Senate’s ACA Repeal Effort, MassHealth Reform, and more...

Senate’s ACA Repeal Effort Begins, Stalls, Eventually Fails

Early on Friday morning the U.S. Senate voted down the latest effort – termed “skinny repeal” – to dramatically alter the Affordable Care Act.  Three GOP Senators – Susan Collins (Maine), Lisa Murkowski (Alaska), and John McCain (Ariz.) – joined the unified block of Democratic Senators to defeat skinny repeal 49-51.

Collins and Murkowski had consistently opposed the GOP’s efforts to gut the ACA in the manner Senate Majority Leader Mitch McConnell (R-Kans.) proposed – without committee hearings, without a clear plan to assist the millions cut off Medicaid rolls, and, in the case of skinny repeal, with a provision to cut funding to Planned Parenthood.  McCain’s was the surprise vote on Friday.

During a dramatic vote on Tuesday to give the Senate authority to proceed on debate over repealing and replacing the ACA, McCain cast a key vote to proceed just days after undergoing brain surgery. (V.P. Mike Pence then broke the 50-50 tie.)

After Tuesday’s vote, subsequent votes failed to pass bills that would have scuttled the ACA entirely or scale back large parts of it – such as Medicaid expansion.

As the week drew to a close, Republicans focused on what was termed “skinny repeal” – which would repeal the individual mandate, among other sections of the ACA.  Passing any bill would have allowed the Senate to send its bill to a conference committee with the House, which has already passed its own repeal bill. The thinking was that in conference – not in committee and not on the Senate floor – the GOP could continue its work to further dismantle the ACA.

With Friday’s vote, it is now unclear what will happen next. McConnell indicated the Senate will return to normal non-healthcare-related business next week.
On Wednesday, Governor Baker joined governors from nine other states in a letter to U.S. Senate Majority Leader Mitch McConnell (R-Kans.) and Minority Leader Chuck Schumer (D-N.Y.) urging them to reject “skinny repeal.” The five Democratic and five republican governors wrote that such repeal is “expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage.”

On Friday MHA President & CEO Lynn Nicholas, FACHE, said she was relieved that the “ill-considered effort to tear down the advances of the Affordable Care Act and leave millions of Americans without health insurance” seemed to be at an end – at least for now. “MHA thanks both Massachusetts senators, Elizabeth Warren and Ed Markey, for their consistent, staunch support of the ACA, and is gratified that Senators Susan Collins, Lisa Murkowski, and John McCain cast courageous votes to oppose this misguided repeal-and-replace effort.”

MHA Urges Collective Effort on MassHealth

Governor Baker’s MassHealth reform package, which he coupled with an increase in the per-worker assessment employers pay, suffered a setback last week as the Massachusetts House and Senate – after public hearings on Tuesday – rejected the reforms while re-enacting the employer assessment and returning it to his desk.

The Baker administration has argued that, because insurance reforms take significant time to implement, the proposed steps are necessary at this point to preserve universal coverage and maximize federal matching dollars. Throughout the Tuesday public hearings held jointly by the House and Senate Ways & Means and Healthcare Financing committees, it was evident that many legislators were skeptical of both the potential effects and urgency of the changes.

The House and Senate on Wednesday voted to accept the $200 million increased employer assessment and rejected the MassHealth reforms, arguing that they needed more time to digest the reform proposal. Left intact however was a $200 million cut  to  the FY2018 MassHealth budget. Legislators from both branches indicated that they would continue to review and process proposals over the next several weeks. 
The State House News Service quoted Rep. Peter Kocot (D-Northampton), the new co-chairman of the Health Care Financing Committee, as saying, "The most important thing that we have to do is get this right.”

MHA’s President & CEO Lynn Nicholas, FACHE, in a statement last week said, “As in 2006 when the commonwealth rallied together to forge a pathway toward ensuring healthcare coverage for all, this is now a time that demands urgent cooperation among all stakeholders and our state’s political leaders. It is clear that Governor Baker, House Speaker DeLeo, and Senate President Rosenberg are fully engaged in seeking meaningful solutions to our budget problems, particularly those involving MassHealth. The hospital community is equally committed to being a partner in forging a solution.”

Bad News Regarding Opioids in Mass.

At its Wednesday meeting, the Health Policy Commission (HPC) released data confirming what providers see each day from the opioid crisis in Massachusetts. HPC data shows that from 2000 to 2015, the opioid-related death rate in Massachusetts quadrupled, and by 2015 it was more than twice the national average. (That’s 23 opioid-related deaths per 100,000 population in Massachusetts versus 9.7 in the U.S.) In 2014, Massachusetts had the highest rate of opioid-related emergency department (ED) visits in the U.S. and the second highest rate of opioid-related inpatient stays.

Between 2014 and 2015, the number of opioid-related hospital (ED and inpatient) discharges grew by 18%. Young adults experienced the sharpest increase – 192% from 2011 to 2015.

On Thursday, The Boston Globe had a dramatic news account about the prevalence of fentanyl in Massachusetts and New England. Fentanyl – about 40 times more powerful than heroin – is the leading cause of opioid deaths in Massachusetts, which ranks behind New Hampshire in the per capita deaths caused by the drug.
Providers across the state have been working within their regions and with the state to identify best practices to improve prescribing practices and implement care management services for patents upon discharge.  MHA’s Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) has created guidance for opioid management within hospital EDs and throughout hospital settings, including hospital owned/affiliated clinics or physician practices. That information and more is here.  The data HPC released supports the need for continued work to address the lack of community-based services and supports for communities.

16th Annual Women Leaders in Healthcare Conference

Thursday, September 28; 9 a.m. - 2:30 p.m. Sheraton Framingham Hotel

Working in hospitals and healthcare is challenging – but also exciting. As a leader (or emerging leader) in an organization, how can a woman use her skills and talents to help drive change and get noticed? How will she step up and make her mark in her department, division, or organization? At this year’s program, you’ll hear from seasoned experts and leaders who have blazed trails in healthcare and other industries. Our speakers will share lessons learned and advice about how to forge effective leadership paths. We’ll also take a look at important career communications strategies and share tips on keeping yourself healthier while on the job. Join us at this always-informative program where the networking can’t be beat! In addition to the terrific program, we’ll have a photographer onsite to take head shots that may be useful for your career and networking.  All attendees will have a chance to win a weekend at the Chatham Bars Inn.  Read the complete line-up of speakers and schedule of talks, as well as registration information, by clicking here.

John LoDico, Editor