Massachusetts Health & Hospital Association


> Health Insurer Surpluses
> Vaccine Exemption
> Health Bills in D.C.
> Sec. Jones at Workforce Summit
> MassHealth Redeterminations
> State Senate Supp Budget
> Schwartz Center Dinner


Health Insurers Amass Funds in Excess of DOI Threshold

MHA last week sent members the latest Semi-Annual Health Plan Performance Report that presents an analysis of the financial position of health insurance companies in Massachusetts from January 2018 through December 2022 with a focus on the most recent calendar year. The report shows that as of December 31, 2022, Massachusetts health insurance companies’ statutory net worth exceeded $6 billion in the aggregate, which represents a cumulative 20% increase during the pandemic years (2019-2022) and a 34% cumulative increase since 2018.

Of particular note, MHA’s Semi-Annual Health Plan Performance Report shows that in spite of the pandemic, which led to hospitals postponing elective procedures, patients deferring care, and a decrease in total healthcare expenditures in 2020, health plans continued to increase premiums and add to their surplus. The aggregate amount of risk-based capital above 400%, which is double the company action level that would require intervention by the Division of Insurance, is $2.1 billion.

MHA Endorses Bill to Remove Vaccine Religious Exemption

MHA has submitted testimony in favor of bills at the State House that would remove the non-medical religious exemption for the routine vaccinations necessary for entry into schools in Massachusetts.

H.604, An Act Relative to Routine Childhood Immunizations, and the companion Senate bill, S.1391, An Act Relative to Vaccines and Preventing Future Disease Outbreaks, are from Rep. Andy Vargas (D-Haverhill) and Sen. Edward Kennedy (D-Lowell), respectively.

Vaccines covered by the bills include those for: diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, meningococcal meningitis, Hepatitis B, and varicella (chicken pox). COVID-19 vaccines and those for mpox are not required for school entry. Massachusetts’ requirements apply to all students, even those over age 18, attending public schools, colleges and universities, private schools, and for individuals from another country attending classes or educational exchange programs.

Proponents of the bills say it is clear that vaccines save lives and that “herd immunity’ is necessary to control diseases. Currently in Massachusetts, parents may choose to exempt their child from routine immunizations by submitting a religious exemption. Vargas and Kennedy say there has been a rapid rise – 500% since the 1980s – in the use of such religious exemptions even as the population’s religious affiliations have gone down overall. A handout from Massachusetts Families for Vaccines states, “This indicates that many people are taking advantage of the religious exemption and not vaccinating their children because of personal beliefs and misinformation, rather than religious concerns.”

In its testimony, MHA wrote, “We support all efforts – legislative or otherwise – to improve rates, dispel dangerous misinformation about vaccines, and cure those regions in the commonwealth with higher proportions of unvaccinated citizens that ultimately prove dangerous to patients whose lives depend on herd-immunity.”

Trahan, Neal Introduce Healthcare Bills

Massachusetts Representatives in Congress introduced two important healthcare bills last week.

Lori Trahan (D-Mass.), a member of the House Energy and Commerce Committee’s Health Subcommittee, joined her Republican colleague on the subcommittee, Mariannette Miller-Meeks (Iowa), along with Senators Chuck Grassley (R-Iowa) and Michael Bennet (D-Colo.) to introduce the bipartisan Accelerating Kids’ Access to Care Act to help children with complex medical conditions access critical care.

Children with certain cancers, rare diseases, and other ailments considered complex may not have the specialized care they need within their home state. In these instances, parents must work with healthcare providers and state Medicaid officials to find out-of-state care. The process is difficult, often delaying children and their families from receiving the care they need – and in some cases blocking access to care all together.

The Accelerating Kids’ Access to Care Act allows states to streamline the process for out-of-state pediatric care providers to enroll in another state’s Medicaid program. The legislation enables coordination across state lines by clarifying the process by which state Medicaid programs can cover the care regardless of where the child lives and where the care is received.

Richard Neal (D-Mass.), the ranking Democrat on House Ways & Means, joined Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.), and Education and the Workforce Committee Ranking Member Robert “Bobby” Scott (D-Va.) to introduce the Lowering Drug Costs for American Families Act.

