Here’s what the amendment does: it instructs the state to estimate, every year, what the state of Massachusetts would be saving under a single payer plan that would guarantee publicly-provided, comprehensive care for all residents in the state. If by mid-2014, or any year thereafter, we find that we would be better off under single payer, the state will have to develop a single payer implementation plan and start putting it into practice - much like Vermont is currently doing.

Click here to download the one-page Eldridge amendment, and click here for a short summary. If you are interested in a summary of the whole Senate bill, you can click here.

TIME: Saturday, April 21, 2012 from 1PM to 4PM
PLACE: Ryles Jazz Club, 212 Hampshire St, Cambridge, MA 02139 (click here for directions)
TICKETS: $35 standard admission ($30 purchased in advance or online by clicking “Donate” above), $10 for students - please donate what you can!

Join Mass-Care and the Universal Health Care Education Fund on April 21 for:

• Keynote speaker Jeff Santos, radio host of progressive radio shows Revolution Boston and Rebuild America AM 1510, and frequent contributor to The Ed Show on MSNBC.
• Presentation by Mark Dudzik, National Coordinator of the Labor Campaign for Single Payer Health Care, on activating labor and national organizing after the passage of national health reform.
• Honoring Dr. Arnold Relman, professor emeritus at Harvard Medical School, a former editor of the New England Journal of Medicine, and author of the recent book A Second Opinion: Rescuing America’s Health Care.
• Honoring Sandy Eaton, RN, former chair of Mass-Care, long-time single payer activist, and member of the Massachusetts Nurses Association.

Click here to take out an ad in our event program book!
Click here to download an invitation letter to the event.

Please help support Mass-Care and UHCEF’s ‘Big Cities’ campaign, to grow our grassroots base in Boston, Worcester, and Springfield! This is a movement that will have to be won from the bottom up, and we have dedicated ourselves to growing our movement in the coming year.

Those are some of the findings in a new, exhaustively documented report on the outcomes of the Massachusetts reform law released by Mass-Care and Massachusetts Physicians for a National Health Program. The report draws on hundreds of sources, including academic studies, government statistics and scientific surveys, in the first compilation of its kind.

DOWNLOAD FULL REPORT: Massachusetts Health Reform in Practice and the Future of National Health Reform (PDF)
DOWNLOAD REPORT APPENDICES: Massachusetts Health Reform in Practice, Appendices A - E (PDF)

EXECUTIVE SUMMARY

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available publicly subsidized private health insurance for additional low-income residents of the state. It also mandated that all but the poorest uninsured residents either purchase private health insurance or pay a substantial fine (up to $1,212 in 2011). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance.

Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.

Reform has had a positive impact on access to care in the state, but this impact has affected a modest share of residents, and for some patients has been negative. For example, some low-income patients who previously received completely free care under the state’s prior free care program faced new co-payments and premiums after becoming insured, which impeded their access to care. Reform has not reduced the burden of medical bills and medical bankruptcy on Massachusetts’ families.

The growth of residents with insurance coverage has exacerbated a primary care shortage in Massachusetts by increasing wait times for appointments and decreasing the portion of physicians accepting new patients, creating access problems even for those with coverage. Reform did not reverse growing use of the state’s emergency departments for care, despite expectations that expanding insurance coverage would reroute patients through primary care offices. There is no evidence as of yet that expanding insurance coverage has had an impact on health outcomes or disparities in health outcomes. Reform has also created a financial crisis for safety net providers that specialize in care for low-income communities and the uninsured, by shifting resources away from safety net providers while patient demand for safety net care has actually increased.

The public cost of reform has been high, exceeding $800 million in fiscal 2009 for a state with a total budget of $32.5 billion. However, federal taxpayers paid for the bulk of the law’s public expenses. The state has made a broad range of cuts to the original law in order to its keep costs down, cutting back coverage for over 30,000 documented immigrants, curtailing some benefits, increasing cost sharing, and increasing the share of enrollees required to pay premiums. Substantial funds from the federal stimulus bill were also used to sustain the reform law, but this was a short-term fix only.

