MASS HEATH CARE INSURANCE

The poll results show that residents with incomes below $30,000 — the bracket that would probably make them eligible for state-subsidized care — were the most likely to say the law is helping to control the cost of their care.


The law expanded eligibility for subsidized coverage to thousands more residents, and state figures a year after the law went into effect showed that more than 200,000 residents were added to state-run coverage.


The poll results also showed that the highest income group, those whose income exceeds $75,000, were more likely than the lowest income group to say the law is hurting their health costs.


Kay Lazar can be reached at klazar@globe.com.

uninsured coverage Mass Free Medical Care

Gov. Deval Patrick yesterday shrugged off a scathing inspector general’s report that found costly loopholes in the state’s $414 million free health-care pool — as Republicans pushed to put the brakes on the program.

“The depth of the issues is not as great as first read,” Patrick said of the report during the “Ask the Governor” segment on “Jim and Margery” on WTKK-FM (96.9).

The Herald this week reported that according to the IG probe, the state’s free medical care program — designed to help low-income uninsured Massachusetts residents — spent $7 million on hospital and doctors’ bills for out-of-staters and foreigners, and $6 million on duplicate claims.



“I venture to say that some of these issues might be a little exaggerated. That doesn’t mean to say an isolated incident isn’t significant,” Patrick said.

The IG’s office responded in a statement saying that because the administration had “failed to implement a claims adjudication system for outpatient claims . . . the Office commissioned its own claims editing adjudication.”

The office hired “an experienced health-care provider claims adjudication company,” Senior Assistant Inspector General Jack McCarthy said. “This vendor followed all Massachusetts laws and regulations.”

The report was hand-delivered to Health and Human Services Secretary JudyAnn Bigby on March 3, McCarthy said.

Meanwhile, Senate Minority Leader Bruce Tarr (R-Gloucester) and state Sens. Robert Hedlund (R-Weymouth), Michael Knapik (R-Westfield) and Richard Ross (R-Wrentham) called for better verification of applicants’ Medicaid eligibility, improved safeguards to prevent duplicate payments or payments for medically unnecessary procedures, and an audit of the state’s Medicaid program by the inspector general.

“We find it extremely troubling to learn there are such lax procedures in place that have allowed so many people to take advantage of the system,” Tarr said. “When health-care costs continue to grow at an unsustainable rate, we simply cannot allow such waste and abuse to continue.”

Tarr yesterday filed three amendments to the state’s 2011 supplemental budget to crack down on flaws in the system. The amendments failed last night.

“It’s deeply troubling that, in face of overwhelming evidence that health-care dollars are being spent appropriately, we failed to take action,” said Tarr, who scoffed at the majority party’s suggestion that safeguards are already in place. “If that’s the case, why was this report released?”

Hillary Chabot and Laura Crimaldi contributed to this report.

This week marks the one-year anniversary of the Affordable Care Act.

Millions of Americans are already benefitting from our new health reform law. In the months ahead, even more of us will benefit if it improves care coordination, provides more preventive services, and makes coverage more affordable and secure. It only gets better from here.

That is, if we give reform time to work — and work together to make sure it gets implemented effectively.

Together, we’re working to build better care — care that is better coordinated, more centered on meeting the needs of patients, and more affordable. That's why I'm asking you to encourage the Senate to stand strong against efforts to repeal or defund health reform.

It’s time to move forward and fix our health care system.

We simply can’t afford to let anyone undermine our efforts to make America’s health care system work better for all of us — and especially for older adults, patients with multiple chronic conditions and their family caregivers.

Just ask Leslie Schlienger, a nurse from south Florida, who is working on the front lines.


Since graduating from nursing school in 1980, Leslie has been a head nurse in Veterans Administration and community hospitals, earned her certification in rehabilitation nursing and her master’s degree in nursing administration. For the last dozen years she’s been a home health nurse, and a critical part of her work is coordinating clients’ care with family, friends and medical professionals.

