Eileen McNamara's Sound Advice: Trust but Verify

Eileen McNamara's Sound Advice: Trust but Verify

Promises to watch
(copywright New York Times)

By Eileen McNamara, Globe Columnist April 5, 2006

Trust but verify.
Proponents of universal healthcare should adopt that Reagan-era maxim as they celebrate legislative approval of a bill to expand access to medical coverage to most of the uninsured in Massachusetts.
Maybe the plan approved by the House and Senate yesterday really will provide affordable, comprehensive healthcare coverage to the state's 532,000 uninsured within the next three years. But it would be a mistake for grass-roots organizers to abandon the ballot initiative that will put the demand for universal healthcare in the hands of state voters in November.
Without the pressure of that impending vote, the promised reforms might never materialize. It has happened before.
House Speaker Salvatore F. DiMasi was not entirely accurate when, in the flush of the 152-2 House vote, he said it was too soon to know if the healthcare bill was perfect, ''because it's never been done before." It has been done before, in 1988, when there was a rally no less noisy and optimistic than the one held yesterday in Nurses Hall at the State House. But the universal healthcare bill signed by Governor Michael S. Dukakis with such fanfare that year was never implemented because it was never funded.
Senator Mark C. Montigny, a Democrat from New Bedford, has a longer memory than the speaker, and Montigny struck an appropriately cautionary note in addressing a coalition of religious, labor, and healthcare providers whose organizing and lobbying efforts were instrumental in the passage of this bill. ''I have been around a long time on this issue, and every time we have advanced, we have been in danger of slipping backward," he said. ''If we don't keep our eye on the ball, it will happen again."
The reason, as always, is money.
The legislation headed for Governor Mitt Romney's desk is to be paid for through a combination of federal reimbursements, state funds, new assessments on businesses that do not provide health insurance as a benefit of employment, and a requirement that all residents of Massachusetts buy health insurance or face financial penalties. The state promises to provide subsidies on a sliding scale to those who cannot afford to purchase insurance on their own. How many people will need subsidies and how much those subsidies will cost is not yet certain.
Without a permanently earmarked source of revenue -- a hike in the cigarette tax, say, or income from proposed slot machines at Massachusetts racetracks -- what assurance do we have that the state will continue to subsidize healthcare for the poor if the economy falters and tax revenues slide? If the budget needs balancing, will there be calls to ''cut the healthcare rolls," as there were once calls to ''cut the welfare rolls?"
The Rev. Hurmon Hamilton, pastor of Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, urged the celebratory crowd to bask in its legislative victory but to recognize that complacency could undermine its efforts in the long term. ''We will stay focused on this issue until every ambiguity has been clarified. We will celebrate tonight, but we will continue to fight tomorrow," he said.
Because this is Massachusetts, there will be disagreements among advocates for healthcare reform about the need to press forward with the ballot initiative in November. Should they accept the legislation drafted by the House and Senate conference committee as the best that can be done or press for more from the voters through the ballot initiative?
''It is too soon to talk about that now," demurred Rabbi Jonah D. Pesner of Temple Israel in Boston and the Greater Boston Interfaith Organization. ''Today is a great beginning. . . . We should take today to celebrate."
Tomorrow night, members of the interfaith group have a meeting scheduled at Roxbury Presbyterian Church. The agenda outlined on the flier being distributed yesterday? To begin to answer the question that still looms: ''Health Care: What Next?"
Eileen McNamara is a Globe columnist. She can be reached at mcnamara@globe.com.
© Copyright 2005 The New York Times Company

Trouble in Potomac City

Trouble in Potomac City

Major trouble is brewing in Washington for seniors facing the signup deadline for the flawed Medicare drug program and for the new health care bill in Massachusetts. We in the Bay State thought our legislature had made progress toward providing coverage for the uninsured. But that advance is threatened by a healthcare bill being debated this week in Congress that would allow insurance companies to ignore state coverage mandates.

As part of so called "Health Week," Republican Congressional leaders are proposing to expand coverage to the uninsured by allowing providers to offer stripped down plans - "coverage" in name only - that would exempt insurers from covering services such as mammography screenings, diabetes supplies, counseling for alcoholism, and even mental health treatment.

Ironically, the traditional "state rights" crowd has suddenly decided that certain rights, such as the right to health care, ought to be defined by the federal government, not the states.

Trampling on Massachusetts' progress has angered even major insurers such as Harvard Pilgrim, Tufts, Fallon and Blue Cross and Blue Shield of Massachusetts, which have weighed in against the federal proposal. In a joint letter to Gov. Romney, the insurers wrote that the Republican proposal "could, in fact, dismantle" our universal coverage effort.

Romney now has to decide whether to defend the state's coverage mandates and lobbying against the bill or toe the National Republican line.

Meanwhile, the federal government is pushing ahead with a plan to impose lifetime penalties against seniors who do not choose a Medicare drug plan by May 15, even though the plans are so confusing - and so flawed - that millions of Americans have been reluctant to sign on. Health care activists, many members of Congress and MoveOn.org are pressing for the Administration is end its punitive "senior tax," and to extend the signup deadline.

Members of the Massachusetts delegation support eliminating the "senior tax" and oppose the federal effort to undermine coverage mandates, but, no doubt, they would be gratified to hear from constituents who back their efforts to protect meaningful reforms.

Expanded Health Care: Can the promise be realized?

