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Consumer advocacy works!

Tuesday, September 20th, 2011

That may seem like a no-brainer for those of us in the business, but important new research affirms it. Mathematica Policy Research found in its evaluation of the Consumer Voices for Coverage (CVC) program that 62 percent of policymakers said consumer groups increased their influence during the course of the program, demonstrating the significant impact targeted foundation investment can have on consumer advocacy. You can read the entire paper here.

As part of its long-standing mission to develop policies and programs to expand health coverage in the U.S., the Robert Wood Johnson Foundation (RWJF) established CVC with Community Catalyst as the national program office. RWJF initially funded 12 state-based advocacy organizations to strengthen the consumer voice to promote innovative and comprehensive health reform efforts. Each grantee worked to build a state leadership team and establish common objectives, policy priorities and coordinated advocacy campaigns in their states.

Mathematica evaluated the program across what we call the “six capacities.” This framework, created by Community Catalyst, includes: 1) building coalitions; 2) generating grassroots support; 3) analyzing health policy research; 4) designing and implementing health policy campaigns; 5) crafting media and communications strategy; and 6) fundraising.

As a field coordinator for CVC, I worked directly with several of the CVC states and saw the impact that this support had on their efforts in their states and also on the federal level.

Before CVC, some of the organizations had not worked together in a formal coalition. As a result of the program, all 18 CVC grantee states (RWJF added six states to the program in 2008) now have strong systems of advocacy that enable them to bring the consumer voice to state and federal policy discussions and to be important leaders in these discussions.

For instance, in New York – where there are numerous savvy advocates – a single statewide consumer health care reform coalition made up of diverse constituencies did not exist prior to the CVC program. With the support of the program, the New York consumer advocates came together to create the Health Care for All New York (HCFANY) coalition. The coalition now boasts close to 120 organizational members.

As a result of their work they have made significant gains for New York health care consumers, such as:

  • – requiring the State Department of Insurance to pre-approve health insurance premium hikes on individual and small group policies
  • – creating a buy-in program for the state’s Family Health Plus Program
  • – extending COBRA from 18 to 36 months for laid-off workers
  • – expanding dependent coverage to age 29
  • – expanding New York’s Child Health Plus program to include families up to 400 percent of the federal poverty level

These policy changes only tell half the story. In order for HCFANY to achieve these wins, they also grew their capacity significantly. Guiding their work all along were 10 Standards for quality, affordable health care for all. These principles helped keep the coalition together, build relationships with new organizations and activate grassroots networks throughout the state.

For instance:

  • – HCFANY held the “People’s Public Hearing on Health Reform” and other regional meetings in all areas of the state to engage and build their grassroots networks.
  • – The HCFANY coalition was able to stay together due to the support of the program, enlist new local and statewide partners, and engage in work with small businesses.
  • – HCFANY members built relationships with federal and state policymakers and served as a resource to people on both sides of the political aisle.
  • – HCFANY set up a blog and website and established themselves as the “go to” resource for health policy information.

The successes in New York are not the only story. There are numerous victories and lessons learned from state advocates across the country. And the advocates shared those lessons through what we call the “learning community.” The learning community allows advocates to share strategies, struggles and victories while helping one another replicate best practices and avoid pitfalls. This community continues to thrive and grow beyond the 18 CVC states to include state health advocates across the United States.

The Mathematica evaluation shows that investing in health advocacy works to amplify the voice of consumers in health policy. Now, more than ever, there are more opportunities and more need for national, state and local foundations to support consumer advocates as they work to implement and defend the Affordable Care Act to ensure people can get the health care they need, when they need it.

– Reena Singh, Associate Director of State Consumer Health Advocacy

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Posted in Lessons Learned from the Field, state reform | 1 Comment »

Near-Universal Kids Coverage in Massachusetts: Lessons for the Nation

Friday, December 17th, 2010

This week Massachusetts officials released the latest data from their 2010 state insurance survey. The survey provided continued good news: overall, 98.1 percent of all Massachusetts residents have health coverage. This compares to a national insurance rate of around 83 percent. Remarkably, insurance coverage increased from 2009, despite the deep recession.

But even more extraordinary was the finding on coverage for children. For kids, the 2010 insurance rate is an astonishing 99.8 percent — essentially universal coverage. Children’s health advocates in Massachusetts, who have been steadily working on step-by-step improvements to kids coverage programs, cheered the unprecedented results. We also reflected on how we achieved such success, and how our lessons can apply nationally.

