I think they’ll be saying that it was a very innovative, forward-thinking law which addressed the issues of quality and cost-effective care for all patients. I’m sure we’ll find some things we could have done differently but for pioneers, that’s often the enviable — or not quite so enviable — position.” Continue reading

Mass. Gov.’s 11th-Hour Proposal On Reining In High-Priced Hospitals

Massachusetts Governor Deval Patrick

As Carey wrote yesterday, the House and Senate are under the gun to reach an agreement on how to lower health care costs while improving care. A conference committee aims to have a bill out on Sunday. Their deadline is Monday evening. In the meantime, several major issues are still unresolved, including what to do about hospitals that use their market clout to demand high prices that are not based on higher quality.

Attorney General Martha Coakley, the state’s top insurers and several consumer groups argue that price is a critical issue. “Any meaningful health care reform legislation must include efforts to address the market power of providers and the negative impact on costs that we identified in our reports,” said Corey Welford, Coakley’s chief of staff, in a statement.

‘Patrick and Coakley have treated the market power issue like a hot potato.’ — The Boston Globe

But it’s been clear for a while now that a House plan to penalize high cost hospitals that couldn’t justify their prices would not be part of the final bill.

In response, some of the lower-cost hospitals and the Greater Boston Interfaith Organization have told lawmakers and the Patrick administration that it wouldn’t be smart or look good to pass a law that paid little attention to what’s known in health-care-speak as “provider price disparity.”

So last week, Gov. Deval Patrick began floating a late compromise (full text here) to tackle health care prices. The governor’s plan would let government dig into a provider’s books and forward findings of anti-competitive behavior to the attorney general. The AG would use his or her existing authority to launch an investigation. The AG’s office offered a different plan that would let the administration use the license renewal process to demand lower prices, but a spokesman says “there are positive steps taken in the House, Senate and governor’s proposals” as well.

Sources say the conference committee isn’t paying much attention to the governor’s compromise. Continue reading

Pool: Will Mass. Reform Bill Go All The Way Down To The Wire Next Week?

This is becoming as much a Massachusetts ritual as the annual re-firing of the Shot Heard Round the World. The legislature grapples with the complexities of health care reform so long and so hard that it bumps right up against its midnight, July 31 deadline for the end of its formal session, then passes a bill in the nick of time.

Something of that sort happened in 2008 and 2010, recalls Brian Rosman of Health Care For All. And now here we are in 2012 with a particularly tricky bill aimed at cutting costs. As of this writing, the conference committee has not yet finished resolving the differences between the House and Senate versions — and the formal session closes this coming Tuesday.

CommonHealth reform watchers, let us now open our pool for this round: Just how close do you think the passage of the latest health reform bill is going to get to midnight on Tuesday?

‘I wish it weren’t going down to the wire the way it seems to right now.’ — Gov. Deval Patrick

We promise a nice piece of WBUR paraphernalia to the reader whose bet comes closest. Please post your entry in the comments below, and specify whether you mean, say, 10 minutes before midnight or after midnight. (I hear that the 2008 session voting on a health reform measure actually ran a few minutes past midnight — fortunately, the powers of the legislature seem to extend to re-calibrating the space-time continuum.)

Also welcome in your comment: Which aspects of the proposed reform do you think legislators are likeliest to give up for the sake of compromise?

A pool is a frivolous thing, of course, but some are expressing serious concerns about whether there has been enough time for serious debate over this next, cost-cutting phase of health reform. State House News reports that Gov. Deval Patrick is among them: Continue reading

Mass. Health Reform As Pig In A Poke

Josh Archambault of the Pioneer Institute (Courtesy of JA)

I had to look up this expression to make sure I was using it correctly, but yes, indeed, the opinion piece in the Boston Herald today from The Pioneer Institute’s Josh Archambault argues that the legislature is buying a pig in a poke when it comes to the cost-cutting health reform measures soon up for passage.

(Why we love Wikipedia: The expression means “that something is sold or bought without the buyer knowing its true nature or value, especially when buying without inspecting the item beforehand,” and “A poke is a sack or bag. It has a French origin as ‘poque.'”)

But I digress. Josh warns:

The fact that a bill which overhauls our complex health care system was passed in mere hours without debate should worry all of us. President Calvin Coolidge once said, “It is much more important to kill bad bills than to pass good ones.” Legislators failed to take heed.

The health care cost control bill is a symptom of our current “Facebook” legislative process. It limits deep and meaningful debate and allows members to “like” a bill without understanding it. Taxpayers deserve more.

He expresses particular concern that the bill will undermine the health care industry and cost “billions in unintended consequences.” He writes: Continue reading

Mr. Cape Air Goes To Washington (To Defend Health Reform)

Mass. state senator Dan Wolf, CEO of Cape Air, testifies in Congress (Photo: Rory Sheehan, House Committee on Oversight and Government Reform)

In a prelude to today’s House vote on repealing Obamacare, quite a dire economic picture was taking shape at the House Committee on Oversight and Government Reform yesterday.

Obamacare will hurt business by making labor more expensive, the committee’s Republican chairman, Darrell Issa of California, warned. It will encourage employers to pay their workers less, to hire workers part-time instead of full-time, and to stay small instead of expanding. It will mean higher taxes and more government red tape. (See his statement here.) A line-up of witnesses shared other concerns and warnings.

Then there was Dan Wolf, a Democratic state senator from Massachusetts — in a role a bit like the fairy at Sleeping Beauty’s party who contradicted all the other fairies. Actually, he testified, in his experience as the founder and CEO of Cape Air and a resident of Massachusetts, health reform doesn’t stunt business growth or cost jobs. His full testimony is here. Some excerpts:

I’m here to debunk myths, and dispel fear and misunderstanding about the 2006 health care reform act that Massachusetts enacted with strong bipartisan support. It also is the template for much of the Affordable Care Act now sanctioned as the law of our land.

From Cape Air’s first day in business, we offered health care coverage, knowing that affordable health care coverage helps us retain a great workforce. This year, Cape Air’s health insurance premiums will total close to $3 million, roughly 3 percent of the company’s gross income. The company will pay just over half of that cost, employees the rest.

In 2007, when Massachusetts health care reform went into effect, there were dire predictions of the impact on businesses like Cape Air.
Here’s what really happened: Continue reading