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Cross-Post: Got Coverage? 1,479 More Kids in MA Do Now!

Wednesday, June 15th, 2011

Massachusetts health advocacy organization Health Care for All (HCFA) sponsored a month-long campaign to enroll as many uninsured children in health coverage as possible. HCFA enlisted 66 organizations across the state to participate in its Statewide Enrollment Challenge, part of U.S. Health and Human Services Secretary Kathleen Sebelius’s “Connecting Kids to Coverage” campaign. Three of the state’s major insurance providers donated awards for the six most successful Challenge participants.

This blog was originally posted on Health Care for All’s A Healthy Blog.

It’s been a whirlwind month, but the first phase of the “got coverage?” Kids Enrollment Challenge is DONE! And thanks to the tireless efforts of 66 enrollment organizations statewide, HCFA is proud to announce that 1,479 previously uninsured children now have health coverage!!

The end of the first phase was celebrated today at an event at the State House Grand Staircase, where state and federal leaders extended their gratitude to each of the participating organizations for their devotion and hard work over the last month to find and enroll at least 500 uninsured children. Nearly tripling our goal, we couldn’t be more grateful to these groups for standing up for kids.

Christie Hager, Regional Director of the U.S. Department of Health and Human Services, Senator Sal DiDomenico, and Representatives Tackey Chan, Russell Holmes, Elizabeth Malia, Ellen Story and Alice Wolf were all in attendance to show their appreciation.

In speaking to the organizations, Rep. Story said that state leaders are asked to do a lot of hard and sometimes impossible tasks, but that she knows it is not too hard or impossible to get twelve-month eligibility for families and children. “It’s a no-brainer!” she exclaimed.

But the best appreciation came from the children and families who finally find themselves with insurance after years of no health coverage. Dennis Chang, father of two girls, told us that even though you cannot see his daughter’s illness, it is still there and he is grateful for the coverage he now has to pay for her doctor’s visits. Sonia Costa’s child was born prematurely and she says getting health care coverage made all the difference. Vilma Donis, who found out about the program through church, merely sighed “Thank God!” once she, her son and daughter were enrolled in coverage. Obviously, the work of each of the 66 enrollment organizations will yield healthier outcomes for generations to come.

Today’s event was multipurpose, as it allowed HCFA to both celebrate these organizations and to also kick off the next phase of its enrollment challenge: helping kids retain their health care coverage.

Many participating enrollment groups found that the reason children lack health insurance is because parents are often not sure how or when to reenroll their kids each year. In an effort to address this issue, HCFA has asked these organizations to continue to help keep those kids connected to care by advising parents about the best ways to stay enrolled. For the second phase of the challenge, HCFA has provided participating organizations with educational outreach materials, including bookmarks and magnets, which detail the steps of how to maintain health coverage. These materials feature actionable reminders, such as informing MassHealth about changes in employment status or address, and when their family’s health insurance renewal is due.

We were so pleased with the organizations’ enthusiasm to sign on to the next phase to focus on coverage retention! Got coverage? 1,479 kids do now!!

-Katy Capers, Health Care for All

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Consumer Assistance: What makes health reform go

Monday, July 12th, 2010

It’s no secret that the passage of the Affordable Care Act means lots of new opportunities for health care coverage and access – and that most Americans are confused about what the law actually means for them.  Here at Community Catalyst, we have seen health reform as an opportunity to improve consumers’ ability to get clear information in lay terms from trusted sources to help them understand their health care options.  And consumer assistance programs (CAPs) are a critical way to make this happen.

The Affordable Care Act included $30 million in 2010 to fund state ombudsman offices and CAPs (Section 1002).  The grant guidelines for those funds are slated to come out in the next few weeks, and the grants will likely go to states, who will decide how to best use the funds.

While we’re not quite sure how the guidelines will read or play out in implementation, we have  some core criteria we think are necessary to providing consumers accurate, understandable information and helping them navigate the new world of health care.