We would identify three critical factors to the growth in children’s coverage:

  1. A strong base of public programs: Massachusetts has long been among the leaders in state public programs for children. Our 1996 legislation that expanded Medicaid eligibility for children up to 200 percent of the federal poverty level (FPL) inspired Senator Kennedy to introduce the federal CHIP law. Then in 2006, the state went further and expanded MassHealth, the state’s combined Medicaid and CHIP program, to all children in families earning up to 300 percent FPL. As a result, children’s enrollment grew from 435,000 in June 2006, to 529,000 today. In addition to MassHealth, the state also operates the Children’s Medical Security Plan, which provides basic pediatric primary care to all uninsured children ineligible for MassHealth due to immigration status or income. As a result, all children in Massachusetts are eligible for a public health care program.
  2. Extensive Community-based Outreach: Massachusetts put significant resources into outreach and enrollment assistance, using both a top-down and bottom-up approach. The top-down effort included mass media ads and partnerships with local icons such as the Boston Red Sox. These were somewhat targeted to the low-income and minority community; for example, bus and subway ads were placed on urban lines. The ads were augmented by grants to dozens of community organizations, focusing in areas of high uninsurance, particularly minority and non-English speaking communities. Urban Institute researcher Stan Dorn evaluated the program and found that “these ‘mini-grants’ helped develop a cadre of agencies and individuals who were knowledgeable about the state’s health coverage programs, trained in using the Virtual Gateway [online enrollment system] to complete applications on behalf of consumers, and skilled in culturally and linguistically competent strategies for working with diverse, low-income families.” We learned that having a trusted advisor from one’s own community is critical to build the confidence required to enter the enrollment process.
  3. Spill-Over from the Individual Mandate: While children are not included under the Massachusetts mandate, the extensive attention paid to the need for insurance coverage led many parents to enroll their children. The mandate sets up a social expectation that everyone in the Commonwealth should have health insurance coverage — kids, too. While much of the growth in coverage in Massachusetts was among groups exempt from the mandate — low-income adults and children, the cultural force of the mandate provided the backdrop to encourage enrollment.

We still have more to do to improve children’s health in Massachusetts. The enrollment system could be made accessible, notices could be simpler, and gaps in coverage filled. But this week, kids advocates basked in the knowledge that universal coverage for children is not a dream. If we can do it, the rest of the nation can too. Let’s get to work.

– Brian Rosman, Guest Blogger
Research Director, Health Care for All Massachusetts

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Posted in children's health, state reform | No Comments »

Just the facts, MA’am

Wednesday, December 1st, 2010

Massachusetts’ health reform law generated a great deal of attention during the debate on national health reform. As implementation of the new law moves forward, Massachusetts reform continues to remain in the spotlight, but not always in a good way. Affordable Care Act opponents have made the Massachusetts law their bogeyman in attacks on national reform, often grossly misrepresenting the facts and largely ignoring the law’s success and popularity with Bay State residents. Indeed, there has been much said and written about Massachusetts reform that just doesn’t reflect reality.

The good news is the truth squad has arrived. The Blue Cross Blue Shield Foundation of Massachusetts has launched an excellent online resource dedicated entirely to Massachusetts health reform—offering the most thorough and accurate picture to-date of what the state’s groundbreaking health reform law does, how it is working, and what still remains to be done.

Key topics include:

– The Massachusetts Law and its History
– Health Reform Implementation
– Health Reform Results
– Financing Massachusetts Reform
– Health Reform 2.0: Cost and Quality
– Lessons from the Massachusetts Experience
– How National Reform Affects Massachusetts

We encourage Hub readers to check out the new site replete with helpful resources such as reports, data sources and analyses – and even videos. Its valuable insights into the lessons of Massachusetts reform are of great interest to us all as we work to implement the ACA in our states and communities.

- Kathy Melley
Director of Communications

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Three Strikes and They’re Out?

Thursday, August 12th, 2010

Last Wednesday patients and doctors welcomed a third win in the courts upholding state laws that limit pharmaceutical company interference with good prescribing. Judge Lynch on the U.S. Court of Appeals in Boston (First Circuit) handed down the ruling on Maine’s 2007 “data mining” law banning the use or sale of records showing which drugs health care practitioners have prescribed to their patients. The Maine law is nearly identical to laws in New Hampshire and Vermont that have also survived challenges by industry.

