Category: Health Care

Lawmakers rally in rain for school breakfast bill

BOSTON – Gathered in the rain outside the Statehouse on Tuesday, a group of about two dozen ralliers held signs telling the stories of people experiencing hunger in Massachusetts – among them, a gig worker who relies on supplemental food assistance between jobs, and a disabled man on a fixed income who uses food stamps to buy the healthier foods his doctor recommends.

“The weather is illustrative sometimes of how I think it feels to be battling hunger issues, right,” state Rep. Hannah Kane told the group. “It always feels like we’re battling something.”

The demonstration, organized by the Greater Boston Food Bank and other organizations, was part of Hunger Action Month.

The national organization Feeding America says 652,760 Massachusetts residents – or one in 10 people – are struggling with hunger, including 167,450 children.

Ralliers recognized Kane, a Shrewsbury Republican, and Democratic state Sen. Sal DiDomenico of Everett and Rep. Jay Livingstone of Boston for their work combating hunger.

The group called on the House to pass a Senate-backed bill that would require schools where at least 60 percent of students are eligible for free or reduced-price meals to offer breakfast after the instructional day begins. The bill outlines breakfast service models that include “breakfast in the classroom, grab and go breakfast or second chance breakfast.”

With more than three months left in the legislative session, the “breakfast after the bell” bill, sponsored by DiDomenico, is now before the House Ways and Means Committee. It passed the Senate unanimously on July 26.

“Breakfast after the bell, to get kids into school and performing much better, is incredibly key, and I hope we can still get that done this year,” Livingstone said.

Bills require unanimous votes to advance during informal sessions, but very few lawmakers attend the sessions.

“That should be a question that is as commonplace as ‘What’s your plan for jobs?’ ” she said.

As the rally broke up, Assefa offered a parting note to participants: “For anyone who’s hungry, we are getting pizza.”

https://www.metrowestdailynews.com/news/20180925/lawmakers-rally-in-rain-for-school-breakfast-bill

190th Session Recap: Opioid Legislation

190th Session Recap: Opioid Legislation

H.4742 – An Act for prevention and access to appropriate care and treatment of addiction

Overview: This compromise language includes initiatives to promote behavioral health and prevent substance use disorders, strengthen the behavioral health system, and enhance options for substance use treatment and recovery across the Commonwealth.  Jay has supported and co-sponsored legislation, some of which was included in this bill, to improve treatment options in Massachusetts and to treat drug addiction as a health issue.

Prevention:

  • Creates the Community-Based Behavioral Health Promotion and Prevention Trust Fund to support evidence based and evidence informed programs for children and young adults.
  • Expands access to non-opioid treatment options for pain management.
  • Expands patients’ ability to partially fill opioid prescriptions.
  • Prohibits discounts and rebates for certain prescription opiates.
  • Mandates that providers check the Prescription Monitoring Program prior to issuing any prescription for benzodiazepine.
  • Establishes an Early Childhood Investment Opportunity Grant Program, which will focus on substance exposed newborns.
  • Adds healthcare providers with direct care experience to the Board of Registration in Nursing.
  • Creates a special commission to study ways to strengthen Massachusetts consumer protection laws to hold pharmaceutical corporations responsible for their role in the opioid epidemic.

Strengthening and Expanding the Behavioral Health System:

  • Strengthens Department of Mental Health and Department of Public Health licensing authority over mental health and substance use treatment facilities, giving the departments greater enforcement authority to improve quality care.
  • Requires facilities to accept MassHealth coverage on a non-discriminatory basis.
  • Allows the Office of the Child Advocate to impose temporary cost share agreements, as necessary, to ensure children’s timely access to care.
  • Establishes remote consultation programs that allow primary care and othe rproviders to consult experts in pain management and substance use disorder to improve patient care.
  • Requires electronic prescribing for all controlled substances with limited expectations effective January 1, 2020.