1.     Be truly independent.  Consumers should be able to trust that the information and enrollment assistance they get is unbiased – not informed by state budget problems or politics.  Especially as 20 states’ attorneys general actively oppose health reform, consumer assistance programs should ensure there’s a wall between state and political issues and helping consumers.
2.    States need to do more than they already do.  Many states are currently overwhelmed and understaffed because of budget woes.  Consumer assistance programs need to be separate and robust from current activities in state Administrations – and actually have the capacity to provide necessary help, navigation and information.
3.    Meet the needs of the community.  Consumer assistance needs to be culturally and linguistically competent, and provided by people who understand working with vulnerable populations.  A well-trained staff should be trusted by members of the community, including people at different levels of income and insurance options (from Medicaid to private insurance).
4.    Allow for feedback to policymakers.  A critical reason for consumer assistance is the ability to get real-time, on-the-ground information about what’s working and what’s not.  Regular feedback to state and local policymakers can help improve health reform implementation
5.    Ensure every state has a consumer assistance program.  Even if a state does not set up a program, the federal government should be able to contract directly with an organization to carry out these important duties.

Based on these elements, we think that the best option for CAPs in most states is often non-profit community advocacy organizations.  Examples like Health Care for All Massachusetts’s Helpline, New York’s Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase from 500 to 4000 per month after the passage of that state’s health reforms in 2006.  People call with questions from enrollment assistance to help with paperwork to navigating the health system.
We hope that the grant guidelines will explicitly permit states to contract or partner with community organizations to provide consumer assistance.  We have seen these models work, and know that they are trusted sources of health care information for communities and families looking for help in understanding a system that’s about to get bigger and more complex.

– Christine Barber, senior policy analyst

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Case study shows community health workers improve primary care and enrollment

Friday, July 9th, 2010

Policy changes in two states to expand and strengthen the workforce of community health workers provide a model for other states as they implement the Affordable Care Act, says a new case study, “Community Health Workers: Part of the Solution,” in the July Issue of Health Affairs (free abstract—subscription required). Coauthored by Community Catalyst’s Director of Health Equity Lisa Renee Holderby, who previously headed the Massachusetts Association of Community Health Workers, the paper looks at how Minnesota and Massachusetts turned to community health workers to address shortages in the health care workforce and improve enrollment and primary care.

The case studies found that policy changes that supported the use of community health workers (CHWs), who provide patients peer-to-peer assistance managing their health and navigating the health care system, helped increase enrollment and quality of care in their communities. The Institute of Medicine has recommended that CHWs be included in care teams to help improve the health of underserved communities.

“As members of the community,” the authors write, “these front-line workers are valued for their cultural competence and mediate between providers and other members of diverse communities. Evidence is accumulating that including community health workers in determining the appropriate use of services has a sizable positive return on investment.”

So what policy changes do the authors want to see in other states? First, sustainable funding for CHWs to participate in the system – including reimbursement by public programs like Medicaid, Medicare and CHIP. And they suggest states establish workforce education programs and occupational standards to train and credential CHWs like other health care workers. The authors also propose that states establish some uniform guidelines they can use to chart and evaluate CHWs and their participation in the health care workforce – something that is going to be happening in many corners of the health care system as part of the Affordable Care Act.

“Community health workers can be vital to efforts to restructure the delivery of primary health care. The patient-centered medical home has been described as providing ‘accessible, comprehensive, family-centered, coordinated, compassionate and culturally effective care.’ Although the workforce required for the medical home model has not been fully defined, close ties to the community and cultural competence are essential. Additionally, a successful medical home will require continuity of communication between provider and patient.

“Community health workers are uniquely qualified to meet these responsibilities and to complement other members of the health care delivery team. These workers’ valuable capacity to increase patient engagement will be important to consider in evaluations of quality improvement.”