Prescription data mining, described in more detail here, is the business of health information organizations, such as IMS Health, Verispan and Wolters Kluwer. These companies purchase records from pharmacies containing prescription information (but not patient identities), combine them with practitioner profiles purchased from the American Medical Association and sell complete practitioner prescribing profiles to pharmaceutical companies. These profiles let marketers know exactly which drugs individual practitioners are prescribing so they can tailor their promotional messages to them. Maine’s law allows health care practitioners to “opt-out” of releasing their prescribing data for marketing purposes at each instance of licensure or re-licensure. The AMA has its own “opt-out” system, but few doctors even know about the program. Furthermore, it still allows drug companies to buy the disapproving physician’s prescribing profile, only requiring they refrain from sharing the individual-level prescribing data directly with the sales reps.

It’s clear that showing up in an office to pitch a new drug armed with the doctor’s complete prescribing history creates an unlevel playing field, making the interaction less about education and more about sales objectives. It’s not a surprise that most prescribers are not aware that their prescribing data is for sale. It’s even less surprising that drug reps are reluctant to inform prescribers that they have access to this information.

Solutions and Appeals

In 2006, New Hampshire passed the first-in-the-nation law completely banning the sale and use of prescriber-identifiable prescription data for marketing purposes. Representative Cindy Rosenwald—whom we’ve interviewed on related privacy issues before—pushed the legislation through the state assembly in 2006 as a measure to bolster public health and curb rising drug costs due to industry marketing.

Health information companies challenged the New Hampshire law shortly after it was enacted. A U.S. district court in New Hampshire overturned the law in April 2007 on the grounds that the use of such data by health information companies, pharmacies, and drug companies constitutes commercial speech; the law, they asserted, restricted that speech. New Hampshire Attorney General Kelly Ayotte appealed the decision and took the case to the United States Court of Appeals for the First Circuit. Community Catalyst and other consumer, professional and medical organizations presented arguments supporting the law in an amicus brief filed by, Sean Flynn of American University’s Washington College of Law

Strike One:

In late 2008, the First Circuit solidified the first in a series of major wins for prescription privacy advocates, upholding the New Hampshire law and affirming its constitutionality.  The Court found that the law regulates conduct rather than speech, so does not infringe on First Amendment rights. It ruled that the state can regulate this practice since it affects public health and costs of care. Last year, the Supreme Court refused to hear a further appeal of the New Hampshire law filed by the plaintiffs (IMS and Verispan).

In 2007, Vermont legislators had passed a similar law banning the use of prescriber-identifiable data, except in cases where a health care practitioner “opts-in,” agreeing to release their prescribing records to marketers.

Strike Two:

The Federal District Court in Vermont upheld the law on grounds that it would protect public health and contain drug costs, but the ruling was again appealed by health information organizations. Shortly after the Supreme Court refused to hear an appeal of the New Hampshire law, the Court of Appeals for the Second Circuit denied a request to grant an injunction of Vermont’s law, allowing the law to go into effect last July. We and others supported the law in an amicus brief. The Court is still considering the appeal and a decision is expected soon.

Where We Stand

For those keeping score, we now have three variations of data mining laws in three states. We’ve got the total ban, the “opt-in” and the “opt-out.” Each of the states has also been given the go-ahead to implement its law, though we’re still waiting for the outcome of the final appeal on the Vermont statute.

The First Circuit ruling is another win for prescription privacy and public health advocates. But the ruling may be most significant because there isn’t really anything remarkable about it. It feels like we’ve been here before, heard many of the same arguments and had similar results. Even though these three laws differ slightly in how they go about it, they all have the same intent: to limit drug reps’ access to prescriber-identifiable data. The legal and public health arguments for limiting data mining are clear, and that’s been shown time and again. Last week’s ruling in Maine cited many of the same findings from Vermont and New Hampshire decisions: the statute is constitutional, does not infringe on free speech guarantees, stands to protect public health and will save public dollars.

