The latest effort to repeal the Affordable Care Act (ACA) – through the so called Graham-Cassidy bill – would be, according to analyses from across the political spectrum, devastating to Massachusetts.  Enhanced federal funding  for the ACA’s Medicaid expansions would be eliminated along with insurance tax credits and subsidies for low- and middle-income people that purchase insurance in exchanges.  In their place, states would receive block grant funding at an amount estimated to be lower than current federal spending.

On Friday, Sen. John McCain (R-Ariz.) said he could not vote for the bill, dealing a potentially fatal blow to the slim Republican majority needed to pass the measure. McCain said he could not vote in favor of Graham-Cassidy "without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."  Shortly after his statement, another key GOP vote -- Susan Collins (R-Maine) -- said she was leaning "No" because “the premiums would be so high they would be unaffordable.”  Sen. Rand Paul (R-Ken.) indicated he would vote no because Graham-Cassidy did not go far enough in completely overturning the ACA.

Like previous repeal bills, the federal reimbursement for Medicaid would become a per capita amount instead of the current federal-state match. The Graham-Cassidy bill would go further, however, and penalize states like Massachusetts with higher Medicaid spending due to the state’s higher cost of living and more comprehensive benefits. Insurers would have the flexibility to charge more for pre-existing conditions if state law permitted it and states could do away with the requirement that every insurance plan offer a minimum set of health benefits – such as benefits for mental healthcare.  The federal individual and employer mandate penalties would be reduced to zero.

The bill is named after two of its four main sponsors – Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), who were joined by Dean Heller (R-Nev.) and Ron Johnson (R-Wis.). Republicans had been pushing for a vote on the bill before the end of September, at which time a new set of floor rules goes into effect requiring 60-plus votes for passage. That high threshold would be impossible for the GOP to meet since all Democrats are against the ACA-repeal bill. It is unclear how McCain's Friday decision will affect the plan to move forward with a vote.
  
MHA President & CEO Lynn Nicholas, FACHE, said of Graham-Cassidy, “The latest effort to repeal the Affordable Care Act offers no improvement to previous attempts and in many ways it is worse.  Like its predecessors, this proposal is deeply flawed and would disproportionately harm Massachusetts and other states that have expanded Medicaid/MassHealth under the ACA."

Upon learning of McCain's decision late on Friday, Nicholas said, "From this day on, when I think about 'Profiles in Courage' I will recall Sen. John McCain's wise and reasoned position on how to consider possible changes to the Affordable Care Act. Healthcare reform in Massachusetts is on a successful path because we have had a collaborative and inclusive approach where stakeholders parked their personal peeves at the door and strove to do what was best for the citizens of the commonwealth. I hope the U.S. Congress will follow the same path laid out by Senator McCain." 

Earlier in the week, Governor Charlie Baker signed a letter with 10 other Democratic and Republican governors, calling on Senate leaders to not consider the repeal bill. Instead, the governors said, “Only open, bipartisan approaches can achieve true, lasting reforms.” They said the bipartisan hearings that have occurred before the Senate’s Health, Education, Labor and Pensions (HELP) Committee hold promise for ACA reform.

Nearly every major physicians’ group, led by the American Medical Association, have spoken out against the bill, as have the national Blue Cross Blue Shield Association and America’s Health Insurance Plans, and the American Hospital Association, as well as numerous disease-fighting advocacy groups, like the American Cancer Society.

U.S. Senator Ed Markey (D-Mass.) had scheduled an event on Monday to bring attention to how the Graham-Cassidy plan will be detrimental to Massachusetts. “This legislation is an all-out assault on the healthcare law, Medicaid, Planned Parenthood, our hospitals and access to critical opioid treatment services,” Markey’s office wrote in a memo announcing the 10 a.m. meeting at the JFK Federal Building in Boston. “It contains all the same cruel policies rejected several times before by the American people.”

Berkshire Medical Center on Friday received a strike notice from its nursing union, which set Tuesday, October 3 as the date for its one-day walkout. The term “one-day” is a misnomer as hospitals targeted by the nursing union must hire replacement nurses for a minimum of four additional days.  Berkshire leadership has pledged that they will ensure  strong and supportive nurse staffing during the strike to maintain their record of excellent patient care evidenced by impressive and transparent outcome measures. In a press release, the hospital noted that it has offered the union a generous pay raise package, steps to empower rank-and-file nurses, a formal staffing committee, and staffing plans that meet those outlined by the American Nurses Association, the national professional nursing organization. A sticking point in the negotiations appears to be a plan to equalize the health insurance premiums that union nurses pay so that they are the same as other nurses and employees at Berkshire. Berkshire MC and its nurses have another bargaining session set for Wednesday, September 27.

