The Yawkey Pavilion at Mass. General Hospital. (Courtesy MGH)

 
BOSTON — If you work in the medical field and especially a hospital, there was probably quite a buzz at work on July 17. That's because the annual Best Hospitals ranking was released by the U.S. News and World Report. Massachusetts General Hospital ranked first and Brigham and Women's ninth. MGH president Dr. Peter Slavin called the ranking a "tribute to the more than 23,000" staff at the hospital. 
 
But how much should we pay attention to these rankings? Do they even matter? To gain insight and perspective, I talked with Dr. Harlan Krumholz, professor at Yale School of Medicine. He said that despite the popularity of these lists, there is currently no good place to get reliable information on hospitals: All ratings seem to have their bias and are not completely based on hard outcomes data. However, Medicare is working on a possible solution.
 

 
BOSTON — In the days since Gov. Deval Patrick signed a budget that will, in effect, close Taunton State Hospital, we’ve been hearing from people who stand to lose the most. WGBH News takes a deeper look at the complex matter of taking care of the mentally ill in Massachusetts.

A parent says: Keep the hospital open
 
Brenda Venice has two adult children who suffer from mental illness. Her daughter has spent time at Taunton State Hospital. She said the state’s move toward an emphasis on community-based services is not the answer to treating those with chronic mental illness.
 
“By closing Taunton State, you’re not giving people in our area a chance to heal," she said. "You’re just shoving them out into the community, saying, ‘All right, recovery is real.’ And you’re on your own. And even though my daughter is in the community and she is struggling every single day, she’ll say it herself: People need time to heal and you can’t just rush them."
 
Venice is also the head of the Fall River chapter of the National Alliance on Mental Illness, and said there have been countless occasions when families have called her in desperation in trying to get help for their sons or daughters — often after they were discharged from the hospital after only a few days.
 
"They’re in the hospital 3 days, and then they’re out. In the hospital 5 days, and then they’re out. And if they would have been there a little longer, to make sure that the medication was working and that everyone was OK and [there was] a good transition, that person would be OK," Venice said.
 
Part of Patrick’s decision to close the hospital is the state’s Community First initiative, which is to expand and integrate long-term, community-based support systems that foster independence among people with various disabilities. These supports include group homes, outpatient psychiatric centers and bridge support to help patients transition back into society.
 
An advocate says: Treat people in the community

Deborah Delman is an advocate for the governor’s plan. She's the executive director of the Boston-based Transformation Center, which trains peer specialists who have also experienced mental illness to help people reacclimate back into society.
 
“I think that the state services in Worcester and in Taunton have been really valuable and valued. However, the investment in the community has to strengthen and that’s really the approach that I definitely support," Delman said.
 
She said that bridge programs, not hospital beds, are the step in the right direction for a patient’s recovery process. However, “we don’t have flexibility in this state to provide that lower-cost alternative for those who really are ready for that. And therefore, beds are filled up with people that really don’t need that level of care."
 
But Venice disagreed. To her, the emphasis needs to be on the initial recovery process.
 
“Having people in the community is great. But the thing is — in order to go into the community, you have to be well. And going from Taunton State, a long-term facility — the people are pretty sick. You can’t take a person that’s pretty sick and put them in a group home," she said. "You have to get well in order to be in a group home. Everybody’s recovery is different. Some people recover faster, some people take longer."
 
That’s what makes treating mental illness so complicated. Add to the mix a tight state budget — and not everyone ends up with what they want.
 

HO CHI MINH CITY, Vietnam — This summer, two Boston College professors are leading a group of students to volunteer at a clinic for HIV patients who are at the end of their lives in a society where the illness carries significant stigma.