Maybe this was strike three. Or maybe the final appeals court ruling on Vermont’s law will be strike three. Sooner or later it will come and advocates can focus on developing programs and systems that use prescription information to improve patient care, rather than simply defending against its use for marketing practices that drive up costs. With the passage of the new health law, we need smart strategies like these to make the health care system more sustainable while improving quality.

– Ian Reynolds, program associate

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“Show me” gender equity!

Wednesday, June 30th, 2010

Missouri is trying to remain true to its slogan, the “Show Me State,” by helping lead the charge in anti-health reform legislation prohibiting abortion services for health insurance obtained through the exchange – (the term used for the health care insurance marketplace instituted by national health reform).  Yet it certainly leaves one wondering…show me what?

Now sitting on Governor’s desk is a bill that strips the state exchange of offering any kind of abortion coverage to consumers– even through an optional rider.  Similar to the flurry of anti-reform constitutional amendments being adopted across many states, this legislation is based on a model developed by the Americans United for Life (AUL), a non-profit law and policy group.  The model, entitled “The Federal Abortion-Mandate Opt-Out Act,” is in the pipeline in almost 30 states, according to AUL.  Thus far, Mississippi, Arizona, Tennessee and Louisiana have passed the prohibition measure – the measure was vetoed in Oklahoma and Florida.

Claiming to be founded upon a pro-family platform, AUL aspires to stall the progress of health care reform by barring consumers from some patient services.  Yet eliminating family planning services from exchanges does not promote a family friendly policy environment – but supporting gender equity does.  According to the National Law Center for Women, 17 percent of Missouri women forgo needed care due to their higher cost of health care – these include a broad range of services.  Women in Missouri are, on average, poorer than men and tend to work for small businesses that do not offer health coverage.  This is not only a strain on women and their health but also their families.

Advocates can challenge these flawed attempts to dismantle health reform and propose a broader pro-family agenda by driving home the message of gender equity.   A pro-family message is one that encompasses supporting all women at all times in their lives – daughters, sisters, wives, mothers, and grandmothers alike.  Other states have stepped up to rid their health care systems of inequitable gender rating that charge women as much as 4-48 percent more than men for the same health care policy.

However, these positive steps are not without their critics.  Before Colorado passed its ban on gender rating in the individual market this past spring (in the week following health reform passage), an insurance underwriter commented to the legislature that perhaps “we should ‘blame God’ because men’s parts were on the outside and women’s parts were on the inside.”  State Senator Morgan Carroll responded to his comment by suggesting “perhaps his brain is on the outside.”  Further, Rep. Jim Kerr suggested that women enjoyed shopping and perhaps they should do a better job shopping for health insurance.

The absurdity of the discussion makes you laugh and grimace simultaneously – but the issue remains in play in many states.  Women are often the center of their families, before and after they procreate – a real pro-family policy would be for all to acknowledge their right to a healthy and long life.  So, show me gender equity!

–Eva Marie Stahl, policy consultant

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The Insider: All this could be yours someday

Monday, June 14th, 2010

Fuzzy logic
As the “tax extenders” bill makes its way through the Senate, a provision to extend COBRA premium subsidies for the unemployed is in jeopardy. Opponents in the Senate and the Blue Dogs in the House who stripped the provision from legislation two weeks ago argue that it’s unfair to help people who are unemployed when other, equally needy people are getting no assistance.

Just stop and think about that for a minute: It’s not like they’re identifying an alternative beneficiary for assistance, or arguing to accelerate implementation of the Affordable Care Act. They are basically saying, “Because we can’t help everybody, we won’t help anybody.” If you apply that reasoning more broadly it leads you to advocate the repeal, or at least the suspension, of Medicare and Medicaid until 2014, when financial assistance to obtain coverage becomes more generally available–a move few Congressmembers would dare consider, even in a non-election year.

With unemployment remaining high, the COBRA premium subsidies in limbo are badly needed. They are good for the economy, the health care system, and mostly for the thousands of struggling families who will be able to retain their coverage. Find out more at Community Catalyst’s implementation headquarters.

Faulkner on health care
When William Faulkner wrote, “The past is never dead. It’s not even past,” he could have been talking about the politics of health care more than a half-century into the future. Congressional Republicans’ challenge of the White House public education campaign on Medicare changes as misuse of government funds for partisan advantage hearkens back to Democrats’ attacks on the Bush administration over the original Medicare Part D roll-out.

