Massachusetts #universal health coverage effort carries on

Here in Massachusetts, life goes on in terms of universal coverage.From The Boston Globe:

Health-insurance sign-ups are running ahead of expectations as the Massachusetts Health Connector wraps up the second month of the three-month open-enrollment period, according to Louis Gutierrez, executive director.

The Connector, a state agency that serves people who don’t obtain health insurance through an employer, has drawn in more than 27,600 new enrollees since open enrollment began Nov 1. And Gutierrez expects to see many more before the sign-up period ends on Jan. 31.

WBUR reports that coverage may change:

imgrese head of the Massachusetts Health Connector, Louis Gutierrez, says no matter what happens with the ACA, the Connector is committed to providing affordable coverage, as it has since the state’s own health care overhaul went into effect in 2006. Since then, the ACA has helped the state expand its Medicaid and Medicare programs.

Gutierrez is hesitant to guarantee enrollees will get to keep the exact coverage they signed up for this year, regardless of what happens in Washington. “I can’t make commitments about things I can’t personally control,” he said.

Kaiser Health News: Increase in health insurance exchange enrollment mirrors some state programs, including Massachusetts

Phil Galewitz of Kaiser Health News reports that enrollment increases for federal exchanges  mirror “activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, capturedoubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.

“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael March and, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.

Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.

About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.

Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.

All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.

More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.

In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.

Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.

Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.

In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.

Conservatives warn it’s still too early for Obamacare supporters to celebrate.

“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.

Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.

“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”

Can #Massachusetts tame #health #spending with transparency and oversight?

Stuart Altman, the Brandeis University healthcare economist who has advised presidents from Nixon to Obama, talked to Health Leaders last week. He is capturenow  the head of the Massachusetts Health Policy Commission, which tracks total health spending statewide.  

HLM: How is Massachusetts trying to address high costs?

Altman: First of all, it is the only state that has recognized that it should be involved in total state spending. Some other states that are closer are Vermont and Maryland. But the Massachusetts state government is really acknowledging that it has responsibility for not only what it spends on Medicaid, but that it should be concerned with total spending.

Full story at Health Leaders. 

Single-payer health reform advocates launch new website #HCR #mapoli

The unrelenting supporters of the single-payer approach to health reform  have updated their website. And, it is a quite an update. The old MassCare site was sluggish — infrequently updated and often lacking links to upcoming events. Check it out here or click below. Also in health reform, check out WBUR’s Q & A with David Seltz, the new head of the state Health Policy Commission.

mass care

#mahealthcarecosts: Massachusetts commission meets

  1. More about the chairman. 
  2. HCFA
    Stuart Altman starts w/ a round of introduction. Sec. Bigby talks importance of improving quality of care, not just in cutting cost. #MAHPC
  3. HCFA
    Jean Yang looks forward to next generation of health reform. #MAHPC
  4. HCFA
    Carole Allen, pediatrician, local advocate for children’s health. #MAHPC
  5. HCFA
    More meet the commission: Dr. David Cutler, health economist at Harvard. Marylou Sudders, expert on behavioral health. #MAHPC
  6. HCFA
    Jay Gonzalez, Secretary of Administration & Finance says that controlling health care costs is essential for fiscal health of MA. #MAHPC
  7. HCFA
    Dr. Wendy Everett, president of NEHI, says that the other 49 states are going to be watching us. #MAHPC #mahealthcosts
  8. HealthPolicyHub
    Thinking about health care costs today? Check out @HCFA’s feed – lots of info on MA’s first steps to “crack the cost code” #mapoli
  9. HCFA
    Dr Paul Hattis of @GBinterfaith says statute allows commission to frame, name & if necessary blame & shame to help reduce cost #MAHPC
  10. HCFA
    Rick Lord of AIM and Veronica Turner of @1199mass last to introduce. All the stakeholders working together to lower #mahealthcosts #MAHPC
  11. HCFA
    Chair Stuart Altman says #MAHPC a “sounding board” for the system & not a “one way street.” #mahealthcosts
  12. JC7109
    Groups rally in Lynn against possible cuts to health care – so much for Obamacare http://tiny.cc/g4dknw #MApoli #tcot

The “end of fee for service”: Health cost wars break out in in New England #hcr #mapoli #aca

More than a river divides Vermont and New Hampshire. In the state that lives by the motto, ” Live Free or Die,” regulators and politicians declined to set up a health insurance exchange mandated as part of the health reform law. From the June 22 Concord Monitor:

John Lynch signed into law a bill that prohibits New Hampshire from planning, creating or participating in a state health care exchange under the 2010 federal health care law. The Democratic governor did so with the support of the state Insurance Department and conservative Republicans dead set against the health care law passed under the Obama administration.

Opponent were predicting — at the time of this story — that the Supreme Court would rule against the individual mandate and the health law would “fall apart.” That didn’t happen and now the feds will come in and set up the exchange.

Next door in Vermont,  the Green Mountain Care Board is reviewing hospital budgets. From Vermont Public Radio:

The board has established a cap on spending increases of no more than 3.75 percent annually. But as a group, Vermont’s 14 hospitals are seeking increases of roughly 7 percent for the coming 12 month period. “We know there are some legitimate reasons that hospitals might need to grow higher than the 3.75 percent, most of those having to do with circumstances beyond their control,” said Anya Rader Wallack, the chairwoman of the Green Mountain Care Board.

The board may allow some increases above 3.75 percent, if the hospitals can prove that they are using the money to make investments that will lower costs in the long run.

But Wallack says the bottom line is that hospital spending needs to be kept under control: “We have a responsibility to hold down costs. So we’ll be looking at all of these requests with an eye toward how we can stay within that target, because we don’t think Vermonters can afford more than that.”

Welcome to your future Massachusetts.  Health care cost containment can get ugly. For reporting on the Massachusetts cost control law, go no further than the Globe’s special section. From today’s Bill signing story:

Six years after Governor Mitt Romney required every resident to obtain health insurance, Governor Deval Patrick signed a law that many consider the second phase of that groundbreaking experiment: trying to rein in the state’s health costs, which are among the highest in the nation.

The new law — which Patrick signed Monday at a State House ceremony packed with hospital executives, health care advocates, and lawmakers — seeks to keep health spending from growing faster than the state’s economy through 2017. For five years after that, the law aims to further slow spending, to half a percentage point below the growth of the economy.

Hold the fried chicken: RedSox workout tips from the Globe

Some of the BoSox players were lifting chicken legs instead of weights last spring, but not Ellsbury and Pedroia.  Jacoby returned from an injury for a great year and Dustin was solid all season.

The Globe’s Daily Dose offers some advice from their off-season trainers, who counsel them “on the importance of sleep, self-massage to relieve soreness, and what they need to eat to help build muscle.”

Also, please note this week’s publication of the Health Wonk Review, the biweekly digest of the best of health policy blog. This edition includes links to posts about the upcoming Supreme Court decision on insurance mandates, HIT and primary care and the new Independent Payment Advisory Board. Also note the previous edition, brought to you by Center for Objective Health Policy, a site that encourages “individuals to apply free-market ideas to healthcare.”