Massachusetts

IN THE STATES: Creating Incentives for Primary Care Physicians in Massachusetts

Paul Testa — Wed, 14 May 2008 15:06:00 -0400

Since 2006 more than 340,00 previously uninsured residents of Massachusetts have gained health insurance. As The New York Times recently noted, the expansion in coverage stretched the state's health care resources, especially in primary care. That's why we were particularly encouraged to read Elizabeth Cooney's Boston Globe piece on how community health clinics in Massachusetts have successfully recruited much-needed primary care physicians through a loan repayment program.

Funded by a $5 million grant from the Bank of America and administered by the Massachusetts League of Community Health Centers, the program provides up $25,000 a year for three years to repay loans. In its first year the program recruited 47 clinicians—more than double what they expected. Before the incentives, these centers last year had been unable to fill about 10 percent of their primary care positions.

We've written before about the importance of community health centers in providing primary care to underserved populations. Finding the doctors to meet the demand is not always easy. According to the Globe, doctors working at such clinics earn noticeably less than they would in private practice (Salaries range between $110,000 and $130,000 a year in Massachusetts). But for a typical young doctor who comes out of training with more than than $139,000 in debt, the program helps both the doctors and the patients they serve.

Study after study has shown primary care to be crucial to improving the quality and reducing the costs of medical care. Dr. Roy M. Poses at Health Care Renewal writes frequently about the flawed way we reimburse primary care compared to more procedure-intensive specialties in this country. More broadly, the shortage of primary care doctors in Massachusetts and our country as whole speaks to the need to reform the way we pay for and deliver health care. The goal of the payment system should be keeping patients healthy, not just making specialists wealthy.

COVERAGE: The Big Picture in the Bay State

Joanne Kenen — Tue, 08 Apr 2008 19:32:00 -0400

"Who said it would be easy?" That headline on the Boston Globe's editorial about the Massachusetts health care for all initiative is as wise as it is simple. We often mutter something similar ourselves when we look ahead to the enormous task of fixing the whole country's health care: "If it were easy, we'd have done it already."

We have naturally watched with interest as Massachusetts lawmakers and officials work to close the fiscal gaps (estimated at about $100 million) and develop accurate assessments of future demand as they strive to make sure that everyone in the state has health insurance. The Globe didn't hone in on the financial details today, focusing on the big picture. Although Massachusetts had a relatively low uninsured rate before the reform bill was enacted two years ago this week, it is a high-cost state and enrollment in subsidized insurance plans has been much higher than expected. And it is nearly impossible for a state to fix all the problems on their own, particularly how we pay for and deliver health care, without a systemic nationwide approach. (Hear that Washington?)

But Massachusetts, for all its challenges, has blazed the trail. "While the success of this initiative is not assured, Massachusetts should be proud of accomplishing so much, so quickly," the Globe wrote. According to the editorial, at least 342,000 people had enrolled in insurance plans as of the start of this year, and two in three of them are being subsidized because they are just above the poverty line.

Reform didn't happen because politicians finally decided the time was right (although of course it would not have happened without them). Reform happened because a coalition, both broad and deep, demanded it. It included businesses, health insurers, hospitals, unions, healthcare advocates, and political leaders. "They now need to figure out ways to control costs, maintain quality, and get new money into the system when absolutely necessary," the Globe said, calling on the coalition to "reenergize" itself to preserve its gains and sustain them into the future. We've got our fingers crossed.

TUESDAY ROUND UP: Colorado Corporate Crooks, and Suicide on the Street

Joe Mathews — Tue, 01 Apr 2008 14:51:00 -0400

NYT MISSES THE POINT IN COLORADO: The New York Times weighs in on the Colorado ballot initiative that would make corporate executives criminally responsible if their companies break the law. The Times focuses on the angry Qwest employees who are backing the measure, and misses the larger context. The initiative is part of a union-business battle that encompasses other measures in the state. The center of the fight is a right-to-work initiative, which has been countered by five recent initiatives filed by the United Food and Commercial Workers, best known for representing the people working in grocery stores.

RIGHT TO DIE ON THE STREET: Well, not yet. But the attacks have begun on the latest assisted suicide initiative from ex-Governor Booth Gardner. Petition gatherers, many from California, are already on the street gathering signatures. Anyone out there know the price?

DOG DEBATE: A debate breaks out over how many workers might be affected if a dog-track measure doesn't pass in Massachusetts.

