At health summit, experts point to need for outreach about new access law
by Statehouse News ServiceNovember 16, 2006 -- Seven months after the passage of a pioneering law that expands health care access to the uninsured and requires individuals to have insurance, experts this week highlighted the importance of educating individuals and small business owners about the law as a way of ensuring its success.
During an annual summit yesterday sponsored by the Blue Cross Blue Shield of Massachusetts Foundation and held at the JFK Library, health insurance experts examined strategies to build public support and tackle challenges facing the implementation of the new heath reform law.
The law, also known as Chapter 58, was enacted in April to provide coverage to nearly all residents through a combination of Medicaid expansion, subsidized insurance plans, health insurance market reforms, an individual mandate and new responsibilities for employers.
Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, presented the results of the first poll taken after the new law was passed. The results show wide support for the law but also indicate that people are "cynical" and "skeptical" about it, he said.
From his experience, Blendon said health care laws often lose support as more people learn about the laws. But in Massachusetts an "unusual" phenomenon seem to be happening, he said, noting 80 percent of the people polled have heard about the law, and 61 percent of those polled support it.
"Here is quite the reverse. Those who know about the plan are quite positive at the moment," said Blendon.
Officials stressed a need for far more education about the individual mandate that requires people to purchase insurance or face financial penalties, as well as a measure calling for employers of 11 or more workers to contribute to their employees' coverage or pay an annual assessment per employee.
Blendon said an outreach campaign is paramount and added the state should work closely with small businesses that stand to feel the biggest impact from the law, especially if the economic climate changes.
Governor-elect Deval Patrick made an appearance during the summit. During a brief media availability after Blendon's presentation, Patrick said he agreed that it's important to educate everyone in the state about the new law, including the people who are not directly impacted by it.
Patrick said he is concerned with the financial aspects about the law and whether the state can "close the gap" between the uninsured and the insured. "It's important to keep the optimism high and ensure it can be done right," said Patrick.
The summit was divided into two panels; with the first focused on strategies to maintain public support and the second discussing the challenges of implementing Chapter 58.
The following is a summary of some of the major points made by speakers at the summit:
JOHN MARTTILA, MARTTILA COMMUNICATIONS: The senior strategic advisor to the Patrick campaign said in terms of strategies to maintain public support, the most important aspect was to educate people about it. "The large reality is that the majority of people don't know much about any of this stuff," said Marttilla, even the most educated people, he added. He said the education campaign should be launched on "core values." He said Patrick "is the ideal governor" to manage the public discussion on those values. Keeping the small business community "deeply involved" is also crucial, he added. The individual mandate could be "troublesome" for people to understand, he said, adding Massachusetts has a high number of educated people. "These people should be the targeted audience for more sophisticated information."
JON KINGSDALE, EXECUTIVE DIRECTOR, STATE HEALTH INSURANCE CONNECTOR: Kingsdale said he hopes the health care consumers realize they are part of a "shared responsibility." "So I'd hope what they are looking for is a sense that we're all in this together," he said. Kingsdale, who has been working with different constituencies in trying to implement the law, said he feels there is a "strong" sense of shared responsibility and partnership to make the new program work. "There is a tremendous good will," said Kingsdale. He said the two years it took to enact the bill "carved out a tremendous amount of support." "We're going to have to find ways to take advantage of that," said Kingsdale. He said there are several challenges ahead of the Connector, the state board overseeing the new law's implementation, including the transition to a new administration and outreach, an effort impeded by Gov. Romney's axing of $2.7 million in outreach funding last week. He also said the board is facing "a tsunami of interest and confusion and ignorance out there on the part of the key constituents."
ROBERT BLENDON, HARVARD SCHOOL OF PUBLIC HEALTH: He said the best way to garner public support is to find the best way to convey the message to consumers. He also said if small businesses start going to the radio talk shows saying how difficult the new law is, it could shift people's opinions and lead to a possible loss of support for the new act. In answering a question from the audience about the impact of the reform law on the middle class, Blendon said in his view, the middle class is concerned about taxes going up and the impact the law will have on the small businesses. He said most of the middle class people are already insured and don't think the law will change their health care status.
