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Health Access in Massachusetts
Welcome to the Massachusetts Health Access Toolkit.
The students of PHR’s National Student Program are united in their commitment to use their medical and public health skills to promote and protect human rights.
However – let’s face it – Massachusetts students are special for a few reasons. First, PHR has a strong foundation in the Bay State: our founders were leaders from the Boston medical community and our headquarters are in Cambridge. Second, the high concentration of prestigious medical, nursing, and public health schools in Massachusetts mean that more 1/6th of our student members call Massachusetts home, at least for the time being, and are concerned by the health disparities here.
This Toolkit is a response to these students’ request for more information about the link between the right to health and the lived experience of their neighbors in Massachusetts.
Massachusetts students have the opportunity to advocate to improve health access for all Massachusetts residents. The Commonwealth already has strong public health policies that reflect PHR’s core values of health and human rights. However, because of factors like the legacy of segregation in Boston and the rising costs of health care, there is a still lot of work to do to ensure that all Massachusetts residents can reach their highest attainable standard of health regardless of class, race, gender, or neighborhood.
Students who do not live in Massachusetts may also be interested in this Toolkit. This state’s unprecedented health reform may serve as a model of interest as we tackle health reform on the national level.
In the Massachusetts Health Access Toolkit, you’ll discover our partners – the Massachusetts Immigrant and Refugee Advocacy Coalition, the Boston Public Health Commission, and Health Care for All. The Toolkit features our partner’s excellent research about health reform and the impact of social determinants of health in the state. You can explore our suggestions for education and advocacy, identify key Massachusetts health legislation, educate yourself and your peers about health access in Massachusetts, learn how to spark debate within your community, influence leaders to enact change.
We hope that every Toolkit is informative and inspirational. Since this is the first time we’ve created a toolkit specifically for one region of students, we hope that you also find it relevant to your work and your home. We look forward to hearing your feedback, questions, and plans.
All the best,
National Student Program Coordinator
Hello all, Welcome to the Massachusetts Health Access Toolkit. The students of PHR’s National Student Program are united in their commitment to use their medical and public health skills to promote and protect human rights. However – let’s face it … Continue reading
Discussion and Debate Guide: Health as a Human Right in Massachusetts
Use a structured debate to inform your audience of the issues and stimulate interest.
Spark debate on health and human rights in Massachusetts
Other students may be interested in learning about health as a human right and health reform in Massachusetts. A great way for them to learn is to engage in discussion and debate; when people have to actively think and argue about these issues they will learn and care about them on a deeper level. You can use our discussion and debate guide as a companion to the educational resources PHR and our partners provide to get people thinking about and discussing health and human rights in Massachusetts.
Students can present opposing viewpoints in a formal debate format. This can be followed by questions from the classroom or a discussion that the entire class can participate in.
A great way to get people interested in participating in debate is by linking discussion topics to current news events. You can use the questions we’ve provided as a flexible template which you can tailor to different contexts; depending on what information you use to supplement the debate.
What kind of current news items should you look to incorporate into discussions and debates? Look for any of these topics:
– Massachusetts health care in general
– Health reform
– Immigrant rights and immigrant health care
– Racial and ethnic disparities in Boston; especially look for articles that touch on disparities in underlying determinants of health, like housing or violence
– Language barriers
– A human rights / social justice / equity based approach to health
– Personal accounts of Massachusetts residents relating to MA health care and access
– Right to health
– De facto segregation of Boston neighborhoods – relate it to underlying determinants of health
Examples of useful articles:
Alternately, you can use blog posts, educational materials, and reports published by PHR and our Massachusetts partners as a supplement to discussion or debate.
You may also want to look into the discussion guides our partner the Boston Public Health Commission provides as companions to the documentary film series Unnatural Causes.
Here are some basic questions on the human right to health
What is the right to health?
What are underlying determinants of health? Think of some examples.
How might the underlying determinants of health you thought of be affected by socioeconomic status, race, or gender?
In what ways does a human right to health framework for public health improve the overall health system?