“Community Health Workers: Part of the Solution” is part of a special issue of Health Affairs on the implementation on health care reform, and the whole thing’s worth a read (caveat: subscription required.)

–Kate Petersen, Health Policy Hub

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East Room Promises

Wednesday, June 23rd, 2010

baracksigningI was invited to attend an event at the White House yesterday to commemorate the 90th day since President Obama signed health care reform into law, and it was a powerful event that underscored how much the law matters to American families.

Following a private meeting with insurance executives, the President walked into the East Room and was introduced by Amy Wilhite from Ohio.  Amy’s daughter, Taylor, was diagnosed with Acute Myeloid Leukemia (AML), a cancer of the blood and bone marrow, for which Taylor received three rounds of chemotherapy and a bone marrow transplant that produced multiple side effects. Taylor’s father’s insurance plan has a $1 million lifetime limit, and as Taylor approached the limit, the family requested a $500,000 extension.  It was granted.  But Amy said that they still have to pick and choose which tests and follow-ups to go through with, because they don’t want to exceed the cap.  She was very grateful that the Affordable Care Act (ACA) banned lifetime caps and thanked the President for his leadership on the law.  Amy was articulate and her family’s story a powerful one, which moved all of us in the room.

After Amy,  President Obama spoke for about 25 minutes on abusive insurance practices that hurt families, and recent exorbitant rate increases that have captured headlines and prompted state action (such as Massachusetts’ prohibition of rate increases within the Connector).  But acknowledging that the cooperation of insurers is critical to making health reform a go, the President also suggested that he was ready to work with the industry to make the bill work.

The President went on to challenge politicians who are running on a platform of repealing the law–who want to go back to the system we had before. “Would you want to go back to discriminating against children with preexisting conditions?” he asked us. “Would you want to go back to dropping coverage for people when they get sick?”  Would you want to reinstate lifetime limits on benefits so that mothers like Amy have to worry?” The room was quiet.

“We’re not going back,” he said.  “I refuse to go back.”

–Rob Restuccia, executive director

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The Insider: The Political Ecology of Health Reform Implementation

Wednesday, May 5th, 2010

Throughout the debate on passage, pollsters regularly found that the public wanted a “bipartisan solution” to health reform. Of course, no such solution was forthcoming if by bipartisan we mean something that attracts votes from members of both parties. As implementation moves forward, the partisan divide looks, if anything, to further grow.

The persistence of these bipartisan wishes suggests that many Americans do not fully appreciate the extent of the rightward shift in the Republican Party. This can clearly be seen in the standing of Republican Governor Charlie Crist of Florida, now a candidate for the U.S. Senate who recently decided to run as an independent after he was overtaken in the primary polls by tea-party favorite Marco Rubio. Crist, while less extreme than former governor Jeb Bush, is no liberal. But he finds no home for himself in today’s Republican party. Similarly, Utah Senator Robert Bennett is at risk of losing his party’s nomination to a challenger on his right, even though he has an 84 percent lifetime favorability rating from the American Conservative Union.

Another marker of this shift is the sharp contrast between the support for reform of recent Republican leaders such as former Senate Majority Leader Bill Frist from the pronouncements of today’s party leaders. Even some of the moderate Republican governors who have been more supportive of reform—e.g. Connecticut’s Rell, and Schwarzenegger—are about to exit the political stage.

If the elections were held today, most projections show that the Republican Party, increasingly indistinguishable from the extreme far right, would claim a significant though not decisive victory, bringing into office a new crop of officials publicly committed to repeal of reform.

That’s the bad news.

The good news comes in two parts:
a) Even if there is an electoral tsunami, the repeal strategy faces enormous hurdles and
b) While the repeal torch burns as hot as ever for the true (un)believers, there is some indication of an upswing in support from the general public.

The latest Kaiser poll shows 49 percent of the public supports reform, compared to 40 percent who are opposed. Importantly, all of the early implementation provisions rack up big majorities among Republicans and Independents as well as Democrats.