The bill builds on provisions in the Inflation Reduction Act that allows Medicare to negotiate drug prices with manufacturers and limits pharmaceutical companies from raising drug prices greater than the rate of inflation. The proposed Neal bill extends the lower negotiated prices to commercial health insurance plans that cover about 164 million workers in the U.S. The bill would also stop drug companies from raising prices faster than inflation by ensuring that the inflation rebates enacted under the Inflation Reduction Act also apply to individuals covered by private health plans.

MHA Workforce Summit Draws 125 Attendees

Approximately 125 people attended MHA’s Workforce Summit in Burlington, Mass., last Tuesday to hear about the efforts from across the care continuum in Massachusetts and beyond to build and retain a healthcare workforce. A recent MHA report showed that there are approximately 19,000 vacancies in Massachusetts hospitals alone, with other sectors of the healthcare system also struggling to fill positions, leading to delays in care and patient transfers.

Lauren Jones, the secretary of the Executive Office of Labor and Workforce Development (pictured at left), delivered the summit’s keynote address, saying, “In order for [Massachusetts] to be competitive, we need to be thinking about our talent. If not, we will fall short on our competitiveness.” She said the Healey-Driscoll Administration is “setting in an agenda in which workforce development is a top priority.”

Mike Dandorph, CEO of Tufts Medicine, provided an update on MHA’s recently launched “Find Your Place in Healthcare” digital campaign and highlighted a number of participating organizations.

MassHealth Redeterminations Continue; Toolkit Available

The effort to redetermine if the current 2.4 million MassHealth enrollees are still eligible for coverage continues throughout the state. MassHealth, assisted by providers and patient advocates, began the redetermination process in April. The massive review is necessary due to the March 31, 2023, ending of the pandemic-era coverage protections, which required that state Medicaid programs keep people continuously enrolled in return for enhanced federal funding. With the end of the protection (as a result of the Consolidated Appropriations Act signed into law on December 29, 2022), the state is requiring everyone on MassHealth to re-enroll by April 2024. To achieve that goal requires a massive outreach program, in which providers are paying a central part.

Last week MassHealth put out a reminder for its partners in the effort to share the Phase 2 Redeterminations Outreach Toolkit that is designed to assist members re-enroll. It contains downloadable flyers, posters, and other materials in nine languages; messaging for specific populations, such as MassHealth members experiencing homelessness; and an updated version of the MassHealth Renewal Help Guide, which is a detailed resource for anyone who is helping members with MassHealth renewals.

“We ask that you share these materials in your offices, community spaces, as well as through your own communication channels and social media to help all members receive this important information,” MassHealth wrote.

Many people will be automatically renewed. Many that aren’t, will receive a blue envelope in the mail with reenrollment instructions. People should be aware that if they do not respond, not only will they lose coverage, but their children may too. However, children may be eligible for coverage even if their parents are not, so filling out the paperwork is of great importance.

When the redetermination process was first announced, the commonwealth estimated that approximately 300,000 people would lose MassHealth coverage. Massachusetts has created a redetermination dashboard showing progress on the effort; that site indicates that through June, about 331,000 members have renewed coverage, and that there were 60,000 new enrollees. However, about 69,000 MassHealth enrollees lost coverage. The rough numbers of those no longer on the rolls indicate that 47,600 were deemed to be ineligible, 12,300 had insufficient information to reach a decision, and 2,500 could not be contacted.

Senate Passes Supplemental Budget; FY24 Budget Agreement Reached

The state Senate last Wednesday passed a $513 million supplemental budget, which retains $180 million in critical hospital funding that the House included in its supplemental budget package passed earlier in July.

The House’s supplemental budget proposal totaled $693 million, meaning negotiators from the two chambers will have to meet in conference to resolve the differences. But there is limited time to hammer out a compromise before the legislature’s August recess.

Last Friday afternoon, House and Senate negotiators announced they had reached agreement on the approximately $56 billion FY2024 state budget, and are expected to vote on it today. That budget had been held up in conference committee negotiations for a month. Last Thursday, when it appeared as though the FY2024 budget talks would be prolonged, the legislature passed a $6 billion interim budget to keep the state operating through August.

Schwartz Center Dinner Registration Open

Registration is open for the in-person 2023 Kenneth B. Schwartz Compassionate Healthcare Dinner on November 9, 2023, at the Omni Boston Hotel at the Seaport. Recipients of the 2023 National Compassionate Caregivers of the Year Award will be announced at the dinner. CNN’s John Berman will deliver the keynote address.

John LoDico, Editor