In what ways would people be affected by a comprehensive human right to health framework for public health?
What role do you think community building plays in improving access to health care? Think beyond medical institutions and into every day community elements; schools, grocery stores, the local YMCA, barber shops, restaurants – anything.
Who do you think unaffordable health care hurts the most? And how does it hurt everyone involved?
Questions on the human right to health in Massachusetts specifically
In what ways does Massachusetts fall short in respecting, protecting, and fulfilling the right to health?
In what ways does Massachusetts succeed in respecting, protecting, and fulfilling the right to health?
What parts of existing Massachusetts health legislation erect barriers to access?
What kind of measures do you think would bring those barriers down?
Consider what you know about systemic racism and de facto segregation in Boston. How do you think this affects health care in Boston?
What role do you think health professionals should play in the shaping of Massachusetts health care?
How do you think speaking little to no English could act as a barrier to access to care in Massachusetts?
What human rights are being violated by health inequities in Massachusetts?
How is the right to health violated by disparities in environmental conditions between different neighborhoods in Massachusetts?
Discussion and Debate Guide: Health as a Human Right in Massachusetts Use a structured debate to inform your audience of the issues and stimulate interest. Spark debate on health and human rights in Massachusetts Other students may be interested in … Continue reading
Federal Health Reform & Massachusetts
National Health Reform
On March 23, 2010, President Obama signed into law historic national health care legislation. This legislation will have a significant impact on Massachusetts; for one, the state and its residents will receive new federal support for health care worth $7.7 billion over the next ten years. It will also reduce the federal deficit by $1.3 trillion over the next twenty years. Federal health reform was significantly influenced by the 2006 reform in Massachusetts. Several elements of national health reform were derived from the Massachusetts model, including:
– Expanding preexisting public programs such as Medicaid to “fill in the cracks” and insure more people.
– Providing subsidies for low – income and middle – class people who cannot afford insurance and do not receive it through their employers.
– Creating a program that helps consumers compare and purchase affordable plans, much like the Massachusetts Health Connector.
Check out the following resources for how reform will impact health care and access in Massachusetts.
Boston Globe, “What the Health Care Overhaul Means for Massachusetts”. March 22, 2010.
Committee on Energy and Commerce, “The Benefits of Health Care Reform in Massachusetts”, March 2010.
FMAP, which stands for Federal Medical Assistance Percentage, is a reimbursement for the money the state spends on Medicaid benefits, such as MassHealth, Commonwealth Care, the Health Safety Net, and other programs.
Massachusetts received enhanced FMAP funding in the wake of the federal stimulus bill, but that funding was expected to expire on August 31, 2010, costing Massachusetts over $650 million that would have lent tremendous support to the 2011 health budget. The possibility of losing this money would have struck CommCare Bridge from the budget, leaving scores of otherwise income – eligible legal immigrants without access to care.
But in August 2010 both the Senate and House of Representatives voted yes on an extension of the enhanced FMAP. This restored CommCare Bridge past its expected August 31st expiration date and sustained support for other Massachusetts health programs.
Background on the FMAP issue, A Healthy Blog, June 2010
FMAP on the Way Means Bridge Coverage for Legal Immigrants Secured, A Healthy Blog August 2010.
Federal Health Reform & Massachusetts National Health Reform On March 23, 2010, President Obama signed into law historic national health care legislation. This legislation will have a significant impact on Massachusetts; for one, the state and its residents will receive … Continue reading
What is existing Massachusetts Health Policy?
Basic MA health facts & figures
History of Reform
The passage of the 2006 Massachusetts health care reform bill had its foundation in almost two decades of efforts. Past reforms that provided this foundation include the 1988 passage of legislation under Governor Michael Dukakis that established policy models that survive today, such as a CommonHealth program that provided coverage to adults and children. Furthermore, in June 1996 a bill known as “Chapter 203” instituted a new Medicaid program known as MassHealth that extended coverage to over 300,000 people.