The popularity of these measures muddies the message of the repealers–but only if people know about them. Educating the public about the early provisions of reform, then, is crucial not only to make sure that people get the new benefits, but to influence the future political environment in which reform will be implemented.

Insurance Rate Regulation and Beyond
When it rains it pours for insurance giant Wellpoint. Last week it was outed for its aggressive policy of trying to dump women with breast cancer from its rolls. Then it withdrew its controversial proposal for a 39 percent premium rate increase in California, admitting that there were errors in its calculations but claiming those miscalculations were inadvertent.  (In related news, the company has announced it will be putting the Brooklyn Bridge on the market to help recoup the revenue from the cancelled rate increase, but so far no buyer has stepped forward).

Even taking the company at its word, Wellpoint’s debacle illustrates the need for stronger rate oversight. Leaders of the Senate HELP committee continue to debate the options for moving the Feinstein rate oversight bill, S.3078, which also picked up an important endorsement from the American Cancer Society/Cancer Action Network. Companion legislation has been filed in the House by Illinois Congresswoman Jan Schakowsky.

At the same time, advocates need to be mindful that strong oversight of insurance premiums is a necessary but not sufficient piece of the cost-containment puzzle. The anti-trust investigation into possible monopoly pricing by Partners Healthcare—the largest hospital system in Massachusetts—illustrates a pervasive problem in the U.S. health system. While it remains to be seen if there was anything actually illegal in Partners’ negotiating strategy, the issue of concentrated provider power is real and not confined to Massachusetts. (See this recent report on the effect of market power on health care costs in California.)

In fact, the high prices that we in the United States pay for health care across the board add much more to our high costs than do the mix or amount of services we use, as Ezra Klein shows here. On a series of charts comparing the prices U.S. insurers pay to those of other countries–regardless of procedure or number of appointments–“the block representing the prices paid by American health-insurance plans [looms] over the others like a New York skyscraper that got lost in downtown Des Moines.”

Sure, it’s fun to pick on the insurers, and certainly they deserve it. But we can’t approach cost-containment like the drunk looking for his keys under the streetlight–not because that’s where he dropped them, but because that’s where the light is. Going after the insurers may represent the low-hanging fruit, but the sustainability of health reform will depend on effective cost-containment–and that means taking a close, hard look at the delivery system.

–Michael Miller, director of strategic policy

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America needs better care!

Tuesday, April 13th, 2010

cbcHealth reform is law. The hard work of fixing our health system begins now. That’s the message of  Campaign for Better Care, a recently-launched effort to improve health care coordination and quality for people across the country. (Here’s the ad (pdf) that ran in Politico.)

The Campaign, a joint effort of the National Partnership for Women & Families, Community Catalyst and the National Health Law Program (NHeLP), is working to ensure that we realize the promise of health reform by improving health care quality, coordination and communication for older patients with multiple health problems and their family caregivers.

A newly released national survey of Americans 50+ tells the story.

  • Something to talk about. Nearly three-quarters have wished that their doctors would talk and share information with each other.
  • People who take the most meds need to hear more about medication interactions from their doctor. Forty percent of people who take five or more medications say their doctors do not talk to them about potential interactions with other drugs or over-the-counter medications when prescribing new medications.
  • Different info from different doctors. More than one third of people who use the health care system most say they’ve received conflicting information from different doctors.
  • Taking the test over—and not because they failed. One in eight (13 percent) has had to redo a test or procedure because the doctor or hospital did not have the earlier results.
  • Do you have any questions? Yes. Three-quarters of those who use the health care system most have left a doctor’s office or hospital confused about what to do at home.

But the real story is told by people like Joann, whose life was turned upside down last summer when her 79-year-old mother fell and broke her hip. Because her mother also suffers from osteoporosis and dementia, Joann stayed overnight in the hospital for two weeks to help her navigate the system.  She was physically and emotionally exhausted in this solo effort to make sure her mother was safe and well-cared for once she returned home from the hospital.

