Health Care Reform

Today, August 07, 2008, 4 hours ago | CommonHealth
The Massachusetts Legislature recently adopted a comprehensive proposal to improve the quality of health care and to contain the rapidly increasing cost of care. Both goals are essential to sustaining the Commonwealth’s landmark health care reform law and keeping high quality health care affordable to all our residents.

Some of the most exciting and meaningful reforms in the bill – promoting reform and efficiency in the health care system, improving access to health care services, enhancing transparency of health care costs and quality, and encouraging the adoption of health information technology – will dramatically improve the care provided in Massachusetts as we expand access to care for all of our residents. However, one provision of the bill – regulating drug marketing practices – has generated heated, but not well-informed, discussions with representatives of the bio-pharma industry.

Those of us who helped to draft the Massachusetts Health Care Quality Improvement and Cost Containment legislation firmly believe that marketing practices of pharmaceutical and medical device manufacturers are an important factor in driving up health care costs without, necessarily improving the quality of care that’s delivered to patients here, and across the country. There are numerous books, articles, and academic research papers that clearly demonstrate the pervasive, even corrupting, influence of such marketing practices as gifts, travel, honoraria, and other valuable incentives offered by industry to those with the state licensed power to prescribe medication. Legislators are not alone in our sincere concern.

Dr. Mark A. Levine, Chair of the American Medical Association’s Council on Ethical and Judicial Affairs recently wrote: “While industry and medicine share the overall goal of improving health, their interests and obligations diverge in important ways. Commercial entities have a responsibility to their shareholders and other vested stakeholders to thrive as businesses and maximize returns on investment. Medicine has a responsibility to put the needs of patients first. As relationships between medicine and industry continue to expand, there is growing concern about the impact of industry funding on the integrity of professional education and its implications for public confidence in medicine as a profession.”

As Harvard Pilgrim CEO Charlie Baker wrote in his blog: “A task force that was put together by the Association of American Medical Colleges to study industry funding of medical education just issued a report that recommends, among other things, banning free food, gifts, travel and other services to doctors, staff and students at medical colleges. The report will be reviewed by the AAMC’s Executive Council shortly. He added that, “David Korn, the AAMC’s Chief Scientific Officer, didn’t deny the need for ongoing interaction between practicing clinicians and pharmaceutical and device manufacturers, but said, in effect, that whatever happens needs to be cleaned up, transparent, and tied to the specific practice of medicine.”

This is exactly the goal of Section 14 of Senate Bill No. 2863 which would add a new chapter to the Massachusetts General Laws – Chapter 111N “Pharmaceutical and Medical Device Manufacturer Conduct.” It directs the state Department of Public Health to develop regulations to establish a standard marketing code of conduct for all pharmaceutical or medical device manufacturing companies that employ a person to sell or market prescription drugs or medical devices in the commonwealth.

It’s important to understand that this new code must be based on applicable legal standards and incorporate principles of health care including, without limitation, requirements that the activities of the pharmaceutical or medical device manufacturer agents be intended to benefit patients, enhance the practice of medicine and not interfere with the independent judgment of health care practitioners. In other words, the Massachusetts law puts patients first, the integrity of physicians a close second, and enhancing corporate profits further down our list of priorities.

These regulations that DPH develops must be no less restrictive than the most recent version of the Code on Interactions with Healthcare Professionals developed by the Pharmaceutical Research and Manufacturers of America and the Code on Interactions with Healthcare Professionals developed by the Advanced Medical Technology Association. In other words, the codes that the industry itself has developed would be the basis for the Massachusetts code, and it will be legally enforceable if violated – something that the industry code does not provide. If the industry is serious about its own code of marketing and wants its member companies to follow, how can it be opposed to adopting that same code as the law for such companies doing business in Massachusetts?

The other industry concern – some say “red herring” – relates to the requirement to report payments to physicians in excess of $50 per year. Drug companies suggest that this reporting requirement and subsequent public disclosure will put them at a disadvantage to competitors in other states. However, information from all clinical trials is already public information through a federal clinical trials database. Other states already collect and publish information about research and clinical trials. Certainly, if there are any legitimate issues with the reporting and disclosure provisions, the Department of Public Health can address them in the regulations that must be developed to implement this section of the Quality Improvement and Cost Containment Law.