Public payments account for only a portion of the reform law’s costs. A central premise of the law was that the state, employers, and individuals would all have to sacrifice financially to approach the goal of universal coverage. This premise of “shared responsibility” for the costs of the reform was in many ways disingenuous. Although employers, individuals, state and federal government have shared the burden of increased costs roughly equally, this overlooks the fact that governments pass on their spending to taxpayers, and employers pass on their costs to employees. The actual burden of health reform was regressive, with increased spending after health reform falling disproportionately on lower-middle income residents.

The reform failed to “bend the cost curve” in Massachusetts because it contained no significant cost-control provisions. Health care costs in Massachusetts are higher than in any other state in the nation, and reform has been found to accelerate the rising costs of employer-sponsored health care. There is general agreement that the Massachusetts reform is itself not sustainable without effective cost control.

Massachusetts enjoyed favorable circumstances at the outset of reform, such as previously high levels of spending on health care for the poor, high personal incomes, and relatively low rates of uninsurance. Without controlling costs, national reform will run up against the same difficulties as Massachusetts: growth in public insurance coverage will prove unsustainable and will accompany the rapid erosion of private insurance benefits, while modest gains in access to care will be threatened in the short term by unsustainably high costs that are increasingly shifted on to patients.

While Massachusetts health reform has enjoyed support from a majority of residents in the state, that support has declined since national health reform instigated a broader debate over alternatives to the Massachusetts plan. Moreover, while residents support the Massachusetts reform law over no change at all, they have expressed increasing skepticism that the law is working for vulnerable communities, and more residents report that the law is hurting them than helping them.

We believe that the data in this report should give pause to those concerned with national health care reform. Although not without its successes, the Massachusetts reform has not addressed the fundamental deficiencies in the health care system – treating symptoms rather than causes – and even its modest successes are unsustainable for the state and Massachusetts residents.

Mass-Care and the Universal Health Care Education Fund invite you to join them Columbus Day weekend for a Fall barbecue and bake-off! Set at the beautiful Larz Anderson Park in Brookline, more than eight contestants will work their culinary magic in two separate competitions - for the most mouth-watering grilled appetizer, and the most delectable baked goods. Prizes will be awarded by a star-studded Judges Panel!

We are asking attendees to contribute $35 towards making health care a right ($10 for under age 18), and you will get to taste the competitors’ dishes. Low-income attendees are more than welcome to join us at a discounted rate!

WHERE AND WHEN
Sunday, October 9, 11:30AM - 2:00PM
Larz Anderson Park, Brookline (click here for directions)
Tickets: $35 ($10 for under age 18)

JUDGES PANEL

• Jay Murray, Executive Chef, Grill 23 & Bar
• Jamie Eldridge, Senator, Middlesex and Worcester
• Frank Smizik, Representative, Fifteenth Norfolk
• Dr. James Recht, Psychiatrist, Chair of Massachusetts Physicians for a National Health Program
• Mohamed Maenaoui, Personal Chef and former Executive Chef, The Barking Crab

GRILLING COMPETITORS

• Benjamin Day, Executive Director, Mass-Care
• Jennifer Doe, Workers Rights Organizer, Massachusetts Jobs with Justice
• Mike Fiske, Owner, Fiske & Company
• Robert Hall, Waiter, Grill 23 & Bar

BAKING COMPETITORS

• Olivia Alford, Research Assistant at the Education Development Center, and former Mass-Care intern.
• Reverend Judy Deutsch, retired Unitarian Universalist minister, and health care specialist for the League of Women Voters of Massachusetts.
• Margaret Reeve Panahi, Family Nurse Practitioner, graduate of Madeleine Kamman School for Culinary Arts.
• Denise Zwahlen, Physician Assistant, Codman Square Health Center

EVENT SPONSORS

• Boston Common Coffee Company
• Eagles Deli
• Flour Bakery
• Michael’s Deli
• Panera Coolidge Corner
• Putterham Grille
• Ula Cafe

TIME: Saturday, March 26, 2011 from 1PM to 4PM
PLACE: Ryles Jazz Club, 212 Hampshire St, Cambridge, MA 02139 (click here for directions)
TICKETS: $35 standard admission, $10 for students - please donate what you can!

