June 6 Western HAN: ongoing problems, fresh ideas

• Attendance and Agenda (PDF), Western Health Access Network, 6-6-08

Our June 6 Western HAN meeting was an opportunity to step back and reflect on the next steps toward universal coverage in Massachusetts. Four reports were recently released regarding Health Care Reform: The Division of Health Care Finance and Policy (DHCFP) reported on employers who have more than 50 employees/dependents on publicly funded health care; the Department of Revenue released data about the first year of the individual mandate (PDF); the Division of Health Care Finance and Policy issued its quarterly indicators report; and the Blue Cross Blue Shield of Massachusetts Foundation and Urban Institute released the results of their survey on health care reform at one year.

We had the opportunity to participate in an excellent dialogue with State Representative Stephen Kulik, Vice Chair of the Joint Committee on Health Care Financing (details follow below). And Michael DeChiara, facilitating his last HAN meeting as Community Partners' Executive Director, acquiesced to our demand that he sit still for a moment while we demonstrated our appreciation for his leadership, commitment, and hard work.

Falling down the gaps
At hospitals and health centers, both self-pay charges and enrollments have decreased from last year. However, gaps in Commonwealth Care coverage remain a serious problem. We heard about one cancer patient who suspended chemotherapy during the month gap between the termination of employer-sponsored insurance and the start of Commonwealth Care. This is a common problem for cancer patients and those who depend on certain prescriptions. Making Commonwealth Care coverage retroactive to cover these gaps would provide continuity of needed care.

Outreach and enrollment workers are also seeing problems with college and university students who waive QSHIP coverage through their school, but then either lose their alternative coverage or realize too late that (because they are full-time students) they are ineligible for Commonwealth Care. Students who lose coverage after signing the Q-SHIP waiver must wait until the next September for another opportunity to enroll – a big problem for those with ongoing health concerns such as diabetes. Educating high school students about the waiver, and working with schools to make the waiver forms more clear, may help some students; others have medical needs that Q-SHIP does not meet (PDF).

HAN participants have been receiving lots of phone calls about premium increases in BMC HealthNet plans that take effect on July 1. The problem is that BMC HealthNet is the most widely accepted insurance in Western Massachusetts hospitals; those who anticipate receiving hospital care are having to continue with BMC HealthNet and pay the premium increase, which exceed the standards set by the affordability schedule. Advocates are asking the Connector to institute a waiver process that would allow people to pay the lower premium if they must stay with a plan out of medical necessity. There is also concern about whether the newly lowest-cost plans have adequate provider networks.

Medicare is changing its regulations around rates for durable medical equipment and MassHealth is following suit. These changes, opposed by advocates (PDF), will exacerbate existing access issues. As small providers of wheelchairs and other essential medical equipment are bought up by national chains it is getting harder for people to get what they need.

Meanwhile, the volume of MassHealth mailings that enrollment workers receive is making it difficult to distinguish valid and urgent mailings to MassHealth and Commonwealth Care clients from sometimes contradictory or duplicate notices.

An exchange of fresh ideas: dialogue with Rep. Kulik
The biggest challenge for Health Care Reform going forward will be financial; the next step for the legislature after Chapter 58 is to look at cost control directly. The Committee on Health Care Financing is planning to bring the quality and costs bill introduced by Senate President Therese Murray to the House floor soon. The bill includes a ban on gifts to providers from pharmaceutical companies.

Rep. Kulik expressed optimism that outreach and enrollment grants will be funded within the FY09 budget currently in Conference Committee. (The House budget included this line item, but it did not make it into the Senate budget.)

Many suggestions emerged from the dialogue between HAN members and Rep. Kulik:

• Institutionalize and make permanent the loan forgiveness program for medical students who commit to practicing primary care in underserved areas of Massachusetts.
• Develop a licensing process for foreign-trained physicians, dentists, and pharmacists. California and Minnesota offer vigorous testing and licensure processes for foreign-trained dentists that could serve as a model.
• Require hospitals to accept all MassHealth and Commonwealth Care insurance plans. With the July 1 premium increases, some people on Commonwealth Care have to choose between medical services and affordable premiums.
• Offer long-term care options through the state that give the option of remaining at home and using community-based services. Perhaps people who are not eligible for MassHealth could purchase an optional rider for long-term care insurance.
• Provide stipends to primary care physicians who practice in areas with high costs of living, such as the South Berkshires and Cape Cod, where seasonal workers and lower-income year-round residents have trouble seeing a doctor.
• Take another look at reimbursement systems for primary care. Under the current system, a primary care provider only gets reimbursed for one health problem per visit even if a patient presents with multiple issues. Universal coding would also help stem the volume of paperwork.
• We need "Enrollment and Education Centers" to navigate and maintain people’s coverage within the 152 forms of state subsidized insurance. "Outreach and Enrollment" grants should not be seen as a perk of Health Care Reform.