In 2005, momentum for further reforms was gaining steam due to a combination of pressures and incentives. Because of a federal Medicaid waiver that required the state to redirect funds from safety net hospitals to insurance coverage, Massachusetts stood to lose $385 million in Medicaid funds if it did not pass comprehensive health reform. This significant financial pressure was a major catalyst for reform. The prospect of appealing to a growing base of grassroots and health consumer advocacy voices that called for universal coverage provided an incentive for elected officials to pass reform. Powerful support for reform was also provided by state business leaders, often non – profit hospitals and insurers, who argued that reform was in the economic interest of the state.
In November 2005 both the House and Senate passed comprehensive health reform legislation, which were referred to a legislative conference committee tasked with producing a final bill from the two different sets of legislation. After a series of speeches by Senator Edward Kennedy in March 2006, efforts to finalize the bill were moved forward. In April the final bill, Chapter 58 of the Acts of 2006, An Act Providing Affordable, Quality, Accountable Health Care, was passed by the legislature and signed into law by Governor Romney.
Chapter 58 is a health insurance model, not a universal health care plan. Below is an outline of the key components of the plan. You can find more about the history of reform in MA  and a resource – rich timeline of Chapter 58’s passage from the Health Care for All MassACT! Coalition website. 
Components of the Plan
The individual mandate requires all adults in the state to purchase health insurance, with financial noncompliance penalties of up to 50 percent of the cost of a health insurance plan. The state provides waivers to the individual mandate for those who do not qualify for subsidized care but cannot afford insurance at their income level.
Employers are required to pay a “fair share” contribution or provide health insurance to their employees if they have eleven or more employees.
Commonwealth Health Insurance Connector
The Connector is an insurance exchange for private plans that sets standards and provides opportunity for comparison shopping for consumers. The Connector offers a range of options, among them a special lower – cost plan for 19-26 year olds. Individuals and small businesses can purchase these plans through the Connector.
Commonwealth Care Health Insurance Program
The Commonwealth Care Program plays a central role in the plan, providing sliding – scale subsidies to low income individuals with incomes up to 300 percent of the federal poverty level to help with purchasing insurance. Adults with incomes up to the 150 percent FPL receive comprehensive health insurance that is completely subsidized.
This component expands Medicaid coverage to children up to 300 percent FPL, providing them with completely subsidized comprehensive care. The expansion also raised enrollment caps on Medicaid programs for adults.
Insurance Market Reforms
Reforms to the insurance market included merging the individual and small – group insurance markets, which theoretically decreases individual premiums (Kaiser Commission on Medicaid and the Uninsured Fact Sheet, June 2007).
Preservation of the Safety Net
The Health Safety Net replaced the Uncompensated Care Pool (also known as Free Care) to provide health services for residents with incomes below 400 percent FPL and who do not receive MassHealth or Commonwealth Care. Uncompensated Care Pool funds are combined with other Medicaid funds to reimburse providers.
Commonwealth Care Bridge
Not part of the original 2006 health reform plan, the CommCare Bridge was created after special status (Permanent Legal Resident) legal immigrants lost their Commonwealth Care coverage in August 2009. The Bridge offers much of what Commonwealth Care does, excepting dental care, vision services, hospice, or skilled nursing care. The Bridge was set to expire on August 31st, 2010.
Impact of the 2006 Massachusetts health reform
Influences National Health Policy
While certain components (and catalysts for) the plan could not be replicated in other states, the landmark bill managed to inspire imitation in a number of states in the year following passage. Both California and New York announced health reform initiatives, aiming for policy similar to that of Massachusetts, and numerous states began looking to shore up coverage of children.
Massachusetts also provided the model for national health reform at the federal level in 2009.
During formation of the national health care bill, the late Senator Edward M. Kennedy, who was instrumental in the creation and implementation of Massachusetts reform, asserted that “To those who say these challenges can’t be met, I say, ‘Look at Massachusetts”.