A mile from my hotel, the taxi driver looks at the instructions again, does a U-turn and then speeds down the city's main avenue. A good 45 minutes later we are on the outskirts of Ho Chi Minh City, which most people around here still refer to as Saigon. The driver does a zig and a zag past stores selling pots and portable stoves and through an intersection crowded with commuters on motorbikes. Then tucked away on a side street that meanders past several industrial sites we arrive at an HIV clinic run by the Catholic Church, where I’m met by a woman who calls herself Vee, who tells me the name of the facility, Tieng Vong, is pronounced "Tan Vaughn" and means “Hopeful Voice.”

I’m also met at the gate of the “Hopeful Voice” clinic by Boston College professors Thanh Tran and Rosanna DeMarco. They’re leading a group of BC undergraduates on an eye-opening medical mission to help dying HIV patients at the ends of their lives: learning, relating, struggling with it all and then returning to Boston to make a difference back home.

How the Boston team got involved

“I am an expert in the area. I have been working with black women who are living with HIV who are aging with the disease,” says DeMarco.

DeMarco, a professor of nursing, is far from the HIV clinics of Blue Hill Avenue and the African American and Hispanic women she counsels in Boston. But HIV cuts through boundaries and knows no borders. “I partnered with Dr. Tran and we got five other students interested. All of us came together to try to learn. And see how the health care system works for these patients and what it’s like for them.”

Six students, with plenty of choices for a carefree summer, choose Vietnam instead, a place where HIV carries with it a stigma and a personal and cultural challenge. Says DeMarco:

“Vietnam, although stable in a sense, the rising rates among women and men who have sex with men is very significant. Thus the stigma in the Vietnamese culture. When you are perceived as doing something wrong, like IV drugs or sex working or doing something related to the usual connotation of why people get HIV, then you become ostracized and how painful that is in this culture because there’s so much value on family and connection.”

The students' motivation and the scope of the problem

In the doorway of a one-story suntanned brick building, Pauline Tran of Worcester extends her hand. She is one of five Vietnamese-American students at BC who’ve returned — if you will — to a country they have never known.

“I’ve always had an attachment to my background, to my culture. I’ve always been interested in helping the vulnerable, especially for my family who came from something like this,” she says. Her family escaped to the U.S. after the war. She and the other Vietnamese American students were born in the U.S. They say they have also come to this HIV clinic as a way of giving back to the country of their heritage. And everyone on this trip has a role. For instance, Nguyet Chau, a native of Worcester, helped translate the documents the team uses for the HIV prevention program.

They can use all the help they can get. Vietnam has very limited human resources. In a country of nearly 89 million people, about 300,000 have been diagnosed with HIV. But there are only 1,300 health workers assigned to this population, and many of them are volunteers.

Still, stigma is probably the greatest obstacle to controlling the epidemic, says clinic director Co Vinh, speaking in Vietnamese. “About 13 years ago when we founded this clinic there was no treatment for HIV here in Vietnam and most people had no knowledge about the disease. So their own families discriminated against patients and many of them were thrown out in the streets. Some live in the park under the benches and in the bushes.”

The scene at the clinic

We take a tour of the clinic: There are eight beds, a needle cleaning machine, photos of Jesus and Saigon’s archbishop on the wall; clothing, food and medicine are piled in one corner, medical charts in another. Local volunteers bathe patients, hand out supplies, chart their progress or lack thereof and offer moral support. BC nursing student Mary Gerardo is the only non-Vietnamese student among the six from the U.S.

“I’m from Richmond, Virginia. I don’t travel very much," she says. "They contacted me and I said that would be a great opportunity. Professor DeMarco, after meeting her, I said, 'I can do this.'”

Most local volunteers here are congregants at the Catholic Church that sits on these grounds in Ho Chi Minh City. One is a former clinic patient with HIV who seems amazed by his own survival. “They gave me free medicine starting in 2004,” he says, and that has stabilized his medical condition.

IV drug use in Vietnam is on the rise, as is voluntary and forced prostitution, according to the United Nations. Vinh tells me about a patient who was sold by her own mother into sexual slavery across the border in Cambodia and ended up with HIV.