Massachusetts is not alone in passing legislation to require reporting of payments by pharmaceutical and medical device manufacturers to those who prescribe medication for their patients. Minnesota, Vermont, Maine, the District of Columbia, and West Virginia have all enacted laws to achieve this goal. Eleven other states, including New York and California have seriously considered legislation of this type during the current term, and more will undoubtedly take action in the next session. In every case, the pharmaceutical industry has vigorously opposed such legislative initiatives claiming that they can regulate themselves. However, professional lobbyists for the Pharmaceutical Manufacturers Association traveled all the way from Washington, DC to Boston to testify in opposition at a public hearing on a similar bill that was considered during the current session of the Massachusetts Legislature.

Massachusetts sincerely values the research and products of the Bio-pharma industry. We believe that the industry is a vital part of the state’s economy, and we’ve offered to invest a billion dollars to encourage the development of that industry in the Commonwealth. We accept the word of the industry – as stated in their marketing codes – that the industry wants to preserve the integrity of the medical profession. And our legislation will help them attain this most laudable goal. Therefore, we urge the Governor to sign the Senate Bill No. 2863 into law without amendment!

Senator Richard T. Moore, Senate Chair, Committee on Health Care Financing
Comments

Filing a bill Massachusetts Legislature

Massachusetts citizens are permitted and encouraged to take an active
role in the lawmaking process of the state legislature. It is a good
idea for a person who feels strongly about an issue to present his or
her ideas to a representative or senator. That person may discover that
those concerns have already been formulated into a bill which is
awaiting legislative action. If not, the citizen is allowed to file
legislation addressing the subject. Massachusetts is one of the few
states to allow its citizens to do so. This access is called the "right
of free petition."
Although it is not mandatory that a representative or senator sponsor a
citizen's bill, the rules of the House and Senate provide that a
petition must be endorsed for presentation by a member before it can be
considered by the General Court. Obtaining the support of individual
legislators, then, is most advisable.


Howard McGowan

Health Insurane Bill Massachusetts

The Massachusetts House on Tuesday voted 135-21 to approve a bill that would require insurance companies and health care providers in the state to contribute more money to close a funding gap in the state's health insurance law, the AP/Boston Globe reports. The bill would generate $89 million. A proposal by Gov. Deval Patrick (D) to raise an additional $33 million by increasing contributions from businesses was eliminated from the measure. Patrick had proposed closing a loophole that allowed companies with more than 10 workers or without employer-based insurance coverage to avoid paying an annual penalty of $295 per worker, according to the AP/Globe.

House Speaker Salvatore DiMasi (D) in a statement said that "modest changes" to the measure would allow the law to continue and create the right balance between state and private-sector involvement. The law has expanded coverage to about 340,000 residents since it was enacted in April 2006, but rising costs have forced state officials to raise premiums and seek new sources of revenue, the AP/Globe reports.

Kyle Sullivan, a spokesperson for Patrick, said the governor still has the authority to make regulatory changes to increase business contributions, but he did not say whether Patrick would do that. The bill now moves to the Senate (Johnson, AP/Boston Globe, 7/29).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Main News Category: Health Insurance / Medical Insurance

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Senator Tsei look at Fiscal yr 2009 State Budget

tseMalden -
The Legislature approved a new state budget for Fiscal 2009 last week. Now, the question is, can Massachusetts afford it?

For the first time in memory, a budget emerged from conference committee with a higher bottom line than either legislative branch had proposed. At $28.22 billion, the budget is $160 million more than the senate version and $30 million higher than the house proposal.

Despite all the talk about fiscal restraint and belt-tightening, state spending will actually increase by 5.2 percent this year.

A closer look at the conference committee report shows that more than 140 accounts were increased by more than 9 percent. For some agencies, the increases were much higher, including 77 percent for the Division of Energy Resources, 87 percent for the Department of Higher Education and a whopping 106 percent for the Department of Public Safety.

What these numbers tell me is that state agencies are expanding and growing at an unsustainable rate. Some of the increases are for new and expanded programming, which makes no sense considering we can barely afford to pay for many existing programs.