"The fragmentation of how care is delivered is a big issue," Leslie says. "Because of all the specialties, a single patient often has two or three physicians, and I’ve seen some with as many as seven or eight. Patients are overwhelmed by that. They’re lost in that system." (Read the rest of Leslie's story here.)


Now more than ever, we need better care coordination, improved communication among providers, medical records at our fingertips, and a system that doesn’t leave vulnerable patients and their family caregivers to fend for themselves.

To mark the one-year anniversary of the Affordable Care Act and honor the millions of Americans working every day for better care, urge your Senators to focus on fixing our health care system and reject any attempts to repeal or defund health reform.

I’ve already sent my message to Congress. Please send yours now!

Sincerely,

Medicare Advantage

Improvements to Medicare Advantage • Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. These additional payments are paid for in part by increased premiums by all Medicare beneficiaries—including the 77% of seniors not enrolled in a Medicare Advantage plan. • The new law levels the playing field by gradually eliminating Medicare Advantage overpayments to insurance companies. • If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits. • Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits.

The Effect of Repealing Health Reform on the State of Massachusetts:

CMMENTS FROM SEN. KERRY

•Repeal would take away $2 billion in additional federal assistance for MassHealth, which provides health coverage to more than one million Massachusetts children, families, seniors, and people with disabilities.


•Repeal would eradicate $860 million in federal funding of the Children’s Health Insurance Program (CHIP), which helps to ensure that virtually every child in Massachusetts has health care coverage.


•Repeal would make health coverage more expensive by taking away $4 billion in federal subsidies to purchase health insurance to over 254,000 Massachusetts residents.


•Repeal would prevent 75,000 people in Massachusetts with incomes between 300% of poverty to 400% of poverty—most of whom are older Americans under the age of 65—from receiving subsidies to purchase health coverage.


•Repeal would increase Medicare prescription drug costs for nearly 51,837 seniors in Massachusetts.


•Repeal would cut Medicare’s annual wellness visit and free preventive services for 1 million seniors in Massachusetts.


•Repeal would eliminate financial relief to 162 employers in Massachusetts who offer retiree health benefits.


•Repeal would make it more expensive for over 102,000 small businesses in Massachusetts to offer health coverage to their employees.


•Repeal would eliminate tens of millions of dollars in funding for community health centers in Massachusetts that provide high quality health care to about 800,000 state residents.


•Repeal would abolish $128 million in grants and tax credits to 312 small biotech companies in Massachusetts who are working to develop new therapies that prevent, diagnose and treat acute and chronic diseases.


•· Repeal would increase health insurance premiums in the nongroup market by 14 to 20%, costing Massachusetts families $1,950 to $2,790 more in premiums each year.


•Repeal would eliminate payment bonuses to about 11,500 physicians in Massachusetts who practice primary care.


•Repeal would reinstate a discriminatory Medicare reimbursement provision that penalizes Massachusetts hospitals by hundreds of millions of dollars each year.


•Repeal would expose nearly 4.5 million Massachusetts residents with private insurance coverage to having lifetime limits placed on how much insurance companies will spend on their health care.
# # #

Health Coverage Legislation Small Business

Health coverage legislation enacted this year includes a Small Business Health Care Tax Credit to help small businesses and small tax-exempt organizations afford the cost of covering their workers.
Eligibility Rules
Providing health care coverage. A qualifying employer must cover at least 50 percent of the cost of health care coverage for some of its workers based on the single rate.
Firm size. A qualifying employer must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
Average annual wage. A qualifying employer must pay average annual wages below $50,000.
Both taxable (for profit) and tax-exempt firms qualify.
Amount of Credit
Maximum Amount. The credit is worth up to 35 percent of a small business' premium costs in 2010. On Jan. 1, 2014, this rate increases to 50 percent (35 percent for tax-exempt employers).
Phase-out. The credit phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.
Three Simple Steps for Employers to Qualify