And Senators who opposed PPACA seem intent on re-debating the legislation at every opportunity: first, in the context of Don Berwick’s nomination to head CMS, and now in the debate over the Medicare physician payment fix. Republicans have offered an alternative that does more for the physicians but partially pays for it by eliminating desperately-needed financial assistance for state Medicaid programs—while slipping in a “poison pill” that would roll back the individual responsibility provisions in PPACA. Such a move could appeal to many on the left who are concerned that the affordability provisions don’t go far enough.

Someday, all this could be yours
As the “repeal and replace” drumbeat goes on, a third ‘r’ should be added to the sequence: Recycle. Congressional Republicans are recycling ideas from the debate that were shown to fail to reduce the number of uninsured or eliminate insurance discrimination.

But as several states move forward with anti-Affordable Care Act ballot measures, new research from Massachusetts shows just how wrongheaded such opposition is. Until the coverage provisions of the Affordable Care Act kick in in 2014, Massachusetts provides the closest thing we have to a “beta site” for what the health care system of tomorrow will look like. While critics focus on the continuing cost challenges (problems that pre-dated health reform in Massachusetts  and were not really addressed in the landmark law in 2006) new reports published by the Urban Institute and the National Bureau of Economic Research underscore just what other states can gain as they move forward with implementing the law.

Urban’s latest report shows that the coverage gap between racial and ethnic minorities and non-Hispanic whites has been closed—the only place in the country where this is true. Additional findings show:

  • –high rates of coverage in Massachusetts persist despite continued high unemployment
  • –economic barriers to obtaining care remain low and have declined further for some populations since the inception of the law
  • –four years into implementation, there is still no evidence of ‘crowd-out’ of private coverage, and public support for the Massachusetts system remains high.

Get the details here (pdf).

The NBER paper found that since reform in Massachusetts, there have been fewer preventable hospitalizations and emergency room-generated admissions, and length of hospital stays has been reduced, most likely due to improvements in access to ambulatory care.

Sure makes implementation look like a lot better idea than repeal.

–Michael Miller, director of strategic policy

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Cross-coast Post: Real Choices

Thursday, June 10th, 2010

From our friends over at the Health Access Blog comes a great post about a California bill, SB890, that would implement many of the consumer protection pieces of national health reform early, like setting up strong medical loss ratios, so that insurers spend dollars on caring for people, not admin and profits, and creating minimum benefit standards in the private insurance market to help consumers make good comparisons. Here’s an excerpt:

By standardizing the benefits in the insurance market, consumers can make real apples-to-apples comparisons, forcing insurers to compete on price and quality rather than avoiding sick people. It ensures people know the kind of coverage they are buying, and what that plan actually covers. It prevents consumers from finding out too late that what their ailment isn’t covered. It prevents the worst forms of “junk” insurance, where patients are paying premiums and finding little value in return.

Read the rest of the post about how standardizing benefits allows for real choice at the Health Access Blog.

–Kate Petersen, Health Policy Hub

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Senate should restore COBRA and Medicaid subsidies

Friday, June 4th, 2010

As we said Tuesday, the House removed provisions for federal Medicaid and COBRA subsidies from H.R. 4213, and the Senate departed for Memorial Day recess without taking action. The subsidies are critical to help hurting states that are struggling with budget cuts and families who have lost jobs during the worst economic time since the Depression.

The Senate will take up the bill when it returns from recess, and is likely to make changes. It is critical that the FMAP and COBRA extensions are put back into the baseline bill that is brought to the Senate floor, since it’s difficult to add the provisions back in through a floor amendment.

States are relying heavily on the FMAP extensions in their state budgets. It is very possible that this will be the last chance to secure those funds. Please contact your Senators before Tuesday and ask them to support the inclusion of the FMAP and COBRA extensions in the “tax extenders” bill (Also known as H.R. 4213, “The American Jobs, Closing Tax Loopholes and Preventing Outsourcing Act.”) to be considered by the Senate.  You can use Families USA’s toll-free number to connect to Capitol Hill, 1-866-922-4970.

For talking points, see the Community Catalyst implementation page.


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The Insider: Implementation Nation

Tuesday, April 20th, 2010

Although the national media spotlight has moved on, the work of health care reform is only beginning. Today we  look at some of the recent developments in Massachusetts—which is sort of a health reform “beta site”—and what they tell us about reform in the rest of the country. We’ll also examine one of the early implementation provisions: the temporary high-risk pool.

