Tomorrow the state Senate will begin debating its version of the state budget for fiscal year 2014, which begins on July 1.
Like the House budget did, the Senate Ways and Means version starts out with a strong commitment to building on the state’s health coverage reforms through implementation of the ACA, and some substantial deficiencies in funding for health care programs. The best overview of the Senate budget comes, of course, from the Mass Budget and Policy Center. The overview notes the continued decline in support for public health:
More striking than these differences, however, is the extent to which support for public health activities has been cut over the past decade. Since FY 2001, funding has dropped by about 25 percent, after adjusting for inflation, a decline that has hampered the ability of the Department of Public Health to protect the health of the public through regulation of health facilities and other potential hazards. Cuts have also affected a variety of programs—such as smoking cessation and disease prevention—designed to promote health and wellness and reduce long-term health costs. The Governor’s FY 2014 budget proposal drew on new revenue to make a modest step towards restoring these cuts; the lower House and Senate appropriations reflect the tighter revenue constraints under which the legislature is operating.
More details on the cuts to public health can be found on the Mass Public Health Association blog.
Senators have filed hundreds of amendments to the budget. You can read them here, color-coded by topic. Over 200 amendments are classified as health and human services. We’ve poured through them all, and here are some of our recommendations. We urge you to contact your State Senator on behalf of these amendment positions:
Cuts to the MassHealth adult dental services in 2010 left over 800,000 people without access to dental care beyond cleanings and extractions, including 120,000 seniors and 180,000 people with disabilities. Dentists can identify cavities during an examination, but with the exception of a small number of billing codes, fillings are not covered. Left untreated, a simple cavity can lead to serious medical problems.
- Support Amendment #601 (Chandler) to restore MassHealth adult dental benefits.
Individuals living with disabilities often need specialized medical care, including adapted facilities and equipment, and providers with specific training. Dental care is no exception.
- Support Amendment # 569 (Chandler) to determine the need and the system capacity to provide dental health care to people with disabilities.
Health Care Access
Since 2008, MassHealth operations staff has been sharply cut at the same time the number of MassHealth members has risen dramatically, resulting in paperwork processing backlogs, gaps in health coverage, and delays in enrollment.
- Support Amendment #546 (Jehlen) to provide $3.3 million for MassHealth operations staff.
Prescription Drug Marketing
Last year, DPH ignored directives from the Legislature and failed to establish a meaningful definition of “modest meals” that pharmaceutical sales representatives can provide to physicians during drug marketing presentations.
- Support Amendment # 668 (Montigny) to establish a meaningful definition for modest meals.
Health Care Reform
The Affordable Care Act provides enhanced federal matching funds to states that expand Medicaid, including Massachusetts. The new federal revenue is intended to be invested in MassHealth and other subsidized health coverage programs. Establishing a Health Care Reform Trust Fund will promote transparency in health care spending and ensure federal health care dollars are spent on health care needs.
- Support Amendment #634 (Joyce) to create a Health Care Reform Trust Fund.
As the state implements the ACA’s Medicaid expansion, we must ensure that no residents are left behind. Gaps in coverage can occur when people move from one program to another. MassHealth needs funds to reduce these gaps by funding coverage to the end of the month, when subsidized insurance coverage from the Connector starts.
- Support Amendment #697 (Jehlen) to effectively implement the ACA in Massachusetts.
The Health Safety Net (HSN) program generates federal matching funds which should be used to support care provided to low-income uninsured and underinsured patients. This is particularly important as the HSN has faced significant shortfalls for several years, which burdens hospitals that care for the uninsured and underinsured and destabilizes this important part of the Commonwealth’s safety net.
- Support Amendment #584 (Welch) to reinvest federal Medicaid matching revenue claimed on HSN administrative expenses into the HSN program.
Children have unique health care needs that must be addressed in age-appropriate ways. For very young children with health and developmental needs, the Early Intervention program is a cost- and medically-effective way to address issues when they first arise.
- Support Amendment # 535 (Keenan) to provide $28.2 million for Early Intervention services.
Cuts to the DPH Division of Health Care Quality work would limit DPH’s ability to license hospitals and nursing homes, investigate complaints about care, and inspect facilities. DPH has a 5-month backlog in investigating consumer complaints.
- Support Amendment # 515 (Keenan) to provide $7.8 million to the Division of Health Care Quality.
The Division of Insurance and MassHealth need to issue regulations that provide transparency to enforce the mental health parity laws and to notify consumers of a complaint process and adequately describe the consumer complaint process.
- Support Amendment #540 (Keenan) to further improve enforcement of mental health parity.
Proposed elimination of inpatient pediatric mental health beds are a serious threat to the Commonwealth’s ability to address the mental health needs of children in crisis. One reason some hospitals are considering closing beds is because of inadequate reimbursement rates. Currently, we lack a complete picture of the scope of the need for inpatient beds, the number available, and the impact of current reimbursement rates.
- Support Amendment #723 (Keenan) to delay currently proposed bed eliminations until such time as a study of the problem is completed.
Although Massachusetts continues to lead the nation in health coverage, significant racial and ethnic health disparities remain. Yet, while there are few disparities in coverage between white and other residents of non-Hispanic ethnicity, residents of Hispanic ethnicities are twice as likely to be uninsured. Black female residents are more likely to have trouble paying medical bills. Furthermore, disparities in health outcomes, infant mortality, and rates of chronic disease continue to be prevalent.
- Support Amendments #628 and 631 (Barrett) and 682 (Chang-Diaz) to establish in law an Office of Health Equity within EOHHS and to provide staffing for the Office.