We are in denial if we think we can afford this budget. Considering the latest job reports, stock market volatility, and continued revenue uncertainty, I can’t see how we can possibly justify maintaining these spending levels.

The Fiscal 2009 budget is built on a house of cards that could come tumbling down at any moment. It relies too heavily on borrowing from the Rainy Day Fund, new taxes, overly optimistic revenue projections, and federal funding that may not be forthcoming.

The conference committee report not only withdraws $310 million from the Rainy Day Fund, but also uses $91 million in interest, and spends another $107 million instead of transferring it into the fund. That’s $508 million in reserve funding being used to balance the budget.

The Rainy Day Fund was established during the 1990s so the state would have a reserve to draw on during economic downturns to preserve vital programs and services. In previous years, the state has been able to replenish the fund every time money was taken out, but that won’t happen this year.

Instead of using this fund as a savings account, the Legislature is treating it like a line of credit, a risky proposition that will have negative repercussions for the state down the line.

The recent implementation of a series of new taxes has also put the state on a dangerous path. On June 30, the Legislature approved a new $1-a-pack cigarette tax that took effect less than 24 hours later.

This increase is expected to generate an additional $175 million in revenues, although collections from previous cigarette tax increases have historically come in lower than original projections.

Add in a $485 million corporate tax increase approved on July 1 and $156 million in revenue enhancements for the Department of Revenue that were included in the budget, and more than $800 million in new taxes has been approved in a span of less than a week.

The Legislature seems to be doing everything it can to ensure that the income tax repeal ballot question passes in November. The public is fed up with high gas, food and energy costs, and this “tax and spend” attitude only gives further ammunition to those who are calling for a repeal.

Rising health care costs are another reason why the budget numbers are unrealistic. Commonwealth Care, the state-run program that provides free and subsidized health care to the state’s low- and moderate-income residents, has been funded at $869 million, a figure we know is at least $200 million short. Administration and Finance has already admitted that the true cost will be more than $1 billion.

The state is also still in a holding pattern on the federal Medicaid waiver, which was due to expire on June 30 but has been temporarily extended for two weeks as negotiations continue. The budget is not only counting on a waiver extension, but also a 14 percent increase in federal funding, which seems overly optimistic at this point.

We may have a budget in place, but if spending starts to outpace revenues, we could be looking at mid-year cuts. Reductions made early in the fiscal year can be done fairly painlessly, but the further we go into the fiscal year, the more disruptive and harmful it will be to implement cuts.

The legislature would have been better off waiting a little longer to see what happens with the federal Medicaid waiver and what the June revenue figures look like before finalizing a new budget.

Given the many uncertainties that still exist this year, waiting just a little longer would have given us a better sense of the state’s true fiscal picture and an opportunity to craft a more realistic spending plan.

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Mass Legislation in Session

HOW LONG WAS LAST WEEK'S SESSION? Beacon Hill Roll Call tracks the length of time that the House and Senate were in session each week. Many legislators say that legislative sessions are only one aspect of the Legislature's job and that a lot of important work is done outside of the House and Senate chambers. They note that their jobs also involve committee work, research, constituent work and other matters that are important to their districts. Critics say that the Legislature does not meet regularly or long enough to debate and vote in public view on the thousands of pieces of legislation that have been filed. They note that the infrequency and brief length of sessions are misguided and lead to irresponsible late night sessions and a mad rush to act on dozens of bills in the days immediately preceding the end of an annual session.

During the week of June 30-July 4, the House met for 18 hours and 41 minutes while the Senate met for 12 hours and 48 minutes.

