Enrollment Increases In Massachusetts Premium-Assistance Program For Laid-Off Workers

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Enrollment in a Massachusetts program designed to help unemployed state residents pay health insurance premiums has increased by 73% in the past year, the Boston Globe reports. The state Medical Security Program, which is funded by a tax on employers, pays 80% of a laid-off worker's monthly insurance premium for up to 46 weeks. For people who cannot afford to retain their coverage, even with the assistance money, the program offers full basic coverage and charges a copayment of about $15 per doctor visit. To be eligible for the program, an individual's family income for the six months prior to being unemployed plus projected income for the next six months must not exceed 400% of the federal poverty level.

About 13,000 unemployed state residents were enrolled in the program at the end of November 2008 -- up from 7,710 in 2007 -- and officials say the number continues to rise rapidly. MSP Director Wendy Hamlett said, "The calls are increasing even as we speak," adding, "We are receiving 200 daily applications, on average. Five months ago, we were getting about 75 to 100 applications a day." According to the Globe, "That has raised concerns about the program's solvency, especially after Gov. Deval Patrick (D)" allocated $35 million from the MSP reserves earlier this year to fill funding gaps in the state coverage system established by Massachusetts' health insurance law. However, the $71.8 million remaining in the MSP reserves at the end of November 2008 should be enough to allow the program to continue another year, Hamlett said.

The program is unique to Massachusetts. Health benefits under the program end when unemployment benefits are exhausted, but the federal government twice this year has extended the time limits for collecting unemployment. The Globe reports that other state-sponsored health insurance programs, such as Commonwealth Care, have not experienced such large increases in applications (Lazar, Boston Globe, 12/28/08).

EDs Prepare To End Ambulance Diversions

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Emergency departments in Massachusetts began steps to reduce their wait times in preparation for compliance with a new state law that prevents hospital EDs from diverting ambulances to other hospitals to relieve overcrowding, the Globe reports. The law took effect Jan. 1 (Kowalczyk, Boston Globe, 12/24/08). Under the new rule, diversions will be prohibited in nearly all cases except in the event of a serious internal emergency, such as a fire. A recent experiment in which Boston hospitals stopped diversions for two weeks found that patient wait times or "boarding" of patients in ED hallways did not increase. The experiment also found that ED staff developed strategies to treat patients quickly and admit them into the hospital (Kaiser Daily Health Policy Report, 9/16/08).

Some hospital efforts include hiring more nurses and physicians; requiring phlebotomists to draw patients' blood earlier in the morning to speed up tests; suspending teaching rounds and lectures when physicians are needed to quickly release patients; and hiring consultants to recommend ways to discharge patients faster. The efforts reduced the number of hours EDs were on diversion from 11,605 hours between January 2007 and November 2007 to 7,963 hours during the same period in 2008. In addition, EDs were closed for 232 hours in November 2008, or less than one-quarter as often as in the beginning of 2008. According to the Globe, "Doctors and others predict the new system will be better for patients, who currently can be sent to hospitals that don't have their medical records and where their regular doctor doesn't work." However, Elaine Bridge, senior vice president for patient services and chief nursing officer at Newton-Wellesley Hospital, said, "One of the big fears is that ERs will be overwhelmed and that there will be longer waits for less acute patients" (Boston Globe, 12/24/08).

Boston Globe Examines Agreement Between Partners HealthCare, Blue Cross and Blue Shield of Massachusetts
As part of an occasional series, the Globe recently on reported that an agreement between the former CEOs of Partners HealthCare and Blue Cross and Blue Shield of Massachusetts "accelerated a health cost crisis" in the state. In May 2000, Partners CEO Samuel Thier and BCBS CEO William Van Faasen verbally agreed that Van Faasen would give Partners physicians and hospitals the largest insurance payment increase since Massachusetts General Hospital and Brigham and Women's Hospital merged in 1993, and, in return, Thier would promise that Partners would not allow other insurers to pay less, according to the Globe. The agreement was not written, as Thier's lawyers cautioned that a written agreement might raise legal questions about anticompetitive behavior, officials directly involved in the talks said, the Globe reports.

According to the Globe, the deal "marked the beginning of a period of rapid escalation in Massachusetts insurance prices, ... as Partners repeatedly used its clout to get rate increases and other hospitals tried to keep up." The companies deny that they acted improperly -- both in the agreement and in subsequent negotiations. The Globe reports that officials from Partners say the company is not to blame for the national problem of medical inflation and that insurance companies had been underpaying hospitals and doctors during much of the 1990s (Allen/Bombardieri, Boston Globe, 12/28/08).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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