In 2017, 96.3 percent of #Massachusetts residents had #healthinsurance. Here’s how they got it.

From the Massachusetts Center for Health Information and Analysis:

Enrollment Trends monitors health insurance coverage in the Commonwealth of Massachusetts, where coverage is defined by unique Massachusetts residents with primary medical membership in the 13 largest commercial payers, MassHealth (Medicaid), or Medicare.

The August 2018 edition of Enrollment Trends offers insights into changes in health insurance coverage in Massachusetts from March 2016 through March 2018.

Key Findings from August 2018 Enrollment Trends

    • Over four million Massachusetts residents received their primary, medical health insurance coverage through private commercial insurance between March 2016 and March 2018.

 

    • In March 2018, MassHealth shifted approximately two-thirds of its Managed Care Organization (MCO) and Primary Care Clinician (PCC) plan enrollees to Accountable Care Organization (ACO) plans.

 

    • Unsubsidized Qualified Health Plan (QHP) enrollment decreased by 14.4% (-7,000 members) from March 2017 to March 2018, while subsidized QHP enrollment increased by 55.0% (+5,000 members) over the same time period.

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Will a legislative study put Massachusetts on the path to single-payer? Supporters head to Beacon Hill to push for it.

single payer posterTucked inside the health care bill passed by the state Senate is a provision to study the possibility of a  single-payer health care system.

The bill’s cost control measures are getting all the attention. From the Globe:  

The 100-page bill attempts to help struggling community hospitals by setting a floor for the reimbursements they receive from insurers. It also sets a benchmark for annual growth in hospital spending, estimated at 2.7 percent. If the hospital industry exceeds that benchmark, some hospitals would have to pay hefty penalties.

But MassCare, the state’s single-payer advocacy group, says the proposed study creates “a real path in the near future to create a Single Payer system for the Commonwealth!” They’re headed up to the State House this week to lobby House members. lobbyday-958x538

These folks are in if for the long haul, which, according to political scientist James Munroe of Brown University,  is the way to go on single-payer. Writing in the a recent NEMJ, he says:

It is a policy proposal designed to improve health care delivery, an ambitious claim about equality and social justice, and an effort to usher in a more progressive era in American politics. Each is a long shot, but Medicare for All and its advocates stand in a venerable reform tradition that has rewritten U.S. politics many times in the past. It would be a mistake to dismiss them now.

Mainers choose Medicaid expansion, but will they get it?

Our neighbors to the north have been trying to expand their Medicaid program for years. Lawmakers would endorse it; Republican Gov. Paul LePage would veto it.

Apparently that is no longer an option, but he has vowed to find a way.  More from The New York Times

At least 80,000 additional Maine residents will become eligible for Medicaid as a result of the referendum. Maine will be the 32nd state to expand the program under the health law, but the first where voters, not governors or legislators, decided the issue. Other states whose leaders have resisted expanding the program were closely watching the campaign, particularly Utah and Idaho, where newly formed committees are working to get Medicaid expansion on next year’s ballots.

 More here from NPR.

A round-up here from KHN. 

Sen. Elizabeth Warren is backing the single-payer insurance proposal from Sen. Bernie Sanders. Does it have a chance?

From The Boston Globe:

From 2016  Boston rally: Alan Meyers, a Boston Medical Center pediatrician. Photo: Tinker Ready.

“There is something fundamentally wrong when one of the richest and most powerful countries on the planet can’t make sure that a person can afford to see a doctor when they’re sick. This isn’t any way to live,” Warren wrote, asking her backers to sign a petition expressing their support for the measure. “Health care is a basic human right and it’s time to fight for it.”

Warren’s endorsement is a high-profile boost for Sanders’ legislation, which the Vermont Senator readily admits faces a hard, years-long fight towards becoming law.

Here’s a link to Sander’s “Medicare for All” site. FYI, not an endorsement.

What does the public think? KFF poll this summer found a slim majority in favor 

It is worth noting that another Bay Stater, former CMS boss, gubernatorial candidate and top health policy analyst  Don Berwick, has also endorsed single-payer. 

For some perspective, Kaiser Health News has collected links to recent opinion pieces on the topic. This one from The Washington Post notes that a lot of Democrats are lining up for single-payer

So what lessons can we take from the experience of the ACA that might help Democrats as they move toward another enormous health-care reform?

  • It’s going to take years.
  • Disruption is frightening.
  • We need to think about the transition from where we are now to where we want to go.
  • Republican demagoguery is a certainty.
  • Beware the interest groups.
  • There will be winners and losers.
  • You have to be able to explain it to people.