McFadden Geriatric Authority

REPORT AND SUGGESTION FOR MSAC PARTICIPATION IN FUTURE EFFORTS McFadden Manor
City votes to establish Geriatric Authority for McFadden (as suggested by chapter)
Board
City Council President Gary Christenson\ Councilor at large Gregory Lucy/ a Geriatric Doctor
SUGGESTION (get business men involved thru chamber of commerce Malden Social Services agencies Board of Health.
need people for fund raising and support from local banks and businesses. Non profits have the expertise to write grants. The Malden Redevelopment has Federal Funds to distribute.)
Need Approval of the Massachusetts House of Representatives and Senate to get a legislative act signed into law by the Governor.
This years session ends July31,2008
(Needs a Political Action Group like MSAC (metro north chapter members) to lobby as a unit at both the city hall but now primarily at the state house with as many as the legislators (who need to be make aware of the issues) who will support our local state legislators. The organization "Friends of McFadden Manor should become an affiliate with our State organization and recruit members to join metro north chapter for a united support in this (PAC)
July 30th the end of the Legislative session
Finally need support of all local government and taxpayers for pressure on STATE BOARD OF
HEALTH FOR TRANSFER NURSING HOME LICENSE.
For Information
The House and Senate will continue to meet in informal session after 31st of July.
During informal sessions unanimous consent is needed to advance legislation and the objections of a single lawmaker can stop a bill in tracks.
GET POLITICAL
REQUEST The Malden City Council prepare a resolution of support to send to the State and read at a
public council meeting in support of the NEW GERIATRIC AUTHORITY.




--
Howard McGowan
MaldenSenior
349 Pleasant Street
Malden, Ma 02148
781 324 8076

Transfering Retired City Employees into Medicare

PART I. ADMINISTRATION OF THE GOVERNMENT
1. TITLE IV. CIVIL SERVICE, RETIREMENTS AND PENSIONS
CHAPTER 32B. CONTRIBUTORY GROUP GENERAL OR BLANKET INSURANCE FOR PERSONS IN THE SERVICE OF COUNTIES, CITIES, TOWNS AND DISTRICTS, AND THEIR DEPENDENTS
Chapter 32B: Section 18. Medicare extension plans; mandatory transfer of retirees
Section 18. In a governmental unit which has accepted the provisions of section ten and which accepts the provisions of this section, all retirees, their spouses and dependents insured or eligible to be insured under this chapter, if enrolled in medicare part A at no cost to the retiree, spouse or dependents or eligible for coverage thereunder at no cost to the retiree, spouse or dependents, shall be required to transfer to a medicare extension plan offered by the governmental unit under section eleven C or section sixteen; provided, that benefits under said plan and medicare part A and part B together shall be of comparable actuarial value to those under the retiree’s existing coverage. Each retiree shall provide the governmental unit, in such form as the governmental unit shall prescribe, such information as is necessary to transfer to a medicare extension plan. If a retiree does not submit the information required, he shall no longer be eligible for his existing health coverage. The governmental unit may from time to time request from any retiree, a retiree’s spouse and dependents, proof certified by the federal government of their eligibility or ineligibility for medicare part A and part B coverage. The governmental unit shall pay any medicare part B premium penalty assessed by the federal government on said retirees, spouses and dependents as a result of enrollment in medicare part B at the time of transfer into the medicare health benefits supplement plan.
This section shall take effect in a county, except Worcester county, city, town or district upon its acceptance in the following manner:— In a county by vote of the county commissioners; in a city having a Plan D or Plan E charter by a majority vote of its city council; in any other city by vote of its city council, approved by the mayor; in a district, except as hereinafter provided, by vote of the registered voters of the district at a district meeting; in a regional school district by vote of the regional district school committee; and in a town either by vote of the town at a town meeting or, by a majority of affirmative votes cast in answer to the following question which shall be printed upon the official ballot to be used at an election of said town:— “Shall the town require that all retirees, their spouses and dependents who are enrolled in Medicare Part A at no cost to a retiree, their spouse or dependents, or eligible for coverage thereunder at no cost to a retiree, their spouse or dependents, be required to enroll in a medicare health benefits supplement plan offered by the town?”.

OPENMASS.ORG TRANSPARENCY STATE LEGISLATURE

I read an article in the Malden Advocate that lists OpenMass.org as a site on the internet that sheds light on the innerworking of Beacon Hill.
"the goal was to spark civic engagement and promote greater transparency in government"says Medford Resident Jim Caralis
In the past year over one million times be residents in Massachusetts.
The site was launched in May 2oo7 and now celebrates in first anniversary.
The recent feature added to OpenMass.org allow anyone that writes E-mail to his or her State Representative or Senator to copy openletters@openmass.org
OpenMass.org is a non profit and non-partisan web resource with a mission to make the Massachusetts State Legislature more transparent and to encourage civic engagement