The Commonwealth Fund Blog

The Costs of Failure: Economic Consequences of Failure to Enact Nixon, Carter, and Clinton Health Reforms
December 21, 2009
Authors: Karen Davis, Ph.D., Kristof Stremikis, M.P.P.
Tags: health reform legislation , health reform , health spending
View Citation
CitationK. Davis and K. Stremikis, The Costs of Failure: Economic Consequences of Failure to Enact Nixon, Carter, and Clinton Health Reforms, The Commonwealth Fund Blog, December 2009.
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By Karen Davis and Kristof Stremikis

The U.S. Congress is on the threshold of historic change that will usher in a new era in American health care. In the last 50 years, three presidents—Nixon, Carter, and Clinton—have made a serious effort to enact reform and failed. The nation simply can not afford to fail again—too much is at stake for those Americans who fail to get the life-saving care they need and for those who pay the bills of ever-rising cost of health care. History makes clear that failing to act on health reform has serious and far-reaching economic ramifications. An examination of trends in health spending over the past 50 years shows that if health reform measures proposed by previous presidents had been enacted and slowed the growth in spending by as little as 1.0 or 1.5 percentage points annually, spending trends in the U.S. would have been closer to those seen in other major industrialized countries and fewer adverse health consequences and economic burdens would have been borne by American families, businesses, and government.


Learning from Past Efforts
Over the last half-century, the nation has made several serious attempts to ensure health insurance coverage and control health care spending, either as part of comprehensive legislation or through companion measures.

President Richard Nixon imposed wage and price controls on the entire economy in 1971 in the wake of inflation triggered by the Vietnam War, with special mechanisms developed for controlling health care costs. He then proposed a Comprehensive Health Insurance Plan that received serious legislative consideration in 1974. The central features of the plan were employer-mandated private insurance coverage for workers and their families in firms with 25 or more employees, a plan for low-income families that would replace and improve Medicaid, and a federal health insurance plan that would replace and improve Medicare.1 Reform efforts died when Nixon was removed from office, as proponents hoped to enact stronger legislation in the political aftermath of his impeachment. The Nixon health care cost controls were lifted in 1975 when the industry pledged to control costs voluntarily.2

President Jimmy Carter proposed hospital cost containment legislation in 1977. In 1979, he introduced a national health plan that included minimum standards on benefits and required employer contributions, as well as a new federal HealthCare program to replace Medicaid and Medicare and cover all low-income individuals, in addition to the elderly and disabled. The Carter hospital cost containment legislation, a response to the explosion in health care costs following the lifting of Nixon's health cost controls, was defeated when the industry mounted an alternative "Voluntary Effort." Unfortunately, this voluntary approach to cost control also quickly dissipated once the threat of legislation was removed.3 Inflation in health care spending and a deteriorating economy contributed to the demise of the Carter national health plan in 1980.

President Bill Clinton introduced legislation in 1993 with cost containment measures built into health reform. In particular, his proposal called for controls on the rate of increase in health insurance premiums. The Health Security Act included an employer mandate that required employers to pay 80 percent of the premium (up to a maximum of 7.9% of payroll), with the family share of premiums not to exceed 3.9 percent of income.4 The plan was to be financed by substantial Medicare and Medicaid savings, an increase in tobacco taxes, and cross-subsidies among employers within risk pools. President Clinton's health reform ran into major opposition from small businesses and insurers, and the legislation stalled out in Congress.

U.S. Health Spending Trends and Projections
The federal government's repeated failure to enact health reform has had serious consequences for American government, families, and businesses. The U.S. spent 5 percent of gross domestic product (GDP) on health care in 1960; health care now consumes 17 percent of the nation's economy and will reach 21 percent by 2020, if trends continue. While investment in health care has contributed to improved health and productivity, other countries have devoted a far lower share of GDP to health care and achieved comparable or better health outcomes.