The piece offers details on each bullet and suggests:

We should probably stop referring to what liberals want as “single payer,” because that suggests that the only system they’d accept is one in which there is one government insurer and no private insurers. That’s one possibility, but there are many other ways to get to universal, secure coverage that have multiple payers. I happen to think the best and most achievable system given where we are is one in which there’s a basic government plan that covers everyone — an expanded Medicaid, perhaps — plus private supplemental insurance on top of it, a hybrid system of the kind that works well in countries such as France and Canada. The point is that it would be much better to speak of “universal coverage,” which allows for a number of different designs as long as they achieve the same goal.

How to keep up with the health reform debate in MA and DC: A Twitter list

  CaptureA Twitter list of 60+ key feeds to help you keep up with the  health care debate here and in DC. The two are linked in that the MA program was a model for the ACA. Also, there’s an effort ongoing to track and control the costs of care at hospitals. More on that here.

 

 

Will 21st Century Cures Act benefit hospitals?

captureFirst: The Globe is getting some attention for its five-part narrative about a family that helped  start a drug company to keep their son on an experimental cancer treatment.

Nicely written narrative with illustrations and audio. We won’t give away the ending. 

Also, here’s what people were saying a year ago about the “21st Century Cure Act.” It’s been amended since then, but much of what they have to say still applies. My take was: What’s in it for hospitals? 

The drug development and approval elements in the proposed legislation are the centerpiece of a gift basket that has something for everyone: engaged patients, drug makers, FitBit fanatics, NIH-funded scientists, those faced with rare diseases, and those fighting antibiotic resistance.

What do hospitals get out of it? Of course, it depends on whom you ask. One side says it will clear out bottlenecks that are delaying access to better drugs and new, effective antibiotics. That’s good news for hospitals struggling to improve patient outcomes and prevent readmissions. The other side says it will lead to unsafe drugs and a flawed approach to dealing with antibiotic resistance. That’s bad news for hospitals struggling to improve patient outcomes and prevent readmissions.

John Powers, MD, is a former head of the FDA’s Antimicrobial Drug Development and Resistance Initiatives. He is now a clinical professor at the George Washington University School of Medicine and one of the bill’s critics. If the bill’s provisions regarding FDA approval become law, hospitals should be worried that they will be held responsible for drugs that are ineffective or worse, he said.

“If you have a new drug and it doesn’t make the patient better, what you actually end up doing is spending more money in the long run because they stay in the hospital longer,” Powers said. “Or you may have to administer additional treatment to deal with the side effects of that medicine — which costs money.”

Two Boston meetings look at the role of patient advocates. They offer two very different perspectives.

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Pharmaceutical manufacturers often  look to patient advocates for help winning approval for new drugs. Their most recent success in this area was the FDA’s approval of a new drug for Duchenne muscular dystrophy. That decision came despite recommendations against approval from FDA staff.

In an editorial, the Boston Globe questioned the FDA’s move while noting that eteplirsen’s “entry into the marketplace represents a major victory for the patient advocacy movement, and is bound to encourage more such engagement in the drug-approval process. Based on the infighting that went on over the Duchenne treatment, that’s going to be challenging for the FDA. It has to find a balance between public opinion and what’s truly in the public interest.” (The Globe also featured a story this week about one of those patient advocates.)

Today, drug makers in Boston are hosting a conference for patient advocates. The “Patient Advocacy Summit 2016 – Sharing Our Stories: Building a Patient-Centered Ecosystem” is underway at Novartis facility near MIT.

This event brings industry leaders together with patient advocates and other stakeholders to examine ways in which life sciences companies can more fully incorporate the patient voice into the work they do— not just approaching regulatory applications or at commercialization, but throughout the drug development cycle.

The day-long event will include panel discussions, case study presentations (spotlighting industry/patient partnerships), a keynote address, and awards ceremony, as well as a networking breakfast, lunch and cocktail reception. Expected attendance is 180 patient advocacy professionals, patient organizations and other stakeholders.

Worth noting that the same topic was the subject of  yesterday’s  panel at HUBweek, a  science/tech/arts series ongoing in Boston. The title: “The FDA and the Drug Approval Process: Is it Really Broken?”  Some made the point —  we should listen to the parents of sick children.  Others offered a different perspective: Patients might be better off in clinical trials with informed consent and free drugs,  rather paying  $300,000 per year for that same, unproven medication with unknown side effects.

Contacted after the panel, Zuckerman, president of the National Center for Health Research in DC,  offered these thoughts:

  1. Patient perspectives are crucial in helping us understand what scientific data mean, what the benefits and risks both mean to patients.  So patients should be part of the process – what should the outcome measures be and how can they be measured?
  2. The FDA is listening to patients who desperately want treatments but they are not listening well to patients who are harmed by ineffective or unsafe treatments.  That’s partly because the former are funded by Pharma to attend FDA meetings and to lobby Congress, but the latter are on their own, often don’t have the money to attend FDA public meetings, and wouldn’t even know about them if they don’t read the Federal Register, which is the only place they are announced in advance.

 A few more tweets worth noting.