Join Mass-Care and the Universal Health Care Education Fund on March 26 for:

• The music of The Winiker Band.
• James Haslam, Executive Director of the Vermont Workers Center, speaking on Vermont’s single payer legislation progress.
• Gerald Friedman, UMass Economist, discussing his study on the impact of a single payer system for Massachusetts residents and businesses.
• Honoring the work of: Reverend Judy Deutsh, Matthew Patrick, and Walpole Peace & Justice.

Click here to take out an ad in our event program book!
Click here to download a flyer for the event.

This year health reform is migrating from the national level to the states, with the exciting news that Vermont is on the brink of passing the first state single payer legislation in the country. Our annual fundraising gala for Mass-Care and the Universal Health Care Education Fund is coming up on Saturday, March 26, from 1 to 4PM at the Ryles Jazz Club in Cambridge!

Mass-Care and UHCEF along with the help of many of you was able to put single payer questions in the ballot in 14 representative districts this past election cycle—winning in all 14 districts. In 2011 the state legislature will take up most cost control, and Mass-Care and UHCEF will play an active role in advocating for single payer as the only truly effective cost control measure, and will support the introduction of a public health insurance option for Massachusetts.

Thank you so much for your continuing support. We hope to see you on March 26 at the Ryles Jazz Club for inspiration and fun!

Click here to take out an ad in our event program book!

• Download the slide show from Professor Gerald Friedman, analyzing the crisis of health care costs in Massachusetts and how the Medicare for All Massachusetts legislation would impact households, employers, and the state.
• Click here to view the full report by Professor Friedman.
• Click here to download a one-page Medicare for All Massachusetts fact sheet.
• Click here to download a two-page Frequently Asked Questions (FAQ) for the Medicare for All Massachusetts bill.

Q: What does the Medicare for All bill do?
A: It creates a ‘single payer’ health care system for Massachusetts, which would function for residents under 65 much the way Medicare does for residents 65 and older, but without premiums or copayments: it would be a universal, public insurance plan covering all medically necessary care. Single payer systems are proven to reduce inequalities, improve access to care, and reduce costs for public and private payers.

Q: Why is Medicare for All needed?
A: Massachusetts cannot afford to extend quality health coverage to all residents under our present health care system, because we have no means of reining in costs. In addition to making our health reform law unsustainable, these costs are steadily consuming state, municipal, business, and household budgets. Our best attempts to control these costs within the present private insurance system have failed, and have often undermined quality of care as a side-effect.

Q: How does the bill deal with federal waivers?
A: The Medicare for All Massachusetts bill initially creates a transitional single payer system until federal waivers are obtained for Medicare, Medicaid, and other federal or federally-matched programs. The transitional single payer system will cover people who currently have private health insurance or are uninsured. People in Medicare or Medicaid will receive additional benefits such as having their co-payments, premiums, and prescription drugs paid for by the transitional system. The Medicare for All Massachusetts bill instructs the administration to apply for waivers that would allow existing federal payments to be paid directly to the single payer system.

Q: How would Medicare for All legislation be paid for?
A: The bill would replace current employer and employee premium payments with an employer and employee payroll tax. The total payroll tax would be 10% - the same as current average spending on health insurance - and would default to 7.5% for employers and 2.5% for employees, although employers could choose to pay for part or all of employees’ portion of the payroll tax, and collective bargaining agreements would be recognized. Because payroll taxes primarily impact low- and medium-income wage earners, a 12.5% tax on unearned income would be imposed, reversing large cuts to state taxes on dividends and interest passed between 1998 and 2002. Lastly, all current state spending on health care would be consolidated, and the state would seek to have federal funds - such as those paid for Medicaid and Medicare recipients - paid directly to the state’s single payer fund by applying for federal waivers.