Ever-higher health spending has directly contributed to stagnating incomes and rising health insurance premiums for middle-class families and workers. Commonwealth Fund analysis has shown that premiums have risen from 11 percent of family income in 1999 to 18 percent in 2009. If current trends continue, average family premiums will reach 24 percent of median income by 2020.

Rising health care costs–and the subsequent rise in health insurance premiums–have fueled an increase in the number of Americans without insurance over the past three decades. Nearly 50 million Americans are expected to be uninsured in 2010. Cost growth also has placed enormous pressure on employers' ability to provide comprehensive benefits, leading many to shift to less generous policies or drop coverage altogether. Employees of small businesses, which are much less likely to offer coverage, are at particularly high risk.

It is difficult to estimate with precision what would have happened had proposed reforms been enacted. Still, it is instructive to consider where we would be today if those efforts had succeeded. Each included provisions designed to provide health insurance coverage for all.5 Each set out regulatory restraints on the growth in provider payment or insurance premiums, or both. All had significant mechanisms to control costs, including changing provider payment, increasing competition in the insurance market, and controlling the growth in private insurance premiums.

Exhibit 1 shows the growth in national health expenditures as a percentage of GDP and what we would have spent as a nation if effective measures to slow the growth in health expenditures by 1.5 percentage points a year had been adopted in 1975, 1980, and 1995. In 1960, we spent 5.2 percent of GDP on health care, compared with the 3.8 percent of GDP median rate in all major industrialized nations. Today, we spend 17.7 percent—nearly twice the rate of 9 percent that is devoted to health care in other industrialized countries.



If President Nixon's health reform plans had been enacted in 1975 and slowed the annual rate of spending by 1.5 percentage points a year, today we would be spending 10.7 percent of GDP on health care. In dollar terms, we would spend only $1.6 trillion on health care in 2010, instead of projected health spending of $2.6 trillion. This savings of $1 trillion in 2010 alone would remove much of the financial burden on families, businesses, and government. Even if Nixon reforms had slowed spending growth by "only" 1 percentage point a year, health spending as a percent of GDP would have been $1.9 trillion in 2010, or 12.7 percent of GDP—a savings of 5 percent of GDP.

If cost containment measures slowing spending by 1.5 percentage points a year had been enacted in 1980 under President Carter, the trends would be similar, with spending rising to $1.7 trillion in 2010, or 11.5 percent of GDP. Even if we had acted as late as 1995 under President Clinton, health spending in 2010 would be $2.1 trillion, or 14.2 percent of GDP.

The federal government would have been a major beneficiary of comprehensive health reform under Presidents Nixon, Carter, or Clinton. Instead of consuming 6.2 percent of GDP in 2010, federal health outlays would have been 3.7 percent in 2010 under Nixon reforms that slowed spending growth by 1.5 percentage points, 4.0 percent under Carter, and 5.0 percent under Clinton.

Bending the Health Care Cost Curve Today
In the current round of health reform, the primary strategy for controlling costs has been legislative changes to Medicare and a public health insurance plan that encourages private insurers to control costs. While enrollment in the public health insurance plan in the House bill has been narrowly targeted on the uninsured and small businesses, the proposal faces an uncertain future in the legislative process.

The House of Representatives has added provisions to negotiate pharmaceutical drug prices, review insurance premium increases, and set standards on the share of premiums devoted to health care. Both the House and Senate have provisions for rapid testing of new methods of provider payment in Medicare. The Senate bill calls for an independent Medicare advisory board to facilitate rapid consideration of recommendations to limit the rate of increase in Medicare outlays.

Several commentators have questioned whether the cost containment provisions in the health reform bills passed by the House and under consideration in the Senate are sufficient. Neither bill includes the aggressive system-wide cost control measures that were part of the Nixon, Carter, and Clinton proposals. But the House and Senate bills would begin to bend the curve in total health spending and encourage the development of mechanisms for extending cost control measures more broadly once experience is gained. A recent analysis by the Council of Economic Advisers estimates that private and governmental spending would be slowed by 1.0 percentage points a year.