Governor Baker announced on Wednesday that he intends to file a new bill to address the opioid epidemic. The details of the bill have not been revealed yet, but the State House News Service quoted the governor as saying it would deal with “prevention and education, intervention, and treatment and recovery.”

Massachusetts has previously passed bills to address the opioid problem and the provider community has stepped up on its own to fight the problem. MHA’s Substance Use Disorder Prevention and Treatment Task Force developed operational guidelines for hospitals and physician practices to use that have begun to reduce the number of opioid pain prescriptions. The Massachusetts Medical Society has issued its own set of prescribing guidelines and MD education protocols.

Additionally, scrutiny of opioid manufacturers and insurance company practices is emerging.  On Tuesday, Attorney General Maura Healey said she is expanding her office’s role in investigating the marketing and sale of opioids by major drug companies. In a media release, the Massachusetts AG’s office said, “Healey is investigating whether drug-makers sought to increase profits by misrepresenting the dangers of prescription painkillers and ignoring the public health risks of spiking opioid sales.”

And on Monday, The New York Times published the results of an investigation it conducted with the investigative journalism group ProPublica. The paper’s report implied that health insurance companies “are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications. The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.”

Curahealth – the system with 12 long-term acute-care hospitals in Massachusetts, Arizona, Oklahoma, Louisiana, Tennessee and Pennsylvania – has announced it will close the second of its three Bay State hospitals. In August, Curahealth announced that it was closing Curahealth Hospital Boston – North Shore (Peabody) by the end of September. Now Curahealth Hospital Boston (Brighton) will be shuttered by October 25. Together the two hospitals employ about 200 people. Curahealth Hospital Stoughton will continue to operate. The system blamed the closures on declining Medicare reimbursements and low admissions.

The Commonwealth Fund Mongan Fellowship in Minority Health Policy has announced the call for applications for the 2018-2019 year.  At the Harvard Medical School, Boston, applications are now being accepted for a one-year, degree-granting, full-time fellowship beginning July 2018. The application deadline is 5 p.m. on Friday, December 1, 2017. All application materials must be submitted through this online application system by the deadline.  The fellowship is designed “to prepare physician-leaders who will, over time, improve the capacity of the healthcare system to promote policies and practices that improve minority, disadvantaged and vulnerable populations’ access to high-quality care.”

Join the Massachusetts Lean Health Network on Tuesday, October 17 for a special evening program: “Healthcare's Best Improvers: Learning from Virginia Mason Institute and Catalysis (formerly ThedaCare Center for Healthcare Value).” A dedicated lean journey in healthcare is an arduous climb but having a mentor along can help you navigate culture change, resistance, and questions from executives and staff about pace and expectations. Hundreds of U.S. healthcare systems are working with experts from two of the most experienced and written-about lean hospitals in the U.S. (Virginia Mason in Seattle, and the former ThedaCare in Appleton, Wisconsin). Both have published multiple, highly recommended books about their journeys, and have formed or spun off training or consulting units. On October 17, the Mass Lean Health Network will learn from several New England health systems who are working with Catalysis or VMI. Please e-mail masshln2009@gmail.com to save your spot. (Please note that a previous Monday Report story contained an incorrect e-mail supplied by the event’s organizers.)

Is The Price Right? The Emergence of Pricing Transparency

Friday, November 3; 8:30 a.m. – 12:15 p.m.
MHA Conference Center, Burlington, Mass.

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Pricing transparency has been Massachusetts law since Ch. 224 passed in 2012, requiring healthcare providers to give consumers the costs of admissions, office visits, or procedures within two business days of a request. The law also requires that insurance companies provide their members with price information in real time, including the member’s out-of-pocket costs and an online cost estimator tool. Consumer awareness of this law has been low, but is expected to increase sharply in coming months as the state’s Center for Health Information Analysis launches a cost transparency website and patients with high deductibles seek more affordable options for care. Is your organization ready to respond? Join us at this conference where we’ll take a look at the latest trends in healthcare pricing transparency and consumer engagement, and help answer questions like: What is working well?  What are the challenges” And how can organizations be sure they are putting their best foot forward in providing accurate and meaningful information to consumers?  Learn more information, including registration details, here.