June 2006
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In his own words:
Joshua Greenberg, Office of Child AdvocacyMassachusetts health reform law
Joshua Greenberg is the director of State and Federal Relations for Children's Hospital Boston's Office of Child Advocacy.
What is the new health care law?
It's landmark legislation reforming the Massachusetts health care system that seeks to provide insurance coverage to nearly all of the 600,000 uninsured residents of the Commonwealth over the next three years. In addition, there are significant pieces of the new law focused on improving quality and controlling costs.Children and young adults make up a significant percentage of the uninsured in Massachusetts. As many of us know first hand, lack of insurance can often lead to delays in accessing care, allow chronic conditions to go untreated, and make follow up care more difficult.
A lot has been written about the law, but the stories have tended to focus on adults. How does it help children?
The new law means that Massachusetts will continue to be a national leader in child health coverage for years to come. The legislature has done a lot to make coverage for children more affordable. The state's MassHealth [Medicaid] program, for example, provides a safety net for many low income children, but not all Massachusetts children are eligible, as the state law limits how much income a family can have and still qualify for the Medicaid program. The new law, which will take effect in July, expands financial eligibility for the MassHealth program to 300 percent of the federal poverty line’Äîfor a family of four, that's a yearly income of about $60,000.At Children's Hospital Boston, nearly 30 percent of our patients are covered by Medicaid, and we expect that about 27,000 children will gain coverage and will have access to a comprehensive benefits package. Some of the children will be transitioned directly from the Children's Medical Security Plan, which is a state-funded program that provides basic preventive care. These recipients will have access to a much more comprehensive package of benefits, including sub-specialist services, diagnostic and ancillary services, prescription drugs and dental coverage. The legislature also recognized the special problem of children "aging out" of coverage when they become young adults. The new law allows parents to keep their children on their family plans until age 25, and creates special insurance products specifically designed for young adults. Finally, the law ultimately requires individuals to purchase "affordable" insurance, although it's still unclear what "affordable" means or how this requirement applies to family coverage.
How will the new law impact Children's and our providers?
Hopefully, we'll see fewer uninsured children because more children and young adults will have coverage through Medicaid or their parent's insurance. The law specifically funds a substantial outreach effort to get eligible people enrolled in available public programs. We'll need to be ready to answer patient questions and assist with the enrollment process. We do expect to see new forms of health plans emerge that have higher deductibles and increased cost-sharing, but are awaiting the details from the private payors. As the law takes effect, we expect to see additional emphasis on quality reporting and efforts to address disparities in health care. There is also a significant increase in hospital and physician rates budgeted for the MassHealth program over the next three years. However, the law is very comprehensive, very complicated, and is likely to be tweaked, embellished and modified as we go along.How did Children's participate in the development and passage of the legislation?
Children's has been involved since spring 2003, when we proposed the MassHealth coverage expansion that was ultimately adopted, and by the fall were actively engaged in discussions about this phase of health reform with other hospitals, the Massachusetts Medical Society, and community, religious and business groups.We were primarily focused on a number of issues. In addition to financial coverage for children, we wanted to make sure that we didn't trade comprehensive benefits for expanded coverage. For example, a number of the early conversations on low-cost plans proposed dropping the requirement that they provide mental health coverage, which we vehemently opposed. We also wanted to see some aspect of the legislation address public health or child health issues that don't fit neatly into an insurance model. In this area, we were thrilled to see funding for diabetes care management, anti-smoking programs and a new pediatric palliative care center included in the bill.
We also worked really hard on educating legislators by knocking on doors at the State House. We participated in a broad coalition over many months that pushed for a comprehensive bill. Dr. Mandell [Children's president and CEO] has spent a lot of time with Massachusetts State House leaders and staff emphasizing our commitment to expanded child health coverage. In the Office of Child Advocacy, we have used our grassroots network, the CAN [Children's Advocacy Network], to engage our own internal community in direct advocacy on key child health concerns. It has been a long haul, but we are thrilled with the outcome.
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