Improvements in Access to Care
– Massachusetts now has the lowest uninsurance rate in the nation at 2.6%
(Health Care in Massachusetts: Key Indicators – Report May 2009 )
– Only 11% of insured individuals reported cost as a barrier to care in 2008 as compared to 17% in 2006 (Community Catalyst Fact Sheet – Massachusetts Health Reform: The Facts, June 2009 )
– Usage of the Health Safety Net in the first six months of HSN08 declined, indicating that more people have access to primary care (Health Care in Massachusetts: Key Indicators, May 2009 )
– From 2006 to 2008 key statistics showed access improving. Adults were more likely to have the following: a place to go for care, a preventive care visit in the past 12 months, and a dental care visit in the past 12 months (Sharon, Long and Paul Masi, Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 )
Second Phase of Reform – Costs and Primary Care Shortage
Chapter 58 of the Acts of 2006 was designed for providing insurance, not tackling cost containment or managing shortages of primary care doctors, or other challenges facing the health care system.
In 2008 Chapter 305 of the Acts of 2008 – An Act to Promote Cost Containment, Transparency, and Efficiency in the Delivery of Quality Health Care – was passed to tackle health care costs and establish a framework for analyzing health care spending. Among other measures, the new legislation required annual public hearings to investigate influences on cost and recommend cost reduction mechanisms, banned gifts to physicians from pharmaceutical companies and provided education to physicians on cost – effective prescription practices, and established mechanisms for attracting primary care providers to rural and underserved areas.
The legislature also created a Special Commission on the Health Care Payment system, which recommended in July 2009 that the Commonwealth switch from a fee – for – service payment system to one in which providers share the responsibility for the patient’s care.
The almost exclusive focus on insurance in the 2006 reform ignored the need for comprehensive and equitable health policy that addresses factors beyond coverage. Many residents, as well as having disproportionately less access to insurance and/or care also find their right to health violated by the barriers to health they face in every day life. Unaffordable health care, sub – par care quality, and disparities in health outcomes are issues that persist in the Commonwealth. The 2008 legislation tackling health care spending was a step in the right direction, but more needs to be done[s1]  .
As future medical professionals, you may be undergoing hands – on training working with patients or at a health clinic. Health Care For All  provides a Consumer Health Helpline. You can refer patients, friends, or family to the Helpline to find out more about their health coverage options in Massachusetts, or use it as a resource for learning more about the consumer side of Massachusetts health policy.
[s1] Can we have a more nuanced analysis here? If not, this is okay…but this should be a call to action with specifics…this is a little watery….
What is existing Massachusetts Health Policy? Basic MA health facts & figures History of Reform The passage of the 2006 Massachusetts health care reform bill had its foundation in almost two decades of efforts. Past reforms that provided this foundation … Continue reading
An Act to Eliminate Racial and Ethnic Health Disparities in the Commonwealth
Lead Sponsors: Senator Susan Fargo and Representative Byron Rushing. S. 810
The act creates an Office of Health Equity that will address socioeconomic factors that influence health inequality, support community level solutions to disparity; prepare an annual “report card” monitoring health inequity trends, and replicate programs shown to be successful.
An Act to Promote Grant Programs to Eliminate Racial and Ethnic Health Disparities in the Commonwealth
Lead Sponsor: Senator Fargo (d-Lincoln. Senate Bill No. 810)
This legislation would establish community – based grant programs to eliminate racial and ethnic health disparities. This is an accompaniment to S. 810
Food Policy Council Bill
Lead Sponsor: Representative Linda Dorcena Forry (HD2055)
This bill will create a Food Policy Council which will work to link local agricultural producers with communities that need improved access to healthy, fresh, affordable, locally grown food. This can improve the overall health outcomes of entire neighborhoods that traditionally have been “food deserts” – areas without access to fresh, unprocessed, healthful food.
An Act Relative to Health Care Affordability
Lead Sponsors: Senator Mark Montigny & Representative John Scibak. S. 549/H. 1102
MA requires residents to purchase health insurance coverage if they can afford it, but only takes into account the cost of health insurance premiums in relation to income. This act brings costs such as co – pays and deductibles into that equation to expand the definition of affordability. This way the affordability rates of different types of coverage are accurately assigned to their respective income levels.