Expanded Health Care in Massachusetts:

Can the promise be realized?

While meeting many of the long-held goals of health care advocates, Massachusetts' recently enacted health reform law has drawn dire predictions from a number of medical professionals, even while it has side-stepped the broader issue of a single payer plan.

Meanwhile, the legislative debate brought out an unprecedented lobbying effort, as vested interests battled to advance their agendas in the final language of the law. In 2005 alone, more than $7.5 million was spent on everything from splashy public relations to quiet Beacon Hill persuasion. Figures for 2006 are not publicly available but they are sure to add to the record spending. Health care lobbying has become big business in the Bay State.

The good news is that the law expands eligibility for children whose family income is up to 300 percent of the poverty level, and it reinstates dental and eyeglass benefits for adult MassHealth recipients. The law also subsidizes private insurance coverage for residents whose household income is up to 300 percent of the poverty level. And it imposes a financial penalty on employers with 11 or more workers who do not provide health insurance. Employers would be assessed a charge of up to $295 per full time employee, with contributions pro-rated for part time and temporary workers.

Some health professionals argue that the legislature has underestimated the cost of expanding coverage and predict that many of the promises of the new law will never be fully realized. Because the new law does little to control costs, they say, expenses will outrun tax revenues and coverage will be curtailed.

One of the many uncertainties is the bill's "individual mandate" provision which has been portrayed as imposing financial penalties on people above certain income levels who do not purchase health insurance. However, the actual language of the law is far less directive. People must have access to health plans that are both "comprehensive" and "affordable," as determined by a new state agency before any penalties would be instated.

(A thoughtful and detailed critique of the Massachusetts law has been prepared by the Boston-based health advocacy organization Community Catalyst and can be found at its web site: www.communitycatalyst.org.)

Massachusetts has expanded health coverage even as national studies show the percentage of uninsured has reached record levels. Americans, you might say, are dying for health insurance. Economist Paul Krugram, writing in the May 1, New York Times, cites a study from the National Academy of Sciences estimating that lack of health insurance leads to 18,000 unnecessary American deaths each year.

Yet, our inadequate system, Krugman writes, "actually costs more to run than we would spend if we guaranteed health insurance to everyone."

Our fragmented, privatized approach squanders more than 20 cents of every health premium dollar on outlays other than medical care, such as marketing, administration and insurance company profits. By comparison, Krugman notes, the single-payer system already in place for older Americans , Medicare, allocates "about 98 percent of its funds on actual medical care."

Here is Krugman's bottom line: Older Americans are already covered by a national health insurance system; extending that system to cover everyone would save money, reduce financial anxiety and save thousands of American lives each year."

Massachusetts has taken a step toward expanding coverage. The next order of business would be moving to a single payer system.

Addressing Racial Disparities, Closing the Health Care Gap

Addressing Racial Disparities, Closing the Health Care Gap
Policy activists, including Critical MASS and Health Care for All, have organized a conference on addressing racial disparities in health care, June 13, at the Hoagland Pincus Center in Shrewsbury. Conferees are expected to roll out the latest data on local, state and national disparities in accessing health care and begin crafting a policy response. More information can be obtained from cwatson@hcfama.org or by calling 617.275.2936. The Pincus Center is on the campus of UMASS Medical Center, just off Route 9.
How stark are the disparities? Take a look at some figures compiled by Critical MASS:
Blacks are twice as likely and Hispanics almost three times as likely as whites to be without health insurance.
Black, non-Hispanic mothers, followed by Hispanic mothers have the lowest percentage of women receiving prenatal care during their first trimester of pregnancy.
Asian and Pacific Island women are three times less likely than whites to receive PAP smear exams on any regular basis.
Disparities lead to deaths and disabilities.
The mortality rate for black non-Hispanics is the highest of all major race groups, and is 22 percent above the statewide age-adjusted mortality rate in 2000.
The infant mortality rate was 3 times higher for black non-Hispanics than white non-Hispanics for the period 1998-2000.
In 2000, black non-Hispanics died from HIV/AIDS at about 10 times the rate of white, non-Hispanics.
Black, non-Hispanics in 2000 were 10 times more likely than white non-Hispanics to be murdered.
The teen birth rate in 2000 for Hispanics was almost 6 times higher than the rate for white, non-Hispanic teens
A successful conference could, ultimately, save lives by opening a new chapter in the pursuit of access and equity in health care.

Proposed State Legislation: Why the employer assessment is good economics

Why the employer assessment is good for Massachusetts

There are approximately 532,000 Massachusetts residents with no health insurance, and hundreds of thousands more are struggling with unaffordable premiums. Of the uninsured, 87% are working adults.

These 532,000 residents receive health care in emergency settings, and their care is paid for by a $1 Billion “Free Care Pool.” This pool is funded in part by a $160 million tax on private insurance premiums, a tax mostly borne by businesses which purchase insurance for their employees.

Inspired by the work of the Affordable Care Today! Coalition, the House of Representatives has crafted and overwhelmingly approved legislation that would address the epidemic of un-insurance by expanding MassHealth to the working poor and requiring employers who do not offer health insurance to contribute to the costs of this public program – a fair share employer assessment.

How the House Bill Fair Share Employer Assessment Works......

Why the Employer Assessment is Necessary

The current system is unfair because it puts the burden of paying for the free care pool on employers that already purchase health insurance......

For the full report, see:
http://www.hcfama.org/act/Good4MA.asp