• Western Health Access Network attendance and agenda (PDF), 9-11-09
• Metro Boston Health Access Network attendance and agenda (PDF), 9-24-09

As proposals for national health care reform were taking over the front pages, HAN outreach workers were dealing with the impact of budget cuts to our Massachusetts program made necessary by the recession—especially on "Aliens With Special Status" (AWSS) immigrants who lost their Commonwealth Care coverage on September 1 and who will receive reduced benefits through the new CeltiCare program.

Our traditional fall guest, Health Care For All Research Director Brian Rosman, gave both our Amherst and Boston meetings additional background on this issue along with a broader view of how health care reform in Massachusetts is faring in these challenging times.

• Click here for our Western HAN Community Updates notes; we discussed the transition to CommCare Bridge, MassHealth's email noticing, Medicare News, and community resources.

• Click here for our Boston HAN Community Updates notes; we talked about CommCare Bridge, MassHealth dental services, the end of Commonwealth Care auto-enrollment, and community resources.

What's happening with state and national health care reform?

Brian began by sharing the results of recent studies regarding uninsurance rates from the U.S. Census and the Urban Institute (PDF). The Census found that while the national uninsurance rate was 15.3%, Massachusetts was at 5.4%: by far, the lowest in the country. Some highlights of the Urban Institute report:

• The report found a lower Massachusetts uninsurance rate than the Census, at 4%; it continues to decrease. There is also a growth in employer coverage in the state.
• The public approval rate of Massachusetts health care reform went down in 2007 but bounced back up to 72% in 2008.
• Of the remaining uninsured, 72.6% are men, who are most likely to be young and single.
• 14% of the state’s uninsured are in the Boston area, 30% are in the metro-West region, 10% in the Northeast, 8% are in Central Mass, 24% are in the Southeast, and 14% are in Western Mass. To see the number of uninsured as a percentage of the population in these areas, view this map of the uninsured by region.

Who’s losing Commonwealth Care
Commonwealth Care enrollment is declining as a result of two major decisions: the elimination of auto-enrollment, and the exclusion of legal immigrants termed "Aliens with Special Status" (AWSS) from Commonwealth Care. The decision to stop automatically enrolling non-premium paying members who don’t choose a plan is anticipated to mean that 18,000 fewer people will be on CommCare.

CeltiCare won the bid for $40 million to provide insurance to the 31,000 AWSS immigrants who lost Commonwealth Care. The cost of full Commonwealth Care for that many people would have been over three times that amount.

HAN participants brought up and discussed some concerns about the "CommCare bridge" plan for these legal immigrants:

• The enrollment is capped, and the program is only available to legal immigrants who were terminated from Commonwealth Care on August 31, 2009. New applicants with the same status will only be able to get Health Safety Net and/or MassHealth Limited.
• There is a $50 co-pay for each brand name drug per month, with no co-pay hardship waiver process. This can really add up for a low-income individual.
• To reduce costs, some services are not covered, including skilled nursing, vision, and dental.
• Some large provider systems appear to be having trouble meeting the requirements to be part of CeltiCare's network because they would have to change the way they provide ancillary and laboratory services.
• Due to the different network, many patients will have to switch primary care providers, facilities and specialists; this will disrupt care.

Funding the Medical Security Program
The Medical Security Program's (MSP) funding is running low. MSP is funded by Massachusetts businesses: employers pay an annual assessment of $16.80 for each employee into the Medical Security Trust. This rate was set during the Dukakis administration, and has not been raised since. During strong economic conditions, the MSP fund grows. In 2001-2003, the fund was large enough that the state took some money out to free up general revenues. This is part of our current problem.

The recession we are experiencing is worse than predicted—not only because of the number of unemployed, but because of the length of time people are jobless. The law states that any time the MSP fund runs out of money, a committee of three has the power to raise the employer assessment; we will see if there is the political will to raise the assessment in the next year.

Health Care Reform II: Payment reform
Currently, we have a fee-for-service system of paying for health care—which reimburses medical professionals based on the quantity of care and does not provide a system for coordinating services and focusing on quality. A special commission has recommended a "global payment" system instead. It has been shown to be extremely successful in managing health services and reducing costs if done well; it all depends on how it is implemented. Governor Patrick is a supporter of the idea. Both the House and Senate are working on bills which we expect to see between now and spring.

Outreach grants
As of our September 24 meeting, we were still waiting for $2 million in funding from the Massachusetts Health and Educational Facilities Authority (HEFA) to come through to support state grants to organizations working on outreach, enrollment and continuity of care. The Health Connector has paid its $500,000 to support these grants. Information about the grant-making process and exact timeline is not yet available.

Special thanks to Olga Deshchenko for her valuable work drafting these notes.