AMENDMENT TO LONG TERM CARE BILL

Notwithstanding any general or special laws to the contrary, there shall be a special commission established to examine the Commonwealth’s institutional long term care system, which shall recommend a plan to provide a seamless transition to a continuum of long term care services for elders and persons with disabilities that recognizes the central place of consumer choice and consumer control in any long term care setting; evaluate options and prepare policy recommendations regarding potential savings to the commonwealth achieved by reducing the number of MassHealth licensed nursing home beds; develop recommendations as to the criteria to be used to determine which beds are de-licensed, provided that said criteria shall include at a minimum established Quality Indicators and other quality measures, such as staffing levels, turnover rate and training options for direct care staff; and to consider any programmatic or financial incentives to reduce the number of nursing home beds, convert said beds to subacute beds or other uses, or otherwise more efficiently use the institutional long term care facilities in the Commonwealth. The commission shall examine the eligibility requirements, services, and costs for each state-funded long term care program, including but not limited to nursing homes, assisted living, group adult foster care, rest homes, home care programs, and managed care dual eligible programs; and to make recommendations for organizing the continuum of long term care in a cost-effective way.

The commission shall consist of 18 members, 1 of whom shall be the secretary of health and human services or his designee, 1 of whom shall be the secretary of elder affairs or her designee, 1 of whom shall be the director of the office of Medicaid or her designee, 1 of whom shall be the Attorney General or her designee, 1 of whom shall be the Auditor or his designee, 1 of whom shall be the house chair of the joint committee on elder affairs, 1 of whom shall be the senate chair of the joint committee on elder affairs, 1 of whom shall be the senate chair of the joint committee on health care financing, 1 of whom shall be the house chair of the joint committee on health care financing, 1 of whom shall be a consumers or consumer surrogates member of the PCA quality home care workforce council approved by a majority of the Council, and 8 persons to be appointed by the governor, 1 of whom shall be a health care economist, 1 of whom shall be a representative of 1199SEIU, 1 of whom shall be a representative of the Statewide Independent Living Council, 1 of whom shall be a representative of the Massachusetts Extended Care Federation, 1 of whom shall be a representative of Mass Home Care, 1 of whom shall be a representative of the Mass Alzheimers Association, 1 of whom shall be a representative of MassAging and 1 of whom shall be a representative of AARP. The commission shall be co-chaired by the senate and house chairs of the joint committee on elder affairs.


The commission shall meet within 30 days of passage, and not less than quarterly thereafter, and shall release its first recommendations to the house and senate committees on ways and means no later than December 31, 2008.

PRESCRIPTION ADVANTAGE AMENDMENT

Representatives Reinstein of Revere, Kafka of Stoughton, Fagan of Taunton, L’Italien of Andover, Guyer of Dalton, Sannicandro of Ashland, Smith of Everett, Koczera of New Bedford, Brownsberger of Belmont, Linsky of Natick, O’Day of West Boylston, Lantigua of Lawrence, Fernandes of Milford, Haddad of Somerset, Rush of Boston, Fresolo of Worcester, Callahan of Sutton, Wolf of Cambridge, Canessa of New Bedford, McCarthy of East Bridgewater, Verga of Gloucester, Speliotis of Danvers, Allen of Boston, Ayers of Quincy, Keenan of Salem, Provost of Somerville, and Binienda of Worcester move to amend the bill in section 2, in item 9110-1455, by adding the following: “; and provided further, that the secretary shall not implement cost sharing increases during fiscal year 2009 unless the executive office has given 90 days notice to the general court and has received approval of the proposed plan from a majority of the general court.”

Universal Health Plan Massachusetts

In its first full year, universal health coverage in Massachusetts will cost the state $153.1 million more than was budgeted, according to a supplemental budget request released Monday by Gov. Deval Patrick. The state had appropriated $472 million for the fiscal year ending June 30, but enrollment in the state’s subsidized insurance programs for low- and middle-income workers exceeded expectations. About 340,000 of the state’s estimated 600,000 uninsured have gained coverage since Massachusetts began requiring health insurance. The state had projected that 136,000 people would sign up for its Commonwealth Care policies, but 174,000 are now enrolled. Cyndi Roy, a spokeswoman for Mr. Patrick, a Democrat, said this year’s shortfall would be offset by surplus revenues in the state’s general fund. For the coming fiscal year, Mr. Patrick has requested $869 million for Commonwealth Care, but his aides have already conceded that will not be enough as enrollment continues to grow.