The new health reform bill is full of programs that could help people like Joann and her mother by providing the comprehensive, coordinated, patient-centered care they need.  And, the Campaign is committed to taking the essential next step: ensuring that these programs are designed and implemented with the needs of patients and their family caregivers front and center.  Because if we can make the system work for people with the most challenging health care needs, we can make it work for everyone.

To support the national Campaign, Community Catalyst is also working in six states to build support for these kind of programs:

Maine (Consumers for Affordable Health Care)

Massachusetts (Health Care for All)

Ohio (UHCAN Ohio)

North Carolina (NC Justice Center)

Pennsylvania (Consumer Health Coalition)

Wisconsin (Coalition of WI Aging Groups)

Check out the state campaign websites to learn more about what they’re doing to promote better care in their states.  And be sure to visit the national campaign website www.CampaignforBetterCare.org to learn more about the campaign and how to get involved.

-Renee Markus Hodin, project director

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Health Reform Insider Goes to the Toast and Polls

Tuesday, March 30th, 2010

President Obama signed the final piece of the health reform package today. So before we do anything else and get caught up in the next round of debate, here’s a toast to all those who have worked so hard over the past year to get us this far.

And what goes better with toast than a bill summary?

(We couldn’t think of anything, either.)

So now what?
Congress’s work on health reform is complete (at least for now) but with barely a pause for breath, the hissy fit against reform has continued, merely shifting venue to the states and the upcoming fall elections. Public outreach is still needed, both because a number of provisions take effect very quickly (here they are), and the ongoing smear campaign against reform.

Thirty something
As we mentioned last week, legislators in over 30 states have filed legislative proposals or constitutional amendments regarding health reform. Although there are a few variations on the theme, the main claim is that Congress does not have the authority to impose a tax penalty on people who do not have qualifying health insurance.

And a dozen or so Attorneys General have filed suit against the federal government, claiming, among other things, that it does not have the authority to condition federal Medicaid matching funds on states meeting federal eligibility criteria, because to do so would impose costs on the states. (This is a strange argument, since the federal government has been doing exactly that since the beginning of the Medicaid program.)

Analysts have concluded that the proposed challenges lack legal merit. See:

But merits shmerits. Remember, the goal here isn’t to build sound legal cases but to gin up fervor to elect anti-reform members to Congress (or in the case of the AGs often to get themselves elected to higher office) and create a screen of apparent public opposition to reform for state officials intent on foot-dragging to hide behind.

They may also be trying to force the administration to make a potentially damaging public admission that the individual mandate constitutes a tax—thus violating an Obama campaign pledge.

A dead end strategy?
Given some truly awful recent Supreme Court decisions, no one can afford to laugh at the prospects of litigation, even though most nonpartisan analysts have concluded that they are without merit.

Still, challenges aside, there is reason to be optimistic about the future of reform.

First, the status quo is unsustainable—and more and more civic leaders are recognizing that. Reform opponents have no meaningful alternative that will address the rising costs and rising numbers of uninsured that are undermining the system.

Second, reform does a number of popular things (insurance reforms and subsidies, say) that will be not only be difficult to undo, but also difficult to separate from some of the less-popular aspects.

Third, reform creates more winners than losers among interest groups. There are not that many stakeholders who have a vested interest in repealing (not to be mistaken for amending) key parts of reform. Hospitals, doctors and drug companies can all find provisions they do not like but on balance, the extension of coverage to more than 30 million people will be good for the health care industry. States have concerns about the cost of the Medicaid expansion, but the expansion is 100 percent federally-financed in the short run, and provisions like increasing the Medicaid drug rebate rate will reduce state costs.

What about businesses? Although some may have concerns about the “free rider” provisions, only a very small percentage of employers will actually be subject to any penalties (The Congressional Research Service estimates only about 5 percent).