LEAVE FUNDING HEADED TO BALLOT? A Washington state law giving parents five weeks off with pay to be with a new child is set to take effect in Oct. 2009. But there's no funding mechanism. A tax measure is likely headed to the Nov. 2009 ballot that would provide the funds, but that may be too late.

ALASKA, NATION UNTO ITSELF: Your blogger, in this new attempt to track ballot measures nationwide, continues to be amazed by how Alaska is governed. He's planning a trip there this summer to cover the August state elections. Here's an explanation of the tax cap in Fairbanks. He dares you to understand it.

Department of Threats: The Latest

Joe Mathews — Thu, 20 Mar 2008 13:39:00 -0400

Interest groups and politicians often get what they want simply by threatening an initiative or referendum. They never bother to go through with the campaign.

In Massachusetts, a supporter of Gov. Deval Patrick's plan to license three casinos in the state is threatening to take the idea to the people if it fails to get through the legislature. Massachusetts has the referendum and the initiative, but the power is weak in the state constitution. Such a vote might likely be advisory.

St. Patrick's Day Round Up

Joe Mathews — Mon, 17 Mar 2008 13:09:00 -0400

Lots of items this morning

INITIATIVE SPONSOR TO GAYS: 'JUST SHUT UP': One of the two Oregon legislators sponsoring a ballot initiative that would allows employers to discriminate on the basis of sexual orientation shares "my advice to the gay community". That advice? "Shut up, just don't talk about it." He nows says that he was sharing advice he used at his own business, which produces hazelnuts.

RIGHT TO WORK EQUALS NIXON: An interesting Huffington Post item recalls then Vice President Nixon's backing of ballot initiatives to establish "right to work" laws, overturning "closed shop" rules that required workers to join unions as a condition of employment. A battle is brewing now in Colorado over a similar measure. (Click read more to see more items)

BUT YOU CAN STILL GET A GOOD STEAK THERE: Kansas City votes April 8 on a local ballot initiative that will strengthen its relatively weak anti-smoking law. The city council there is trying to beat the initiative by adding its own tweaks to the law.

MORE BLOOD: Dan Weintraub takes a look at the possibilty of California adding a severance tax. Republicans have blocked it in the Assembly, but I suspect this is an idea that may reach the ballot in California before too long. It's already headed to the ballot in Arkansas.

TAXACHUSETTS: A ballot initiative is launched to end the income tax in Massachusetts.

RESURFACING: A veteran of ballot fights surfaces in Utah after a Mormon mission -- and already she's putting together a ballot measure. Elaine Bonavita was a key player in a 1980 tax ballot measure fight in Massachusetts and in an anti-abortion measure in Iowa. Now she's putting together a referendum to block a new coal plant in the town of Salina, where she settled six months ago.

CALIFORNIA LOCAL DEVELOPMENT MEASURES: The onslaught of such initiatives continues. Here's a report on an attempt to limit heights of buildings in Chula Vista (That's near San Diego). And here's more on the anti-growth initiative in Redwood City (northern California, just south of San Francisco).

IN THE STATES: Massachusetts Looks to Address the Linked Problems of Cost and Coverage

Paul Testa — Fri, 14 Mar 2008 15:40:00 -0400

Two years ago, Massachusetts produced an impressive example of bi-partisan health reform when a Republican governor, Mitt Romney, agreed to cover all citizens and a Democratic legislature agreed to operate within a private market system. This week, that conversation continued, as leaders in Massachusetts examined different ways of controlling costs and changing the state's payment system. The goal is to make the state's commitment to coverage a sustainable reality.

Speaking before the joint Committee on Health Care Financing, Senate President Therese Murray outlined the major points of proposed legislation to control costs, noting that health care spending had grown 33 percent between 2002 and 2006, to $62.1 billion, Murray concluded "We cannot afford to stand by and let this continue."

On A Healthy Blog, John McDonough, executive director of Health Care for All,said that the hearing on costs signaled that "Health Reform Phase II is off and running." We're pleased to hear it, because for the state of Massachusetts (and while we're on the subject, for the United States), the goals of covering all citizens and controlling health care cost growth are inextricably linked. And while we often hear that reducing costs must be a condition for covering all Americans, we think that covering all Americans can actually be a step toward reducing costs over the long term. As the Boston Globe's Alice Dembner has noted on the paper's blog, White Coat Notes, the use of the state's free care pool has declined significantly from 2006 to 2007 since the reforms were enacted. That means an estimated savings of $240 million projected for the 2008 budget can be folded back into subsidies to help make insurance more affordable in Massachusetts.