Q: How would providers be paid under Medicare for All?
A: The bill requires that institutions - such as hospitals and health centers - operate under a global budget. This means they will be paid prospectively, and will be required to live within a budget. This allows planning with available resources across the entire health care system, to direct funds to the communities most in need and to address gaps in quality or availability of care. Physicians and other clinicians could be paid fee-for-service or using other payment methodologies to be determined by the director of the Health Care Trust.

Q: Who would administer Medicare for All in Massachusetts?
A: The bill creates a Board of Trustees with 23 members: 3 are ex officio members of the administration, 12 are appointed by the Governor and Attorney General, and 8 are elected using the Governor’s Council districts. The Board makes policy and regulatory decisions regarding the single payer system, and appoints an Executive Director to administer the Trust.

Q: Could residents “buy out” of the single payer system and opt for private insurance?
A: No. Studies show that the growth of a parallel private insurance system for high-income residents leads to longer wait times and shortages for those left in the public insurance system. However, residents may buy private supplementary insurance for any services not covered by the Health Care Trust.

Q: Does Medicare for All save money?
A: Yes. A recent study by UMass economist Gerald Friedman estimates that the Medicare for All Massachusetts bill would save 15.75% of our current spending on health care in the state, or $9.7 billion. It does so primarily by reducing administrative burdens on providers and insurers, but also by using the negotiating power of a single, public payer for health care goods and services.

Please join us at 10:30 for the briefing by UMass economist Gerald Friedman and former commissioner of insurance for Massachusetts Peter Hiam, and we are hopeful that Marcia Angell will also be able to reschedule and join us for the briefing. Afterwards, at about 11:30, we will send off delegations to speak with their legislators.

Please spread the word, and we are really looking forward to seeing you all there!

An Act for Improved Medicare for All in Massachusetts: Providing Guaranteed, Affordable Health Care

Section 1. Preamble - outlines the reasons for establishing Medicare for All.

Section 2. Definitions

Section 3. Establishment of Massachusetts HealthCare Trust - creates Trust and sets out ground rules for Trustees.

Section 4. Powers of the Trust - ability to enact regulations, enter contracts, etc.

Section 5. Purposes of the Trust - lists the goals of the Trust, such as universal, high quality care, cost control, etc.

Section 6. Board of Trustees - lists composition of the Board (23 members: 8 elected, 12 appointed), which will establish policy, evaluate proposals, and set standards.

Section 7. Executive Director - hired by Board of Trustees; decisions subject to approval of Board; primary responsibility for negotiating or establishing terms for provision of high quality health care services.

Section 8. Regional Division - establishes regional offices responsible for outreach and responding to complaints.

Section 9. Administrative Division - day-to-day operations; develops management systems and operational budgets, assists the planning division in developing capital budgets.

Section 10. Planning Division - responsible for annual of adequacy of health care resources and  review of capital health care needs.

Section 11. Information Technology Division - develops confidential medical records and prescription systems to simplify the billing process and reduce medical errors and bureaucracy.

Section 12. Quality Assurance Division - sets standards of care, conducts an annual review of the quality of health care services and outcomes, and submits recommendations to the Board of Trustees.

Section 13. Eligible Participants - establishes eligibility of all Massachusetts residents and certain categories of non-residents, such as some who work in Massachusetts, or require emergency care     in-state.

Section 14. Eligible Health Care Providers and Facilities - establishes requirements for participating providers and health care facilities: such as no discrimination, no co-payments.

Section 15. Budgeting and Payments to Eligible Health Care Providers and Facilities - Trust sets prospective budgets and retrospective reimbursement rates, capital budgets, etc.

Section 16. Covered Benefits - includes all medically necessary health services; preventative care, physical health, mental health and substance abuse services, laboratory and imaging diagnostic testing; dental, vision, hearing services; acupuncture, physical therapy, chiropractic, and podiatric services; home care, long term care, hospice care; durable and non-durable medical equipment,     supplies, and appliances; no co-pays or other cost sharing imposed for covered benefits.