So too with the individual mandate. Most people already have private or public insurance or would voluntarily purchase coverage once a subsidy is available. The mandate is a tool to ensure the broadest possible risk pool and to prevent people from churning off and on health insurance on an as-I-need-it basis.

But if Massachusetts is any guide, the mandate will (notwithstanding the political furor of the moment) be, in practice, fairly acceptable to the general public.

Even the insurance industry, which spent millions to defeat reform, may think twice before getting behind a repeal effort. Especially since if the effort is only partly successful, it could be left with new requirements to cover high-risk and high-cost individuals without the guarantee of a bigger and on average healthier subscriber base.

And it looks, early on anyways, that public opinion is swinging toward reform.

This may be the case in part because broadstroke polling has always overstated the opposition—polls and stories before reform passed often failed to break out the anti-reformers from those who were unhappy with the current bills because they wanted reform to go further.

But new post-reform polls (check out this Five-Thirty-Eight post) that have gone deeper show an upward trend of support for reform.

Those, for instance, who say the law is a step in the right direction are unlikely to see repeal as anything but two steps back.

The question becomes: How much of the public can be made to believe things that are not true about health care reform—and for how long—now that it is law?

And here, there’s some cause for concern that goes beyond the persistent misunderstandings of what is in the law. A recent Harris poll shows 23 percent of adults in the US (41 percent of Republicans) think that President Obama wants to use an economic collapse or terrorist attack to assume dictatorial powers, and 24 percent of Republicans think President Obama may be the anti-Christ. We may surmise that these folks are unlikely to be persuaded on health care no matter what advocates (or anyone else) says or does.

On the other hand, as Nate Silver noted in the above link, public support seems to be going toward reform, though it is too soon to say whether this is a long-term trend.

The best thing advocates can do is go out and explain what reform really does (and what it doesn’t do). The more public understands reform, the less support there will be for a rejectionist agenda. Reaching out to constituencies that will benefit from early improvements (again, check out our Quick Win fact sheet)—including seniors, small businesses and children and adults with pre-existing conditions—are a good place to begin.

Seniors have generally been more opposed to reform than most age groups, and opponents have consistently claimed that reform is bad for Medicare. The first changes that seniors will see is the beginning of a phase out of the doughnut hole and new preventive care benefits in Medicare.

Many small businesses are probably unaware that they are exempt from “free rider penalties” or that the new law includes an immediate tax credit for small, low-wage businesses that offer health insurance.

For children and adults with major or chronic conditions, the bill has provisions to, immediately eliminate pre-existing conditions for children (pending HHS regulation), allow young adults to remain on their parents’ plan, eliminate lifetime benefit caps and create (or enhance) a high risk pool, and will provide immediate benefits for children and young adults with special health care needs.

Implementation: a three-piece puzzle

Going forward the keys to successful implementation include:

-An aggressive effort to build public support for reform

-Engagement at the state and federal level around the state laws and state and federal regulations that will govern the details of implementation

-Maintaining and strengthening the Medicaid program during the interim period when the states’ fiscal crisis is still squeezing the program and new federal coverage rules have not yet kicked in.

We’ll look at the way these three interlocking pieces fit together and developments in the weeks ahead.

–Michael Miller, director of strategic policy

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Land Ho!

Monday, March 15th, 2010

After a stormy voyage of more than a year, this Monday morning finds the good ship health reform within sight of a final vote. The tentative timetable has a CBO score out today or tomorrow, Rules Committee action on Wednesday and a vote before the end of the week.

Our understanding is that House leaders are leaning toward a single vote on the Obama fixes that will contain a clause passing the Senate bill passed upon passage of the amendments. That way, House members who are unhappy with the Senate bill will never actually have to vote on it. We do not expect House leadership to wait for all the votes to be locked down before going to the floor, but instead think they will schedule the vote once they are close and try to round up the last few yeses as the debate and vote are happening.