JOHN MCDONOUGH, EXECUTIVE DIRECTOR, HEALTH CARE FOR ALL: Looking back on the seven months since the law's passage, he said he would give the state a B+ in launching the health reform law. "Some of our concerns? We think that the definition of fair and reasonable for the employer contribution was not really fair and not really reasonable," said McDonough. He said the disjuncture between what is expected from individuals and what is expected from employers needs to be addressed. He also said he believes the poll results would have showed stronger support for the individual mandate had respondents who are on the lower half of the income spectrum known about the subsidized Commonwealth Care plans.
ROSEMARIE DAY, DEPUTY DIRECTOR AND COO OF THE CONNECTOR: She said the launch of the first phase of Commonwealth Care was a success, with 24,459 people eligible to enroll and 8,200 people enrolled so far. The first phase consists of enrolling individuals whose income falls below the 100 percent of the federal poverty level in fully subsidized health insurance plans. She said there are several challenges ahead and an aggressive schedule the Connector needs to meet to implement the second phase of the program, which starts in January when people who are between the 100 to 300 percent of the federal poverty level will start enrolling in partly subsidized health care plans. "We're working hard to meet the deadline," said Day. The effort doesn't stop there, she added, as the Connector is also trying to establish minimum coverage standards in the commercial market for people who are not eligible for the subsidized Commonwealth Care plans because their income is above the 300 percent of the federal poverty level.
FRANCES ANTHES, PRESIDENT AND CEO, FAMILY HEALTH CENTER OF WORCESTER: She said community health centers assist about 70 percent of the uninsured population. It is important to preserve the continuity of patients in the centers, she said. In terms of outreach, the center has been working on educating patients about the new law, issuing flyers in seven different languages, she added. Some of her concerns were people's full understanding on their health care plans, their options, benefits and coverage. She also said she is concerned whether people can pay for their premiums.
DEBORAH ENOS, CEO OF NEIGHBORHOOD HEALTH PLAN: She said in implementing the other phases of the plan, the system will get more complex and she highlighted the need to maintain a collaborative effort with the Connector and other groups to assist with the implementation and outreach. "When we're talking about outreach, it really happens at the grass-root level," said Enos. "Health insurance is complicated."
STEVEN BRADLEY, VICE PRESIDENT OF GOVERNMENT AND COMMUNITY RELATIONS OF BAYSTATE HEALTH: He said out in Springfield there is a huge poverty issue and he is hopeful more patients, if they have primary care, will have a "medical home" and see improved health status and lower health care costs. He said one of the concerns from the provider community is the question of capacity and looking at how many people each provider could take before costs start shifting and more capital investments are needed. "We're hoping that we're not entering a situation where we drive up the affordability of the product but at the same time we create a problem by creating products that don't do everything that needs to be done," he said.
ALI NOORANI, EXECUTIVE DIRECTOR, MASS IMMIGRANT AND REFUGEE ADVOCACY COALITION: Noorani said the state has to address the issue of coverage for undocumented immigrants. "We have to address this reality, these are people here, these are people working in Massachusetts," said Noorani. In Boston alone, there are 8,000 immigrant-owned businesses, he said. "In terms of communication, we ought to be on the same page, and I don't think we can ignore it anymore," he said. Noorani said he thinks there will be a perception that immigrants, documented or undocumented, should not be able to have access to health insurance. He said if they walk into a health center and have a good experience, they will come back, so it all depends on the interaction with the staff and service.
RICK LORD, EXECUTIVE DIRECTOR OF ASSOCIATED INDUSTRIES OF MASSACHUSETTS: He said he has been explaining to the business community the responsibilities the employers will face with the new law. He said he believes most employers will buy into it because it allows their workers to buy health insurance with pre-tax dollars. "But there are some benefits to that as well, because if they have those wages withheld on a pre-tax basis, the employers don't have to pay Social Security tax on those wages, so they actually save in terms of what they owe the federal government in terms of Social Security. So we have been selling that in terms of a benefit to the employers and to the employees as well," said Lord. He also highlighted the importance of keeping the business community informed and involved in the process because confusion may drive employers against the measure. There are a lot of unanswered questions, he added. "I can tell you they are hungry for more information," said Lord. "I see an enormous need for education in this education campaign for employers and we really need to embark on that fairly soon," he said.
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