Treatment and Recovery:

  • Expands access to naloxone (Narcan) in the community by (1) establishing a standing order, providing access to naloxone without a prescription, (2) allowing certain Sheriffs to purchase naloxone at a lower cost through the state’s bulk purchasing program, and (3) allowing local governments and agencies to exchange unexpired naloxone.
  • Requires treatment facilities that provide mandated treatment (under section 35) and emergency rooms to provide access to evidence-based care for people struggling with opioid use disorder, including medication-assisted treatment (MAT).
  • Establishes a program offering MAT to persons with an opioid use disorder at 3 state prisons, as well as a pre-release program at MCI Cedar Junction, with rigorous patient protections, a warm hand-off to community treatment, and data reporting requirements.
  • Establishes a pilot program offering MAT at 5 county correctional facilities for those who received MAT prior to incarceration, as well as a pre-release program, with rigorous patient protections, a warm hand-off to community treatment, and data reporting requirements.
  • Establishes a Center for Police Training in Crisis Intervention to support cost-effective, evidence-based mental health and substance use crisis response training programs for law enforcement, providing the tools to respond appropriately to behavioral health crises.
  • Establishes a commission to make recommendations on the certification of Recovery Coaches.
  • Establishes a commission to make recommendations on harm reduction strategies to engage people at all stages of substance use disorder and encourage recovery.
  • Establishes a commission to study the efficacy of involuntary inpatient substance use treatment, including long-term relapse rates, overdose risk, legal implications, and capacity of the voluntary treatment system.

Outcome: This bill was passed in both chambers and was signed by the Governor on August 9, 2018

To read the full text of the bill, click here.

Understanding Baker’s Health Care Package

At the end of June, Governor Charlie Baker introduced a health care package that boasted Medicaid (MassHealth) reform and cost savings in an especially tight budget year. At a glance, the proposal seemed like a standard Republican response to the current financial state of the Commonwealth, but after a closer look, juxtaposed with Baker’s generally supportive views of the Affordable Care Act nationally, it paints a bleak picture for working families in Massachusetts.

If you have any additional questions, feel free to contact my Legislative Aide, Caitlin Duffy (Caitlin.Duffy@mahouse.gov)

What did Baker’s original MassHealth plan contain?

The Governor’s Health Care Reform Package introduced this Summer served as a Phase 2 of a larger reform. Phase 1, which was supported by the Obama Administration, was an effort to transform much of MassHealth (the State’s Medicaid program) into “accountable care organizations.” According to Commonwealth Magazine, Accountable Care Organizations (or ACO’s) aim to focus hospitals, physicians, and other providers on improving population health, care integration, and efficiency. Back in November, days before the election of President Trump, Massachusetts was awarded a grant by the Obama Administration to carry out the program, which aligned with the out-going administration’s mission to move US health care away from expensive fee-for-service payment and toward value-based financing that rewards quality and efficiency.

Gotcha. But what is included in Phase 2 of the Health Care Package? More Obama approved reforms?

Unfortunately, no. Phase 2 of Baker’s plan is a bit more complex and requires more focus. It includes 5 key changes:

  1. Temporarily reestablishes employer responsibility for health insurance through two new assessments.
  2. Closes access to MassHealth for otherwise income-eligible individuals and families who have access to affordable coverage through their employers.
  3. Seeks to transfer 140,000 lower-income, non-disabled adults from MassHealth to the ConnectorCare program, as well as transfer 230,000 non-disabled parents and caretakers from MassHealth Standard to CarePlus, effective January 1, 2019.
  4. Seeks to align MassHealth benefits more closely with those of commercial insurance plans by encouraging limited network products, by eliminating non-emergency transportation to medical appointments, and by using commercial tools such as closed formularies in selecting outpatient drugs.
  5. A series of reforms to state commercial insurance laws 

Okay, so what does this mean for employers?

Employers would be responsible for a higher rate of “Employer Medical Assistance Contribution” (EMAC) from $51m to $71m effective January 1, 2018. EMAC is what funds  subsidized health care to low-income residents of the Commonwealth. Finally, Employers will be required to pay 5 percent of annual wages for each non-disabled employee who obtains public health insurance coverage (from MassHealth or the Massachusetts Health Insurance Connector), up to the annual wage cap of $15,000, or $750 maximum. 