She says, “The young woman ended up in critical condition with tuberculosis and I met her in a local hospital. I got her address from the hospital and later I was looking for her but the address wasn’t clear. So one rainy afternoon I was looking for her and found her sitting on the streets; coughing on the streets by herself. And when I saw her like that I just could not stand it and I used my own money to rent her a small room.”

To listen and to learn

While most of the Boston College team are visitors to this faraway land, Professor Thanh Tran knows Vietnam well and struggles — perhaps more than we can ever know.

“I was born and raised up here until I finished high school and came to the U.S. at the end of the war," he says. "I’m always very hesitant to return to Vietnam because I belong to a different generation and a member of the Vietnamese community in the United States that’s extremely anti- this government. But I came here with Dr. DeMarco and a group of students to learn about the health care system; how these people find resources [to take care of patients] under very limited conditions.”

And the commitment to reducing HIV infections and the stigma of AIDS outweighs any ideological tug of war between Vietnamese Americans and Vietnam, between heritage and politics, says Professor Tran.

DeMarco agrees and says being here offers an invaluable lesson: “No matter what the care is, whatever level it is, whatever is here or isn’t here, when people come here — they come with their family members and they don’t feel any stigma, they feel respect. When they come here they don’t have people not listening to them. They have people listening to them.”

And that’s perhaps the most important lesson here. These professors and their students are not missionaries. They’re not here to tell Vietnamese clinicians, caregivers and patients what to do and how to do it, but instead they listen and learn, says DeMarco. “As professors we’re interested in helping students not understand research like they are reading it out of a book but understanding that it’s a relationship with people who have real experiences and in order to ask good questions and to figure out the answers to those questions you really have to get to know the problem, up close and personal.” 

And “up close and personal,” says DeMarco, is a step nearer to addressing the stigma of AIDS that keeps many from admitting a problem that is worldwide in scope — from Ho Chi Minh City to Boston.
 

 
BOSTON — The fight to save Taunton State Hospital is not going away ... it may actually be stepping up. On July 8, Gov. Deval Patrick used a line-item veto to cut $5 million for the mental health facility and transfer services more than 1 hour away to Worcester. Southeastern Massachusetts is angry, some lawmakers are working toward an override and the local newspaper is voicing support for the facility.

Arguments for and against

Karen Coughlin, a nurse at Taunton State Hospital, said closing the 169-bed facility will hurt those in need of inpatient care in Southeastern Massachusetts, and will overwhelm emergency rooms.

“I think we’re going to see more patients, unfortunately, who do not have the community supports that are out there, [who] are going to end up either in an emergency room or unfortunately involved in the legal system or not receiving services whatsoever or spinning in and out of acute care facilities," said Coughlin.
 
But Marcia Fowler, commissioner of the State Department of Mental Health, said the location should not have any impact on the quality of patient care since admissions are done on a statewide basis.
 
“People are admitted based on where the first available bed is, not necessarily on where they live because we want to meet the needs of the individual as soon as possible. And we have 28 site offices around the state where our staff assists family members who may have difficulty visiting folks in the hospitals," Fowler said.
 
A difference in treatment philosophy
 
While Patrick is counting on a progressive approach to treating the mentally ill, Coughlin believes that approach comes with a risk.
 
“There has been a large push within the last month to discharge patients out into the community. And unfortunately, I believe some of them aren’t ready. It’s kind of like a wing and a prayer," she said.
 
Fowler said the focus should not be on inpatient beds, but on rehabilitation and transitioning back into society.

“We have more people that are sitting in our facilities — and these are locked psychiatric facilities — that are waiting for discharge into an appropriate community placement. So we have more individuals waiting for discharge than we do individuals wanting to get into one our continuing care beds," Fowler said.
 

BOSTON — During his two terms as Massachusetts governor, Michael Dukakis had health care reform on his agenda. In fact, in 1988 Dukakis signed into law a health care act that would have forced businesses that didn’t offer their employees health insurance to contribute to a fund to provide such insurance — but Dukakis said his successor William Weld did what he could to stymie the effort.
 