Massachsetts Health Care Bill

In its first full year, universal health coverage in Massachusetts will cost the state $153.1 million more than was budgeted, according to a supplemental budget request released Monday by Gov. Deval Patrick. The state had appropriated $472 million for the fiscal year ending June 30, but enrollment in the state’s subsidized insurance programs for low- and middle-income workers exceeded expectations. About 340,000 of the state’s estimated 600,000 uninsured have gained coverage since Massachusetts began requiring health insurance. The state had projected that 136,000 people would sign up for its Commonwealth Care policies, but 174,000 are now enrolled. Cyndi Roy, a spokeswoman for Mr. Patrick, a Democrat, said this year’s shortfall would be offset by surplus revenues in the state’s general fund. For the coming fiscal year, Mr. Patrick has requested $869 million for Commonwealth Care, but his aides have already conceded that will not be enough as enrollment continues to grow.

The Community Preservation Act

The Community Preservation Act is statewide enabling legislation to allow cities and towns to exercise control over local planning decisions. This legislation strengthens and empowers Massachusetts communities:
All decisions are local.
Local people must vote by ballot to adopt the Act.
Local legislatures must appoint a committee of local people to draw up plans for use of the funds.
These plans are subject to local comment and approval.
If residents don’t feel the CPA is working as they expected, they can repeal it.
The Community Preservation Act provides new funding sources which can be used to address three core community concerns:
Acquisition and preservation of open space
Creation and support of affordable housing
Acquisition and preservation of historic buildings and landscapes
A minimum of 10% of the annual revenues of the fund must be used for each of the three core community concerns. The remaining 70% can be allocated for any combination of the allowed uses, or for land for recreational use. This gives each community the opportunity to determine its priorities, plan for its future, and have the funds to make those plans happen.Property taxes traditionally fund the day-to-day operating needs of safety, health, schools, roads, maintenance. - and more. But until the CPA, there was no steady funding source for preserving and improving a community’s infrastructure. The Community Preservation Act can give a community the funds needed to control its future.
I heard a discussion at the Senior Building meeting that they would like to be sure that our Historical Society to be involved in developing a plan for the decorating and furnish memobelia and funding for the New Senior Communit Center "A WAY OUT SUGGESTION??" Any consiedation for opening dialog on this act. Failed Election
1/6/01 3129-5531 Howard McGowan

Establishing Paid Sick Days (HB 1803/ SB 1073)

Almost half of Massachusetts workers lack a single guraranteed paid sick day. That's nearly 1.5 million workers who risk losing pay or their job if they need to take a sick day. That's not right and it isn't fair. This month, the Massachusetts Paid Sick Leave Coalition delivered hundreds of messages to our state legislators urging them to do something about this situation by supporting An Act Establishing Paid Sick Days (HB 1803/SB 1073). The bill would ensure that all Massachusetts workers can earn a minimum of seven paid sick days a year to take care of their own health needs and those of family members. All Massachusetts workers should be able to take the time to recover from an illness or injury or care for sick or injured children, without risking their pay or their jobs. The legislature should pass and the Governor should sign An Act Establishing Paid Sick Days as quickly as possible.
Howard McGowan
349 Pleasant Street
A2 #3
Malden, MA 02148

Pols push relief in bills for reform

Top lawmakers and industry Leaders will testify at a hearing to examine bills requiring health providers and insurers to justify their costs and open their books to state regulators
"We cannot sustain the continuing rise in health-care costs" aid Senate President Therese Murray. "When you add it to the rise in energy and food costs, families are not making it here in Massachusetts".
Murray's bill would force health providers and non profit insurers to document reasons for cost increases, among other things.
Another bill by State Sen. Mark Montigny would cap pay at 500,000 for executives working at tax-exempt non-profits with annual revenues of more than $1 million.
But the health industry reps said executive salaries are being blamed for cost hikes that have more to do with increasing prices for medical procedures and prescioption Drugs.
"Focusing on executive pay is misunderstanding waht the real cost-drivers are" said Marylou Buyse, presiden of the Massachusetts Association of Health Plans