This is bad news for business, but the Baker administration lessened the pain by a $334 million drop in the unemployment insurance rate schedule to make up for it. That deal is likely why groups like the Associated Industries of Massachusetts and the Massachusetts Taxpayer Association are on board with this plan. Also, the assessments would be only effective for 2 years.

Interesting. I’ve heard people talking about “employer assesments” before. What are they and what is their significance?

Employer Assesments are reports submitted by companies regarding the health care plans that they offer and the eligibility percentage of current employees. Unless you’re incredibly interested in all things Health Care Policy, you probably first heard the concept mentioned back in 2006 during Massachusetts’s Universal Health Care debate. The Affordable Care Act also included an employer responsibility assessment, set to take effect in 2014, but it was never implemented. Anticipating the ACA assessment, Gov. Deval Patrick and the Legislature repealed the 2006 mandate in 2013. Baker proposed a more costly assessment last January, which is part of the reason why businesses are on board for these reforms.

That’s great for businesses, but what does the package change for families and individuals already on MassHealth?

Well, this is where Baker’s policy gets a little bit more treacherous. This plan would close access to otherwise income-eligible individuals and families who have access to healthcare plans deemed “affordable” by the government at their current job. The trouble is that health care costs add up and this could be seen as a huge burden on working people. Advocates worry that many low-income adults will be dropped from coverage, though the Baker Administration claims that they will provide assistance to those affected in finding affordable coverage. Until this assistance is proven to be adequate, moving ahead on this policy would be incredibly risky for vulnerable families and individuals.

 

What about the 140,000 people that would be shifted from MassHealth to Connector Care, or the 230,000 non-disabled parents and caretakers that would be shifted from MassHealth Standard to Care Plus? Should they be worried?

When you look at what would theoretically qualify a person to be deemed eligible for MassHealth in this regard, the 140,000 individuals especially should be alarmed. These are all people whose income is 100 to 138 percent of the federal poverty level. In other words, you’d have to be a lot more poor to qualify for MassHealth and families that fall between those benchmarks would have to rework their financial situation to afford subsidized care (which, can truthfully be costly). The disparity gap between plans becomes a significant hurdle for working families. The loss of coverage could also affect MassHealth recipients with dental plans and other elements crucial to caring for one’s health that may not carry over to ConnectorCare.

It’s important to remember that the poverty level is calculated on a national level.  It does not account for higher cost states, like Massachusetts, or higher cost cities, like Boston or Cambridge.

 

Okay. Well, what about the steps Baker is making to make MassHealth look more like Commercial models of insurance?

The Baker administration seeks to do this with MassHealth by encouraging limited network products, eliminating non-emergency transportation to medical appointments, and using commercial tools such as closed formularies in selecting outpatient drugs.

What about his efforts to reform Commercial Insurance? What would that entail?

  • Imposing a 5-year moratorium on new health insurance mandates;
  • Providing consumers with price information for common procedures and services;
  • Increasing premium differentials for tiered network insurance plans from 14 percent to 28 percent; and
  • Expanding the scope of practice for nurse practitioners, optometrists, and podiatrists, while creating a new mid-level provider called “dental therapist.”

This sounds like it could be devastating to families on MassHealth. What’s the pay off? How much does the governor claim that the State would save if we did this?

Baker’s team claims that these reforms would save $314 million in fiscal year 2018, which starts July 1, and more beyond. Those savings would be great, but it seems to be on the backs of the working poor in Massachusetts.

Well, what does Jay think about these changes?

As an advocate for working families and individuals, I was incredibly disturbed by Baker’s proposal and the lack of public process in determining the details. It felt like businesses and insurance companies got a seat at the table whereas MassHealth recipients did not get to voice their input/concerns. I understand that this was and remains to be a tight fiscal year, but I do not believe that working families and individuals should be first on the chopping block at their expense. After hearing about the proposal and getting sense of a momentum on the issue, I teamed up with Representatives Barber and Balser to pen an op-ed in Commonwealth Magazine about these changes. I’ve been part of a vocal opposition to any changes made to balance the budget on the backs of the working poor. 