An Act Strengthening Health Care Reform
Lead Sponsors: Representative Kulik (D-Worthington) and Senator Moore (D-Uxbridge). House Bill No. 4258; Senate Bill No. 873
This bill makes coverage consistent throughout public health care programs (Commonwealth Care, MassHealth, and Health Safety Net) to cover gaps in coverage and helps individuals receive appropriate health coverage. It helps MA residents retain coverage and grants flexibility to the Office of Medicaid to provide cost – effective health care to elderly and disabled legal immigrants.
An Act Relative to Shared Responsibility in Health Reform
Lead Sponsor: Representative Kulik (D –Worthington) and Senator Montigny (D-New Bedford). House Bill No. 1084; Senate Bill No. 550
Legislation that requires contributions from employers who do not provide minimal health benefits, increasing revenue for reform. With added revenue sustainability for reform can be established.
Children’s Health Care Reform
An Act to Assure Equitable Health Coverage for All Children
Lead Sponsors: Representative Malia (D-Boston) and Senator Chang – Diaz (D-Boston). House Bill No. 1087; Senate Bill No. 537
The existing standard of care under Children’s Medical Security Plan (CMSP) is not adequate. The bill would make the CMSP benefits equal to those of MassHealth so that all Massachusetts children will have access to the same level of care regardless of the program that provides their coverage.
An Act Ensuring Access to Basic Health Care for Children and Young Adults
Lead Sponsors: Senator Thomas McGee and Representative Danielle Gregoire. Senate Bill 54.
The bill expands eligibility for MassHealth coverage to youth through age 20, opening access to care in a key transition period in which low income youth have difficulty affording the higher costs of Commonwealth Care.
An Act to Assure Continuity of Health Coverage for Children
Lead Sponsors: Senator Jen Flanagan and Representative Ellen Story. HB 188 / SB 39)
The bill provides 12 – month continuous eligibility for children under CHIP and Medicaid. This helps bridge the lack of coverage families experience when their income level fluctuates over 300% of the federal poverty level, the cutoff mark for receiving CHIP and Medicaid.
Relevant Legislation An Act to Eliminate Racial and Ethnic Health Disparities in the Commonwealth Lead Sponsors: Senator Susan Fargo and Representative Byron Rushing. S. 810 The act creates an Office of Health Equity that will address socioeconomic factors that influence … Continue reading
Tracking Legislation: Lawmaking in Massachusetts
The legislative – making body in Massachusetts is called The General Court.
It is split into the House of Representatives, which has 160 members, and the Senate, which has 40 members.
The Path of Legislation
- Petitions are first recorded in a docket book in the House or Senate Clerk’s office. The clerks assign numbers to bills and assign them to the appropriate joint committees. There are 26 committees who study bills pertaining to their area of expertise <http://www.mass.gov/legis/commenu.htm >>.
- The committee schedules a public hearing on the legislation. Citizens, legislators, and lobbyists can voice their views at these hearings. The committee later meets in a session (open for observation to the public) to discuss public testimony and the bill.
- The committee makes recommendations to the House and/or Senate, issuing a report labeling the bill “ought to pass”, “ought not to pass”, or “as changed”.
“Ought To Pass” “Ought Not to Pass”
The bill goes to the Journal The bill is referred to the Committee
of the House & Senate Clerk on Ethics & Rules in the Senate or
for reading. Placed in the Orders of the Day for
the next session of the House.
- The bill is open to amendments and motions after its second reading, and is
referred to the Committee on Bills for a third reading, to check its constitutionality and that it does not repeat or conflict with existing legislation.
- The bill then must pass through three readings and engrossment in the second legislative branch.
- If the second branch amends the bill, it returns to the original branch for a vote. If it is rejected, a committee with three members from each legislative branch representing both parties is formed to create a compromise bill. It is then sent to both legislative branches for approval.
- The House and then the Senate vote to “enact” the bill.
- The bill is reviewed by the governor, who can sign it into law, allow it to become law without signing it (if the bill is held for ten days without action while the legislature in session, it automatically becomes law), veto it, or recommend changes and return it.