Massachusetts: The gift that keeps on giving

Throughout the debate on national health care reform, Massachusetts has played an outsized role. The bipartisan nature and popularity of reform in the state, its success at reducing the number of uninsured, and the prominent role Massachusetts pols from both parties played in the national reform saga have all helped to make what happens in the Bay State unusually significant. This is likely to continue to be true going forward.

Because Massachusetts is farther down the implementation path, it has already encountered issues that will come up in other places. Three recent developments in Massachusetts highlight the state’s continuing relevance to the reform debate.

The first is the controversy over insurance premium rate hikes.  Earlier this spring, the Massachusetts Division of Insurance denied dozens of premium rate increases as being excessive. (See the Boston Globe article.) The ruling led to a court challenge by insurers and a brief insurance “strike” as Massachusetts insurers took their plans off the market.  (Since the court refused to grant the insurers a preliminary injunction most plans are again available). Although this preliminary ruling went against the insurers, there is no guarantee about the final outcome.

The takeaway? Insurers will play hardball to resist downward pressure on premiums. States need strong tools and political will to fight back. An effort to beef up premium oversight had to be stripped from the final national health reform bill because it did not fit within the rules of the budget reconciliation process, but a stand-alone rate regulation bill is being championed by Sen. Diane Feinstein. A hearing is scheduled for this Tuesday in the HELP committee, but odds of passage are uncertain, since it’s likely that Republicans will present a united front in opposition, making it hard to get the necessary 60 votes.  In the absence of federal authority,  advocates may want to turn their attention to strengthening state oversight.

A second issue to hit the Boston media recently also has lessons for national reform. Insurers allege that there is a group of people taking advantage of continuous open enrollment to purchase non-group insurance for a short period of time, schedule costly medical care, and then drop out. Like so much of national reform, this claim comes with a heavy dose of politics attached, since the charges are being made by a former insurance industry exec who’s running for governor.

These “short-stayer” allegations have yet to be substantiated. So far insurers have not provided data which shows what medical care alleged short-stayers are using, whether or where they were previously insured, and whether the problem is growing or actually diminishing. The Division of Insurance is studying the issue and its report is expected soon.

Meanwhile, we can and should expect insurers to fight to undermine the impact of guaranteed issue by narrowing access to insurance. This battle will be fought first at the federal level as HHS determines the initial and subsequent enrollment periods, and it’s critical that consumers push back to make sure that insurance remains as accessible as possible.

The third implementation issue in Massachusetts with implications for the states is one that has received no media attention (and was not heeded by federal lawmakers during the debate): When it comes to helping people make informed choices among competing insurance plans, standardizing actuarial values is simply not enough.

Within any given benefit tier (gold, silver, etc.), insurers can vary cost-sharing arrangements so much that comparison remains difficult. Focus groups in Massachusetts show what those done by national organizations do: What people want is better choices, not an infinite number of choices. And so after several years of experimenting with actuarial value, the Massachusetts Connector has moved to standardize benefits. Federal law does not require states to create standard benefits, but it does not prohibit it, either. Nor is there any reason that standardization has to wait for the 2014 kick-off of health insurance exchanges.  Advocates should consider pushing for greater standardization in their state markets now.

High-Risk Pool rules present states with tough decisions

One of the first provisions of national health care reform slated to be implemented (90 days after passage) is the creation of a temporary high-risk pool (HRP) for those excluded from coverage due to a pre-existing condition. As welcome as this new program is, given that most existing state high risk pools perform poorly, it may prove difficult to effectively integrate the new program with existing state law.

PPACA establishes a set of rules for both the federal HRP and any existing state pool that wants to tap into the $5 billion in federal support made available by health reform.  These rules include setting a minimum actuarial value and out-of-pocket maximum for HRP coverage. They also prohibit the imposition of pre-existing condition exclusions, require rates to be the same in the HRP as in the market generally, and set a limit on age rating of no more than 4-1. All of these are welcome changes.

