Statement of The Honorable JudyAnn Bigby, M.D., Massachusetts Secretary of Health and Human Services, Boston, Massachusetts

Testimony Before the Subcommittee on Health
of the House Committee on Ways and Means

July 15, 2008

My name is Dr. JudyAnn Bigby, and I serve as Secretary of Health and Human Services for the Commonwealth of Massachusetts.  I am honored to be here with you today to represent Massachusetts and Governor Deval Patrick in offering testimony before the House Ways and Means Subcommittee on Health about Massachusetts’ historic health care reform initiative. 

I particularly want to thank Chairman Pete Stark of California for inviting me to testify today and for holding a hearing on states’ health care reform efforts.  I also want to thank the other distinguished committee members for their interest in and commitment to this important topic.  I look forward to sharing Massachusetts’ health care reform experiences with you, and  I also look forward to hearing your insights and perspectives. 

Massachusetts is proud to be leading the way toward near-universal coverage and working to ensure that everyone has access to high-quality, affordable health care. 

From the very beginning, the strength of health care reform in Massachusetts was the support of a broad and diverse coalition, including representatives from across sectors and across the political aisle.  Coalition members included representatives from the executive and legislative branches of both federal and state government; providers; insurers; employers; consumer advocates; and community leaders. 

In April 2006, Massachusetts enacted a health care reform bill designed to move the state to near-universal coverage.  At the heart of this initiative was the principle of shared responsibility among individuals, employers and government.  The coalition took steps to achieve near-universal coverage through: 

•         Medicaid expansions

•         The creation of the Commonwealth Connector to develop:

•         Commonwealth Care, a subsidized insurance product for low-income individuals not eligible for Medicaid; and

•         Affordable health insurance products for those without access to employer-sponsored insurance and incomes over 300% FPL

•         Transformation of the Uncompensated Care Pool, a fund developed in Massachusetts more than 20 years ago to pay for uncompensated care in hospitals and health centers

•         Insurance reform

•         An individual mandate

•         Employer responsibility through a fair share and free rider assessment.

A Medicaid waiver from the Centers for Medicare and Medicaid Services is a critical component of Massachusetts’ health care reform initiative.  Our partnership with the federal government allowed for expanded Medicaid coverage, including to children with family incomes up to 300% of the Federal Poverty Line (FPL).  The elimination of enrollment caps for Medicaid coverage for several populations—including long-term unemployed adults; disabled working adults; and individuals with HIV/AIDS—also expanded coverage.

We are currently operating under a short-term waiver extension, while we finalize negotiations with CMS for a new waiver.  Extending this state and federal partnership is critical to our historic effort to reach near universal health insurance coverage.   We are working closely with CMS to come to an agreement that will facilitate the long-term success of health care reform in Massachusetts.

Enhanced employer responsibility requires that all employers with more than 10 employees offer access to pre-tax health plans.  Health care reform requires these employers to make “fair share” contributions toward their employees’ insurance or be subject to an assessment fee that is used to help cover the uninsured.  

In addition, health care reform mandates that adults have insurance unless they do not have access to affordable insurance.  The Commonwealth Connector developed subsidized and non-subsidized health insurance products, but also defines minimal creditable coverage and affordability standards.

Health insurance market reforms also merged the small and non-group markets in an effort to reduce the cost of non-group premiums. 

We are seeing the positive results of Massachusetts’ comprehensive health care reform efforts.  Since June 2006, approximately 340,000 individuals now have enrolled in health insurance programs.  Enrollment in the state's Medicaid program has expanded by more than 60,000.  More than 170,000 have enrolled in Commonwealth Care, the state's subsidized plan for low-income residents.  More than 120,000 of them have enrolled in private insurance plans, and the percentage of employers offering health insurance has increased from 68% to 72%, while the percentage has been dropping nationally.

We are seeing the impact.

A recent Urban Institute survey of Massachusetts residents showed that the adult uninsured rate has decreased by 50% in just one year.  Low-income adults, men and young people have seen the biggest drops in rates of uninsurance. 

In addition, more people report having access to a regular health care provider and have made visits for preventative care.  The percentage of adults who reported that they did not access care due to costs have decreased, and individuals report lower out-of-pocket medical costs. 

The percentage of adults who have employer sponsored insurance has increased slightly.

Premiums for non-group insurance have decreased while the benefit package has improved.

Between FY06 and FY07, visits billed to the Uncompensated Care Pool (now the Health Safety Net) decreased by 15%.  The cost of care funded declined by 9% during the same period.  We are projecting it will fall significantly more in the current fiscal year. 

We know, however, that providing health insurance is not enough.  We are also focusing on controlling health care costs to ensure that the gains we have made in expanding access are sustainable.  We will be most successful if we can achieve the most value for the dollars we are spending and do a better job of decreasing costs among the 10% of patients who consume 60 to 70% of the health care dollars. 

We need to focus more on prevention, ensuring that individuals have a medical home, and coordinate the care that those with chronic illness receive across the system.  The issue of whether we have the primary care capacity to meet the increasing demand of the insured is an important question—not just because we do not want people to be frustrated by not being able to get an appointment with a primary care provider once they are newly insured, but also because we know that communities and populations are healthier when they have access to primary care. In addition, care is less expensive when the ratio of primary care to specialists is higher than what we currently have in Massachusetts.

To build on the 2006 health care reform efforts in Massachusetts, the Patrick Administration launched the “Healthy Mass” initiative in December. Nine diverse agencies from across state government—in their roles as employers, purchasers, providers, regulators, insurers, administrators, stewards of public health, and potential sources of health care financing—committed to working closely together to ensure access to care; contain health care costs; advance health care quality; promote individual wellness; develop healthy communities.

In these early stages, we are working together to decrease administrative burdens on providers; adopt strategies to improve quality of care; focus on decreasing the impacts of chronic disease; and align payments to support primary care and community hospitals. 

As part of this initiative, the state announced last month that state agencies, including Medicaid, will no longer pay for costs associated with the 28 serious adverse health care events identified by the National Quality Forum. The state will also no longer permit their providers to bill members for these services. This new policy makes Massachusetts the first state in the nation to establish a uniform non-payment policy across state government.  This policy will not only save taxpayer dollars, it focuses attention on strengthening health care quality.

Massachusetts has come an impressive distance in a very short period of time, and we are committed to ensuring not only that people are insured, but that they also have access to quality, affordable care and the tools to lead healthier lives.  Moving forward, we must share in making thoughtful choices to ensure its continued success. 

Thank you.