I sat down with the former governor and presidential candidate at Northeastern University, where he is now distinguished professor of political science. I spoke with him soon after the Supreme Court decision was released — a decision that somewhat vexed Dukakis

Excerpts from the interview

"Well, I'm pleased that the basic core piece of it was upheld. On the other hand, I must say I'm confused about the decision on Medicaid. Congress has regularly required the states to expand Medicaid coverage as a condition for receiving that money ... So what you're going to end up with, I guess, is a kind of pitched battle in conservative legislatures over whether or not they're going to agree to make it possible for working people and their families — up to 133 percent of poverty, which isn't a lot of money — to get decent, affordable health care. And in point of fact that's the whole issue anyway, which I'm sorry to say my party hasn't done a very good job of explaining. This is all about working folks and their families because the overwhelming majority of uninsured people in this country, and it's about 60 million, are working or members of working families ...

"We're finally going to, I hope, move ahead with decent, affordable health care, especially for working families in this country — unless of course Mitt Romney, who's done his 125th 180, in this case on health care — gets elected! If he does, then forget it."

BOSTON — The Supreme Court has upheld the constitutionality of the Affordable Care Act. Here's some of the analysis airing on WGBH radio and television.

> > Complete WGBH coverage of the decision

Michael Dukakis, former governor of Massachusetts:
"We're finally going to, I hope, move ahead with decent, affordable health care, especially for working families in this country — unless of course Mitt Romney, who's done his 125th 180 — in this case on health care — gets elected! If he does, then forget it." Listen to Bob Seay's interview with Dukakis on Morning Edition on June 29.

Jonathan Gruber, MIT economics professor who helped write Massachusetts' health care law, on the significance of upholding the individual mandate:
"The most popular and important part of the law is ending discrimination by insurance companies. No longer allowing insurance companies to deny people insurance or charge them more for insurance just because they're sick. You can't do that piece without the mandate."

Kerry Healey, Mitt Romney's lieutenant governor, on negative public opinion of the act:
"I just think the voters aren't stupid … there's nothing free coming from the government. Someone is paying for it, and that's the taxpayers."

Andrew Dreyfus, President and CEO of Blue Cross Blue Shield Massachusetts: 
"I think today's Supreme Court ruling really validates almost a decade's worth of work here in Massachusetts to expand health care for everyone in the country and now all Americans are going to have the same health care benefits and protections that people in Massachusetts have enjoyed for years. So we're excited about the ruling and supportive of it. … Not knowing how the Supreme Court was going to rule created a lot of uncertainty for employers, for health plans like ours, for hospitals and physicians because we really didn't know what the rules were. Now we have a clear message."

Renée Landers, professor at Suffolk Law:
"One of the unanswered questions ... is the extent to which the court has really imposed some greater restrictions on Congress using the power of the Commerce clause to legislate." Landers talks with Bob Seay on Morning Edition on June 29.

Dr. Paula Johnson, chair of the Boston Public Health Commission board, on why the federal law matters here:
"Through the Affordable Care Act we've seen elders getting rebate checks [and] physicians being able to get higher reimbursement rates for primary care ... We've had all the public health dollars that have come into our state ... so it absolutely has been a plus for Massachusetts."

Dr. Vivek Murthy of Brigham and Women's, president of Doctors for America:  
"I think this is a victory for the country, for patients, and it’s also a victory for providers like me who see patients everyday and who realize that many of our patients aren’t getting what they need because they are in a broken system. And this law being upheld gives me hope that we can now have a real shot at fixing the broken system. ...

"In this law, there are a number of provisions including wanting to set up health insurance exchanges like what we have here in Massachusetts which will place downward pressure on premiums because it will promote transparency in terms of pricing and information and also create more competition among insurance companies so that patients have more choice." 