However–and it’s a big however–federal law also restricts eligibility for the HRP to those who have been uninsured for at least six months. While this provision is designed to prevent people from dropping existing coverage to enroll in the federal plan and to help stretch federal dollars, it also creates some problems. Consider these four types of states:

States with no HRP and no guaranteed access to insurance in the non-group market–For these states there is no problem: Either the state will set up an HRP that meets federal standards, or the federal government will set up a pool on behalf of the residents of that state. End of story.

States with an HRP that is worse in all respects to the federal law–A state could “true up” its program to meet federal requirements, or it could do nothing, in which case the federal government would set up a parallel program.

What happens then? Everyone with a pre-existing condition (who can afford the premiums) can enroll in the federal program except those who are already enrolled in the state HRP. They either have to take the risk of going without coverage for six months, or remain locked into inferior and costlier coverage in the state pool.

States with an HRP that does not require a six-month wait–Even if a state pool is as good as or better than the federal requirements in most respects, the requirement for a six-month waiting period could create problems.

In general, states can run a program that is better than the federal program if they choose. But, if states do not impose a six-month waiting period, their program will not qualify for federal assistance.So they have the choice:   either impose a new access restriction on people with pre-existing conditions, or set up a parallel pool (or allow the federal government to). In the latter case, those who can take a chance on going without coverage for six months could join the federal pool, while those who could not would retain or join the state pool, leading to a generally sicker pool of enrollees in the state pool.

States that already have guaranteed issue and modified community rating in their non-group market–A number of states, including New York, Maine, Vermont and several others have already eliminated pre-existing condition exclusions instead of having a high risk pool. However, because of the six-month no-coverage requirement it’s unclear if these states would benefit at all.

Regulations for how states should implement the HRP provisions are expected very soon from HHS, but it’s unclear whether the Secretary has the authority to address these problems, or if the solution requires a Congressional fix.

Coming next time: Repeal Watch!

–Michael Miller, director of strategic policy

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State business, health care, labor and faith leaders call on Massachusetts delegation to pass national health care reform

Monday, February 22nd, 2010

A diverse group of leaders joined together in the Massachusetts State House today to deliver one message to the state’s delegation: National health care reform is anything but a raw deal for Massachusetts.

The 16 speakers representing faith groups, advocates, consumers, small business, providers, insurers, labor, immigrants, seniors and government called for Congress to move forward on comprehensive reform now. And they asked the Massachusetts delegation especially to support their constituents by voting yes on national reform.

“This is the social justice issue of our lifetime,” said Rabbi Jonah Pesner, leader of the Greater Boston Interfaith Organization. He added that the state’s 2006 health care reform had expanded coverage to hundreds of thousands of individuals, and he hoped for the passage of national reform to help “continue gains in Massachusetts.”

Even while the state’s reforms have helped insure 97 percent of residents, gaps persist, said Amy Whitcomb Slemmer, executive director of Health Care For All, a health advocacy organization (and Community Catalyst’s sister organization). “Too many people still can’t afford coverage. We need to work to close that gap.”

National reform would accomplish that by offering subsidies to 75,000 middle class families to help them afford quality insurance. Reform would also support businesses that now struggle to offer health care to their employees.

“For my business to grow and thrive, we need healthy workers,” said Phil Edmundson, CEO of William Gallagher Associates. “National health reform would provide tax credits to help small businesses offer coverage, allowing them to create jobs and grow our economy. An estimated 70,000 small firms in Massachusetts would benefit, and our economy and health would improve.”

Speaker after speaker emphasized that reform at the national level would not only provide more state residents with affordable care and help fund Massachusetts’ own reform, but it would also improve health care across the country and give those in other states the quality coverage and opportunities that Massachusetts now enjoys.

“The physicians of the Commonwealth not only support the pioneering effort here in Massachusetts, but we know that it’s going to lead to national health reform that will improve the quality and safety of care,” said Dr. Jack Evjy of the Massachusetts Medical Society. “National reform will further expand coverage so that we’re taking care of all of our sick people, and that’s an important thing for America.”

The state’s health secretary, Dr. Judy Ann Bigby, called on the Massachusetts delegation to do what’s best for Massachusetts – and for the country as a whole – by voting for national health care reform, just as they supported the state’s successful reform four years ago.

“Health care is a right, not a commodity,” she said. “It’s time the richest country in the world provided health care to everybody in the United States.”

See videos of the event from Health Care For All: http://www.youtube.com/user/HCFAMA

-Elizabeth Ress, Health Policy Hub

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