- A bill signed by the governor or passed by 2/3 of both branches over his veto becomes law and can be effective in ninety days.
Tools for Monitoring Legislation
– Visit www.mass.gov/legis  for comprehensive information on the Massachusetts legislature, including full texts of legislation, information on existing laws and committees. You can also view the calendars and journals for the House and Senate.
- Also visit this website for lists of legislature leadership (click on “Leadership” on the main page) and members of the House and Senate (links to these lists fall under the “Legislators” section on the main page). These lists also provide contact information for the legislators you may want to lobby.
– Go to http://www.mass.gov/legis/ltsform.htm  and search for the legislation you want to track. You can either enter a related phrase or search by its House and / or Senate number. This will tell you at what stage in the legislative process the bill is at, and when the public hearing is.
– Also look for advocacy efforts from our partners, such as letter writing campaigns, petitions, and call – ins that are relevant to the right to health in MA.
Based on information from http://www.mass.gov/legis/lawmkng.htm 
Tracking Legislation: Lawmaking in Massachusetts The legislative – making body in Massachusetts is called The General Court. It is split into the House of Representatives, which has 160 members, and the Senate, which has 40 members. The Path of Legislation … Continue reading
How is the right to health related to Massachusetts health reform?
Massachusetts may have world class medical facilites and state health reform, but the state also has a significant number of people who struggle to access quality heath services. PHR believes that protecting human health, regardless of class, background, gender, or race, is necessary to the preservation of human rights. Massachusetts struggles to provide equitable health services to the poor, to immigrant, and to minorities, where race disparities in health continue. As future health professionals and participants in civic discourse you have the power and skills to face these chllanges head on. With your passion and work, we can drive Massachusetts towards permanently respecting, protecting, and fulfilling the right to health for all its residents.
Cost and the AAAQ Framework
Affordability & Payment Structures
Consumers are finding their access to quality care diminished, as hospitals struggle to cover expenses, employers face mounting strains on their ability to provide insurance to their employees, and health care payment structures continue to inflate costs.
Massachusetts sports some of the highest health care costs in the US. Health insurance premiums, driven largely by these costs, have increased almost every year for the past twenty years at a pace that exceeds the annual increase in the cost of living (Recommendations of the Special Commission on the Health Care Payment System, July 2009).
- Insurance companies and employers who provide insurance are forced to shift costs for coverage onto individuals and employees, escalating out – of – pocket costs in the form of increased co – insurance, deductibles, and increasing responsibility for paying premiums. Higher out – of – pocket costs hampers the ability of individuals and families to access health care.
However, high spending levels does not guarantee quality, effective care. This is largely due to existing payment structures, which simultaneously degrade quality of care and inflate costs.
– The current fee – for – service structure, in which doctors are paid for each service performed, rewards physicians for volume rather than overall quality and outcome. It also inflates costs as doctors order multiple and sometimes unnecessary tests and procedures, the out – of – pocket costs of which are often unmanageable for the patient.
– Primary care providers are paid less than specialists, encouraging “brain drain” away from primary care to more specialized fields and decreasing access to primary care.
The AAAQ Framework
The right to health as defined in General Comment 14  and PHR’s report “The Right to Health and Health Workforce Planning”  contains four inter – related and essential elements (1) Availability; (2) Accessibility; (3) Acceptability; and (4) Quality. The AAQ framework is essential both in the creation of public health policy and measuring the success of a health system.
– Availability: Health care and public health facilities, goods and services must be both functional and available in sufficient quality.
– Accessibility: Health facilities, goods and services must be accessible to everyone. Accessibility encompasses non-discrimination, physical accessibility, economic accessibility (affordability) and access to information.
– Acceptability: Health facilities, goods and services must respect medical ethics and patient dignity. They must also respect the culture of individuals, minorities, people and communities, and be sensitive to gender and life-cycle requirements. Health facilities, goods and services must protect confidentiality and be designed to improve the health status of all concerned.
– Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality. This requires, among other things, skilled health personnel, scientifically approved and unexpired drugs and functional equipment, safe, potable water and adequate sanitation.
The role of cost and the effect of existing payment structures on the patient’s relationship with health care are important factors in the success of the AAAQ framework. The current system, in which health care is fundamentally unaffordable and fails to address patients’ needs, has an adverse effect on the ability of Massachusetts to implement the framework successfully.
See: An Act Relative to Health Care Affordability  
See: Health Care for All’s “Campaign for Better Care ”
Barriers to Access
These are factors that influence different population groups’ ability to access health. Look for these factors when we discuss health inequities and their causes.
– Lack of health insurance
- People without insurance are less likely to seek care because of costs – when they do, it is often in an emergency setting in which they can only be treated in a short term capacity.
– Language barriers
- Prevent clear communication between patient and doctor
- Discourage patients who know little or no English from seeking care from fear of difficulties
- Prevent patients from seeking or understanding medical information that will help them make informed decisions about their health
– Lack of educational opportunities
- Contribute to a lack of information, rendering one less able to make informed decisions about one’s health
- Decreased capacity to pursue higher paying careers that would enable one to pursue more expensive health treatments, have greater choice in what kinds of food one can buy, and live in a more healthful location.
– Geographic Location
- Location may have a greater distance from nearest hospital or “safety net” location and may have a greater distance from public transportation that can transport one to a hospital or “safety net” location.
- Location may have lower quality of housing, higher rates of violence, more trash in the streets, higher pollution rates, and less proximity to fitness centers or healthy and high quality food (“a food desert”). These are all underlying determinants of health that are vital to achieving one’s highest attainable standard of health.
Low Income Individuals and Families in Massachusetts
A family or individuals living close to 300% federal poverty level are likely to fluctuate over and under that line over the course of a year. When they fluctuate over they still may not earn enough to afford health insurance coverage, and are therefore exempt from the individual mandate to purchase health coverage. This often results in a lack of health insurance.
– When a family’s income fluctuates around the 300% FPL, the children cycle on and off SCHIP / Medicaid coverage, leaving coverage gaps.
– Because women are more likely than men to be low income, on average earning 77 cents for every dollar earned by a man in Massachusetts, they are also more vulnerable to the coverage gap that results when they earn slightly too much to qualify for subsidized care but do not purchase insurance.
Another barrier providing coverage to low – income individuals and families is existing affordability standards.
– MA requires residents to purchase health insurance coverage if it is affordable to them, but only takes into account the cost of health insurance premiums in relation to income.
– This narrow definition of affordability should be expanded to include factors such as co – pays and deductibles so that residents are purchasing insurance that is truly affordable to them and paying more manageable levels of out – of – pocket costs.
See: An Act Relative to Health Care Affordability  
Racial and Ethnic Disparities in Coverage and Access to Care
Racial and ethnic health inequities are dependent upon a web of interrelated factors, some of which are included in our list of basic barriers to health access. In Boston, Black and Hispanic residents are more likely to have low incomes than White residents. Lower economic status inflicts upon populations such barriers to health as:
– More likely to be low income and therefore be more vulnerable to a lack of health insurance.
– Lower quality / less healthful housing
– Less healthful geographic location
– Lower rates of employment and educational opportunities
– Language barriers: In Boston, 28.5% of Asian residents and 23.5% of Latino residents speak little to no English as compared to 2.6% of White residents (BCPH Disparities Data Report  (PDF).).
– Racism and the stress associated with it (an underlying determinant of health)
The disproportionate levels of health barriers for Black, Latino, and Asian residents amount to discrimination. The pervasiveness, and codependent nature, of these factors indicate that a solution beyond health care coverage is needed to address health inequities in order to respect, protect, and fulfill the right to health and the right to freedom from discrimination for all Massachusetts residents.
See: Food Policy Council Bill 
Barriers to Health Care and Access for Legal Immigrants
Legal immigrants, regardless if they are income eligible, must undergo a five year waiting period before participating in federal health care plans such as Medicaid that are incorporated into Massachusetts health policy.