Section 17. Wrap Around Coverage for Federal Health Programs - prior to receiving waivers for Medicare, Medicaid, and other federally matched programs, Trust will provide wraparound coverage for enrollees of such programs to eliminate premiums, co-pays, and deductibles.

Section 18. Establishment of the Health Care Trust Fund - the Fund will be administered by the executive director, will consist of all the revenue sources defined in section 20, and will pay for all claims for health services.

Section 19. Purpose of the Trust Fund - amounts credited to the Trust Fund pays eligible providers and health care facilities for covered services rendered; for education and outreach, training of the health care workforce, and medical research; for retraining workers displaced by the transition to Medicare for All for three years following full implementation; and sets up a rainy day fund. The Fund will pay for administrative costs of the trust not to exceed 5% of income.

Section 20. Funding Sources - Trust is funded from existing public spending on health care, an   employer payroll tax of 7.5% (exempting first $30k of payroll with an additional 0.44% surcharge for large businesses), an employee payroll tax of 2.5% (which employers can choose to cover), a 10% payroll tax on self-employed (exempting first $30k), and a 12.5% tax on unearned income. Trust will also recover collateral sources of revenue, and apply for federal waivers for federally-matched funds.

Section 21. Insurance Reforms - insurers are prohibited from charging premiums to eligible       participants for coverage of services already covered by the Trust.

Section 22. Health Trust Regulatory Authority - enables the adoption of regulations to implement the provisions of the Trust.

Section 23. Implementation of the Health Care Trust - provides a time frame.

LEGISLATIVE COSPONSORS FOR 2011-2012:

Lead Senate Sponsor: Jamie Eldridge (Acton)

Lead House Sponsor: Jason Lewis (Winchester)

Senate: Sonia Chang-Diaz (Boston), Cynthia Stone Creem (Newton), Sal DiDomenico (Everett), Ken Donnelly (Arlington), Benjamin Downing (Pittsfield), Susan Fargo (Lincoln), Patricia Jehlen (Somerville), Thomas McGee (Lynn), Stanley Rosenberg (Amherst), Daniel Wolf (Harwick).

House: Denise Andrews (Orange), Cory Atkins (Concord), Ruth Balser (Newton), William Brownsberger (Belmont), Christine Canavan (Brockton), Gailanne Cariddi (North Adams), Marcos Devers (Lawrence), Gloria Fox (Roxbury), John Fresolo (Worcester), Denise Garlick (Needham), Anne Gobi (Spencer), Jonathan Hecht (Watertown), Kay Khan (Newton), Peter Kocot (Northampton), Stephen Kulik (Worthington), Timothy Madden (Nantucket), Paul Mark (Hancock), Paul McMurtry (Dedham), James O’Day (West Boylston), Sarah Peake (Provincetown), William “Smitty” Pignatelli (Lenox), Denise Provost (Somerville), Byron Rushing (Boston), Tom Sannicandro (Ashland), John Scibak (South Hadley), Carl Sciortino (Somerville), Frank Smizik (Brookline), Christopher Speranzo (Pittsfield), Ellen Story (Amherst), Benjamin Swan (Springfield), Timothy Toomey, Jr. (Cambridge), Cleon Turner (Dennis), Martha Walz (Boston), Alice Wolf (Cambridge).

NOT SURE WHO YOUR LEGISLATORS ARE?

• Go to http://www.wheredoivotema.com:
• Enter your address and click “Find My Election Information.”
• Scroll down to the bottom of the screen and find your “Senate in General Court” and “Rep in General Court.”
• By clicking on your Senator’s or Rep’s name, you will be taken to their web-site with phone numbers and email addresses.

DOWNLOAD SPREADSHEET OF COSPONSORS FOR PREVIOUS YEARS:

• Spreadsheet of Single-Payer Cosponsors in Massachusetts Since 1995, Ordered by Last Name.