Deconstructing the Opposition Strategy: Be Very Afraid

The Republicans’ strategy at this point boils down to trying to scare the House Democrats into voting no. Their two main lines of attack are:

  1. The Senate won’t pass the fix-it bill, leaving the House stuck with the Senate bill.
  2. It will mean electoral trouble for Democrats in the fall.

Let’s break down each argument:

The first argument has shifted in recent weeks. Originally, the Republicans tried to play on the institutional distrust between House and Senate, suggesting that if House members “took the plunge,” Senate Democrats would leave them high and dry. But as more and more Senate Democrats committed to voting yes on a package of amendments (at least the necessary 50 have done so) the power of this scare tactic has waned, and so Republicans now threaten instead to gum up the works, making passage as hard as possible.

As we observed before, the bill that comes to the Senate will be small and will contain things that are easy to support—e.g. closing the Medicare doughnut hole, increasing federal funding for Medicaid, taking out special deals. Though Republicans certainly might play obstruction games, such parliamentary delay tactics may not play out the way they hope—think of the way Gingrich shutting down government in the 90s backfired with the public.

The second line of attack is that if Congressional Democrats vote yes, it will cost them their jobs. Republicans recently put out a poll from districts of swing members purporting to show that vote for reform would hurt their electoral chances. Whether a coordinated part of the strategy or on their own initiative, two former Democratic pollsters made the same argument in a Washington Post op-ed.

What makes the piece fishy is that a) the only polling they cite is from Rassmussen, a polling company with a well-known “house effect” in favor of conservatives and Republicans  and b) they conclude that what the Democrats should do is essentially pass the House Republican health care proposal (you can compare the GOP proposal to Obama’s plan here).

A more fair reading of the polling:

  • People want major change
  • The main elements of the reform bill are popular, and some are very popular.
  • People don’t know what’s in the bill. As Jon Stewart pointed out (watch at 4:05), there have been not a few misinformation campaigns to take the credit there. But once they learn what’s actually in the bill, they like it a whole lot better.

As the President has become more active in the debate and pushed out a clearer message about what reform does—eliminate insurance company abuses, provide people with security of never losing their coverage, provide tax credits to small business to help them afford insurance—public support has trended up.

Not to say that there aren’t some fundamental glitches in public opinion. Voters think a bipartisan bill is important, and that Democrats should keep working with Republicans until they get it. What the media have failed to convey is that

  1. the bill is supported by Republicans, including governors, former Senate leaders and former administration officials and
  2. the bill is essentially what Republican Senators proposed as an alternative to the Clinton plan in the 90s.

Finally, what should be clear after the Blair House summit is that there is no hope of getting any kind of bipartisan agreement, short of giving up and passing the Republican plan. It would be much more meaningful if pollsters confined their questions to the real choices that are available instead of setting up straw men.

Polls aside, there’s no doubt Democrats are sailing into a stiff headwind right now. The President’s party usually loses seats in the midterm, and this year the persistently high unemployment is fueling voter discontent. Discontent is aimed at incumbents generally, but with a large number of House seats to defend in historically Republican-voting districts, and with incumbent Senate Democrats from conservative states like North Dakota and Indiana retiring, the GOP could see substantial pick-ups. Add in the expected flood of corporate cash into the elections courtesy of the Supreme Court and it is shaping up to be a tough year for Democrats, indeed.

But the fundamental political question persists: are Democrats helped or hurt by failure to pass health reform? They are already on the hook for voting yes and attack ads are already being produced. Flip-flopping is famously unpopular in politics and is unlikely to win a pass from reform opponents in the election. Passing reform gives House Democrats a concrete historic accomplishment with which to fight back.

It don’t come easy: Math in the House
In November, the House health care reform bill passed with  220 votes. Currently with vacancies, 216 are needed to win.  If everyone who voted yes last time votes yes again, reform passes. But House leaders can’t count on every yes vote remaining in place, so every yes-to-no vote must be offset by finding a no-to-yes.