– These individuals are currently covered by the Commonwealth Care Bridge, which provides income eligible legal immigrants who have lost their coverage due to the federal waiting period. However, this plan fails to cover vital areas such as dental care and is only a short term solution to the problem.
– Legal immigrants who must undergo this waiting period are, from the inception of their residency in the US, marginalized into lower incomes and inferior health outcomes from having to pay more out – of – pocket costs for health care, facing barriers to accessing important health care services not covered by CommCare Bridge, and being more likely to use Health Safety Net services which provide less comprehensive and more short – term care.
Reforming these laws would not provide federal coverage for undocumented immigrant adults. It should, however provide legal immigrants with the following:
– Subsidies to legal immigrants as they do for legal citizens, with no discriminatory barriers or waiting periods.
– Elimination of the five year waiting period that prevents legal immigrants from receiving federal Medicaid coverage.
– Access to affordable children’s health insurance regardless of immigration status.
See: An Act Strengthening Health Care Reform 
How is the right to health related to Massachusetts health reform? Massachusetts may have world class medical facilites and state health reform, but the state also has a significant number of people who struggle to access quality heath services. PHR … Continue reading
H.1517 and the Office of Health Equity
In January 2011, State Representatives Jeffrey Sanchez and Byron Rushing introduced bill H.1517 to the General Court of Massachusetts. Bill H.1517 would establish an Office of Health Equity in the Office of Health and Human Services. The bill was referred to the Joint Committee on Public Health in February 2011.
Functions of the Office of Health Equity
The proposed Office of Health Equity (OHE) would deal with the many issues that impact health outcomes and cause health disparities by1:
- coordinating and monitoring Department of Public Health (DPH) activities regarding disease prevention, health promotion, service delivery, and research concerning racial and ethnic minority populations
- participating in decision making and policy development regarding priority areas for the DPH
- providing assistance to the DPH and the community on data about the health status of racial/ethnic minority populations
- serving as an active link between the DPH and racial/ethnic minority communities
Why is an Office of Health Equity Necessary?
To make gains that are both substantive and sustainable toward the elimination of health disparities will require political will and coordinated oversight, which the Office of Health Equity is uniquely positioned to provide. The proposed OHE would create a permanent place in state government to spearhead efforts to eliminate health disparities in the Commonwealth. The OHE would fill an important and currently unfulfilled role in coordinating statewide efforts and evaluating state progress in eliminating health disparities to improve public health statewide.
Advocacy Opportunity: Tell your Rep. to Address Health Disparities in MA
Your Representative needs to hear from you! Visit the Student Chapter Toolkit’s Advocacy page  for more information about how to:
- Call your representative
- Write a letter
- Attend a district meeting or public hearing
As a health professional student, your support is essential in the effort to eliminate health disparities. Make sure your voice is heard!
H.1517 and the Office of Health Equity Background/Bill Info In January 2011, State Representatives Jeffrey Sanchez and Byron Rushing introduced bill H.1517 to the General Court of Massachusetts. Bill H.1517 would establish an Office of Health Equity in the Office … Continue reading
For more information about planning and hosting educational events, such as panels or speakers, please visit the Chapter Toolkit .
Invite a speaker
Speakers are available at our partner organizations. Please contact them directly to find out their area of specialization and to invite them to come to your campus.
- Massachusetts Immigrant and Refugee Advocacy Coalition MIRA 
- Healthcare for All 
- Boston Public Health Commission BPHC 
Discussion and debate guide
Call, email, or visit your members of Congress (state or national) usa.gov 
Once you have expressed your preference to your elected representative, monitor the progress of the legislation.  Up-to-date information  will allow you to follow up your efforts with the member of Congress whom you contacted to thank them or pressure them further.
Participate in local advocacy
By responding to local news items and demonstrating your interest in promoting health access, you can impact local opinion .
Planning events For more information about planning and hosting educational events, such as panels or speakers, please visit the Chapter Toolkit. Invite a speaker Speakers are available at our partner organizations. Please contact them directly to find out their area … Continue reading