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Senator, advocates raise concerns over
proposed health 'safety net'
By Gintautas Dumcius and Priscilla Yeon August 22, 2007…..An advocacy group today thanked state regulators for making last-minute tweaks to rules governing a state pool that pays for health care services to the uninsured and underinsured, but remained opposed to charging low-income individuals for certain deductibles and fees if they use hospital and community health center services, saying that would defeat the purpose of the so-called Health Safety Net. The regulations also drew concerns from a lawmaker who was one of the architects of the last year's health insurance expansion law and from "safety net" hospitals, which deliver care mainly to minorities and the poor, who say funding for care to the uninsured will be at least cut in half if the regulations are adopted. One of the more controversial aspects of the regulations, according to activists with the Affordable Care Today (ACT!!) coalition, is charging a $35 monthly deductible for individuals who earn between $15,300 and $20,400, after they seek hospital services. Advocates argued that through the regulations, the safety net isn't a safety net at all, since individuals are essentially paying for a health care program but without the same benefits as the state-sponsored Commonwealth Care program. The regulations add another layer of complexity to an already-complicated health care system, advocates said in asking for a delay, like other pieces of the health care reform law have seen, until the reform effort is fully up and running. But members of the business community said the regulations strike the right balance, walking a tightrope between providing benefits that could be seen as too generous, discouraging individuals from getting health insurance, and too harsh and thus not providing a "true safety net." The "Health Safety Net Trust Fund" replaces the "Uncompensated Care Pool" as part of the health care reform effort that was signed into law last year. "It shouldn't be set up like a program," said Rabbi Barbara Penzner, of the Temple Hillel B'nai Torah in West Roxbury, and a member of the ACT!! Coalition. "Rather than paying for services, they're paying for a program." Brian Rosman, research director from Health Care for All, another group with the coalition, was heartened by the division's "changes" to the regulations but said most of the concerns regarding cost sharing were not addressed. Rosman said some of the positive changes the Division of Health Care Finance and Policy announced today were providing coverage to individuals who are in between waiting periods for Commonwealth Care or MassHealth programs and efforts to treat community health centers equally to limit cost sharing. But Michael Widmer, head of the business-backed Massachusetts Taxpayers Foundation, said advocates' testimony ignored that the purpose of the reform is to get as close to universal coverage as possible. "Health care reform will only work if we move people out of the pool and into insurance," he said. Moving more people into insurance is also critical to continuing to get the federal government to reimburse the state and health care institutions for the "free care," he said. But Penzner said the $35 monthly charge - or an accumulated deductible of $420 a year - will have the opposite effect. "What it does is simply serve as a deterrent for people getting health care, period," she said. Sen. Richard Moore (D-Uxbridge), the chair of the Joint Committee on Health Care Financing, who helped put together the reform law, also expressed concern over the deductibles, saying they could discourage patients from seeking care. "One of the primary objectives of health reform was to reduce the cost shifting that has occurred in the past, and I am concerned that an unintended consequence of some aspects of the proposed regulations that I have mentioned, will create new cost shifting to patients and/or hospitals," he wrote in a letter to the commissioner. Hospitals also decried the regulations, arguing that the rules will cause state payments for care of the uninsured to fall to $143 million from $320 million. In submitted testimony, the Massachusetts Hospital Association sharply disagreed with proponents of the regulations, saying they should not play a role in efforts to steer people into insurance plans. Ellen Murphy Meehan, who testified on behalf of the Alliance of Safety Net Hospitals, said the regulations should be postponed until the enrollment process for Commonwealth Care is farther along. On a panel with officials from Fall River, Holyoke and Lawrence hospitals, Meehan said that under the regulations, no payment to the hospitals can come for care provided to any individual who is eligible for Commonwealth Care or is in the process of enrolling in the state health insurance program, or eligible for affordable employer-sponsored insurance. "Given the vast numbers of uninsured in our communities, and our reliance on health safety net fund reimbursement, we predict that this regulation will ultimately reduce our health care capacity," she said. Meehan, the wife of former US Rep. Martin Meehan (D-Lowell), said the 2008 presidential election will keep the state's health reform law at the forefront of debate. "That attention, however, may not be very positive as national networks and media cover minority and poor citizens of Massachusetts being turned away from coverage they need," she said. Eileen McAnneny, senior vice president at the Associated Industries of Massachusetts, said in her testimony that the need for the net will fall as more individuals enroll in public or private insurance programs. As a result, she said, employers would like to eventually see a reduction in the $320 million they contribute each year in the form of surcharges. A number of those slated to testify were also caught flatfooted by a double-sided one-sheet listing of 17 fixes to the proposed regulations that were laid out with the public notice of the hearing. The regulations, likely to be finalized by mid-September, are due to go into effect in October 2007. The "tweaks" announced at the start of today's hearing, are "clarifications," DHCFP Commissioner Sarah Iselin told the News Service. "They were mostly clarifications based on the questions we've received. Most of them were consistent with the intent of the regulations," Iselin said. During a break in the testimony, Iselin, asked if she planned to make any changes to the regulations, said: "We will very thoughtfully consider everything we hear today." Iselin pointed to the importance of aligning the principles of health care reform with the proposed regulations. Encouraging people to enroll in health insurance should still be one of the goals of the regulations, and the law specifically calls for the safety net to be in place by October 2007, she added. Melissa Boudreault, director of Commonwealth Care, testified in support of the regulations and said passing the regulations is the next step in implementing the goals of the health care reform law. Boudreault also said the Connector Authority supports the idea of "shared responsibility" and spoke in support of the regulations clarifying individuals' co-payments. |
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