Here are three places where votes are at risk:

Abortion
The number of Democrats willing to ‘vote off’ because of abortion seems to be declining.  A recent letter from pro-life clerics and theologians looked at the abortion provisions in the Senate bill, chapter and verse, and concludes that the bill does not provide federal funding for abortion.  Several members who voted for the Stupak amendment have publicly reached the same conclusion. And although Stupak claimed that he has about 12 members who will stick with him in voting off, his camp seems to be shrinking as the reality that the Senate bill does not allow federal funds for abortion has begun to sink in. Most analysts put the total number of no votes on account of abortion at five or six.

Immigration
The Senate bill bars undocumented immigrants from purchasing health insurance through the new insurance Exchanges even if they use their own money. It also fails to provide equal coverage to legal immigrants, continuing a ban on federal matching funds for state Medicaid coverage and offering instead less comprehensive and more costly coverage in the Exchange. As a result, a number of lawmakers in the Congressional Hispanic Caucus have said that they were leaning toward a no vote.  The issue is further complicated by the fact that the provision relating to undocumented individuals cannot be addressed via budget reconciliation.

But a Medicaid provision that gives states at least the option to cover legal immigrants could be addressed in reconciliation.  While most states would probably not take up the option, the measure could at least provide fiscal relief and perhaps better coverage in those states who now cover legal immigrants with 100 percent of state dollars.

How possible is this? Remember that in the initial House vote in November, there was an 11th hour change on abortion. It’s still possible that House leaders and the President will see the light on Medicaid for immigrants, especially if it is the only remaining obstacle to passage. However, even if this last-minute adjustment is made, the legislation does not go far enough in providing equal access to coverage for immigrants, which only underscores the importance of comprehensive immigration reform (check out this weekend’s march here).

The Scott Brown effect
In the wake of the election of Republican Senator Scott Brown, the Massachusetts delegation has become visibly uneasy about reform. Despite compelling evidence that the Brown election did not turn on the candidates’ positions on health care,  some members of the normally solidly liberal Massachusetts delegation have indicated concern about moving forward, though not all have given the same reasons.  It’s hard to imagine that Massachusetts Democrats would actually sink national health care reform. But as the Brown election proved, nothing can be taken for granted—even in Massachusetts.

Coming soon

Stay tuned for updates this week as the CBO score becomes available and we get more clarity about the vote schedule.

-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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What we talk about when we talk about Massachusetts

Friday, February 12th, 2010

Scott_P._BrownAs we’ve said here before, the Senate special election in Massachusetts was a lot of things. One can probably find a hundred different explanations for why Scott Brown won in a hundred different bars on a given five o’clock (though we’re not advocating this polling method.)

But there’s hard evidence that whatever else Massachusetts voters were saying, they weren’t saying stop national health reform. Despite our convincing case, the national media kept saying the election was a referendum on health care reform. We kept looking at the polls, which said otherwise. So we’re taking the old statistician’s route: Say it again, with numbers.

The Massachusetts special election was not about health reform.

For voters, the economy came first. Seventy-nine percent of voters said their first priority was to “strengthen the economy and create more good jobs.”

And though 82 percent of voters said they knew of Scott Brown’s position to oppose national reform, this was a wash — just as many said this made them more likely to vote for him, as said it made them less likely to vote for him. (No one said Bay Staters were an easy crowd to figure out.)

And perhaps most tellingly, a majority of both overall voters Brown supporters (including Brown himself) supported Massachusetts health reform – a law that has achieved 98 percent health insurance coverage and served as a model for the national bills passed by the House and Senate. That’s powerful stuff: Opposed to many commentators who have the freedom/burden of conjecturing what reform might do, Massachusetts residents are living with the changes reform made and is making everyday – and they’re pleased.

Hungry for more proof? Check out our fact sheet.

–Kate Petersen, Health Policy Hub

photo credit: Wikimedia Commons

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