Alright. What happens now? Is this a done deal? What can still be done?

Recently, the House rejected the Governor’s MassHealth Reform package in the form of a budget amendment, 41-116, with seven Democrats joining all but one Republican in supporting the governor’s plan. The Senate followed suit on a party-line vote of 6-31. One more vote is required in the Senate to return the budget sections without MassHealth reform to Baker. Baker will have to choose whether to accept the employer assessments without reforming MassHealth and risk alienating the business community, or veto the assessments and I will continue to fight against any similar proposals that would leave the people of Massachusetts without the health care support they need at this time of uncertainty at the federal level.  I am currently working with other representatives on solutions to MassHealth costs that do not involve cuts to benefits or services.

Reforms Or Rollbacks? Baker Battles Dems Over MassHealth

As the U.S. Senate voted to open debate on the Republican plan to repeal the Affordable Care Act, state lawmakers began their own review of potentially significant changes to Massachusetts’ health insurance for the poor. In the interests of balancing the budget an insuring the viability of state health aid, Gov. Charlie Baker is making a big push to rein in Medicaid spending. The result: some Democrats are offering more vocal opposition than Beacon Hill is used to hearing – at least since Baker moved into the corner office.

The cost of MassHealth, the state’s Medicaid program, has ballooned by almost 50 percent over the last 10 years. Baker’s plan would transfer around 140 thousand non-disabled adults from MassHealth to their employer’s plan or to subsidized coverage through the Health Connector. Health and Human Services Secretary Marylou Sudders says there would be little change to coverage and premiums, but co-pays could rise to around $500 a year.

“I’ve read some things recently that suggested that we’re actually cutting people off of access to eligibility. Nothing could be farther from the truth in our proposals before you,” Sudders told a joint hearing before the Legislature’s budget and health care financing committees Tuesday.

Because the cost of MassHealth is growing much faster than state tax dollars, Baker’s finance officials insist eligibility must be paired back to preserve the program for the neediest residents and to maintain the state’s near-universal coverage rate.

“In 2006, we passed universal health care reform, providing the path to the [Affordable Care Act] and today we need to find the path to preserve and protect our gains in coverage,” Sudders said.

Over one quarter of Massachusetts residents, almost 2 million people, rely on MassHealth for at least some health care coverage, according to Sudders. Baker’s plan would affect MassHealth enrollees earning 130 percent or less of the federal poverty line, or about $16,000 a year.

According to Baker’s office, the changes to the program would save the state around $200 million a year.

Democrats on the panels are concerned that forcing people off MassHealth and onto the connector would mean the loss of some dental and long-term care coverage, as well as push the state away from its long-standing commitment to expanding access to health insurance.

Ashland Sen. Karen Spilka, the Senate’s top budget writer, said there need to be solutions to the cost problem that don’t include limiting local Medicaid enrollment, which was expanded under the Affordable Care Act.

“If we accepted the governor’s proposal on this, Massachusetts would be the first state in the nation to start rolling back Medicaid expansion. That is not a direction I would like to see Massachusetts going. We are a Commonwealth. We take care of our residents, particularly our most vulnerable residents,” Spilka told WGBH News.

Several progressive members of the House echoed Spilka’s position in an op-ed for CommonWealth Magazine earlier this week. Reps. Christine Barber, Ruth Balser and Jay Livingstone called Baker out for what they see as supporting policies at the local level that he’s condemned the national GOP for pursuing nationwide.

“These are exactly the types of cuts that the governor is publicly opposing in Washington,” the representatives wrote.

Baker insists the changes are needed to balance this year’s budget and keep MassHealth sustainable.

The MassHealth eligibility changes are paired with another proposal from Baker to increase how much employers pay into the system and to charge an assessment on companies that don’t provide affordable coverage to employees.

http://news.wgbh.org/2017/07/25/politics-government/reforms-or-rollbacks-baker-battles-dems-over-masshealth