History shows that even modest cost-cutting has a significant impact over time and that inaction has a cost. The longer we wait to address the underlying problems in the U.S. health care system, the more health spending will continue on its rapid rise and the more drastic the measures that will be required to right our economy and our federal budget. Congress is right to move ahead. After 50 years of spiraling health care costs and the resulting price paid by American families, business, and government, we can no longer afford to postpone health reform.



--------------------------------------------------------------------------------
1 K. Davis, National Health Insurance: Benefits, Costs, and Consequences (Washington, D.C.: The Brookings Institution, 1975).
2 K. Davis, G. Anderson, D. Rowland, and E. Steinberg, Health Care Cost Containment (Baltimore: The Johns Hopkins University Press, 1990).
3 K. Davis, "Recent Tends in Hospital Costs: Failure of the Voluntary Effort," Testimony before the House Committee on Energy and Commerce, December 15, 1981.
4 Congressional Research Service, Health Care Reform: President Clinton's Health Security Act, (Washington, D.C.: Congressional Research Service, 1993).
5 K. Davis, "Universal Coverage in the United States: Lessons from Experience of the 20th Century," Journal of Urban Health: Bulletin of the New York Academy of Medicine, March 2001 78(1).

Read or Post Comments
Edward Gamache, of Deckerville Community Hospital, say(s):
December 21, 2009

There was a time when the healthcare cost curve started to flatten; it was at the height of the impact of HMO implementation. It is important to remember this historic period. Your article fails to identify this period and the backlash HMO controls had on the general public. HMOs became associated with a loss of choice in healthcare and as a result was pushed back by the very institution that supported its development, the U.S. Congress.

I suspect that whatever elements of cost control are included in the current national health reform bill that creates similar impacts will face the same fate. I’m confident that the first legislative proposal to change the current bill will be introduced that day after the President signs it.

Cost of Health Care Reform

First, Congress is debating how to cover the uninsured, as if that is the principal
problem of our health system.
Should we have a public plan option? Should we expand Medicare? Medicaid?
Should there be a mandate to buy health insurance? Obama believes that health
system reform will require a massive infusion of tax money to cover the uninsured,
also his primary issue.
Both Congress and Obama are wrong. The issue is not coverage, it is cost control,
or more specifically, waste elimination. Per-capita taxation for health care is higher
in the U.S. than anywhere else in the world. More than one-third of the $4 trillion
collected in state and federal taxes this year will go to health care.
If we limited health spending to just those tax dollars we would be spending more
than any other nation on health care. Yet we add another $1 trillion to our health

spending through private payment of employer premiums and family co-payments
. Per-capita health spending is twice as high as it is in any other nation, and rising faster,
because we waste half our health spending on inefficiency and poor quality.

The Health Care Reform up for Vote

Lets let the Republicans PUT UP OR SHUT DOWN !!! Pass meaningful
legislation THE HEALTH CARE REFORM UP FOR VOTE
Lets let the Democrats get on with the peoples
business BRING THE
HEALTH CARE REFORM UP FOR A VOTE

The administration seems to fear a threatened
Republican senatorial
filibuster of health care reform. The Democrats
should call the
Republicans’ bluff and bring a reconciled bill
to a vote. It will pass
or be filibustered.

There is no political cost to threatening a
filibuster, but producing
one is a different thing altogether, especially
if it slows down or
stops other important work. The electorate,
which by and large has
never experienced a filibuster, will get a
great civics lesson about
the arcane and outmoded operations of the Senate and may press for
reforms.

Obsessive media attention to the filibuster will illuminate Republican
obstructionism and the importance of health care reform.
--
Howard McGowan
MaldenSenior