Elizabeth Warren, Democratic U.S. Senate candidate:
"This is really about bringing health care into families in a way that works and starting down the line of trying to bring costs under control. … I think the Democrats are saying we've helped solve a problem. It may not be perfect but we have sure moved in the direction of getting it a lot better."

Arnie Arnesen, N.H.–based political commentator:
"This was just an amazing piece of ballet on the part of the chief justice. It was genius. I wish I could have choreographed it."
 
Robert Whitcomb, editorial page editor of The Providence Journal:
"This is going to enrage people on the right — and they're going to pump vast quantities, even more money, into Romney's campaign."

U.S. Sen. Scott Brown, in a statement:
"The federal health care law may be constitutional, but it is wrong for jobs and the economy. In Massachusetts, we had already dealt responsibly with the problem of our uninsured without raising taxes or cutting care to our seniors. All we got out of this massive new federal entitlement is higher taxes, cuts in Medicare and additional debt at a time when we can least afford it. The bottom line for me is this law makes it harder for our economy to add jobs and for that reason I continue to oppose it.”

Did you miss the president's speech? Watch it online.

June 28, 2012

The Supreme Court has upheld the constitutionality of the Affordable Care Act in a complex ruling. In March, WGBH News followed the case as it was argued with a full week of oral arguments, analysis and features. Today, we have a full day of coverage to help you make sense of the decision.

> > Read the decision (pdf)
> > Consequences of the ruling: WGBH analysis

89.7, 10 a.m.
NPR special coverage

Diane Rehm Show, 11 a.m.
Susan Dentzer, editor-in-chief of Health Affairs, and an on-air analyst on health issues for PBS NewsHour
Susan Page, Washington bureau chief for USA Today
Jeffrey Rosen, professor of law at The George Washington University; legal affairs editor at The New Republic

Emily Rooney Show, noon
Jonathan Gruber, MIT economist and one of the chief architects of the Affordable Care Act
Kerry Healey, Lt. Gov. of Massachusetts under Mitt Romney
David Kravitz, former clerk for Justice Sandra Day O'Connor 
Dr. Harry P. Selker, head of the Tufts Medical Center Institute for Clinical Research and Health Policy Studies

Callie Crossley Show, 1 p.m.
Arnie Arnesen, N.H.–based political commentator
Brian Rosman, Health Care for All
Robert Whitcomb, editorial page editor of The Providence Journal

89.7, 7 p.m.
NPR special coverage

Greater Boston, on WGBH 2 at 7 p.m. and from 7:30 p.m. online
Kerry Healey, Republican analyst and former lieutenant governor
Dr. Paula Johnson, chair of the Boston Public Health Commission board
David Kravitz, co-founder of Blue Mass Group
Renée Landers, Suffolk University law professor and WGBH analyst

June 29, Morning Edition
Michael Dukakis, former governor of Massachusetts
Renée Landers


All segments subject to change.
 

Recent stories

> >  Decision might not mean much in Commonwealth
> >  Renée Landers discusses the possible outcomes

BOSTON — The U.S. Supreme Court is set to rule on the constitutionality of President Barack Obama's health care reform law. But if the Affordable Care Act is struck down, the practical impact in Massachusetts may be relatively small.

Since Massachusetts's pioneering health reform law already instituted many of the national law's initiatives, the impact here won’t be as dramatic as in other states if the law is overturned.

Even if the individual mandate to buy insurance is struck down, the Bay State’s requirement that most people buy health coverage or pay a fine will remain in place. And while other states may choose to drop millions of residents from their Medicaid rolls, that’s illegal in Massachusetts.

Still, the Affordable Care Act has been funding many programs here in the Bay State. It's given grants to address childhood obesity, train health workers, expand immunizations. The law has funded many of the clinicians who work in community health centers. Grant money in the law is supposed to help fund new and easier-to-use health plans for about 111,000 people with serious medical problems who are both on Medicare and Medicaid. And it provides funds to move hundreds of seniors and people with disabilities from institutional settings to community ones with support services.

It’s unclear how much money these programs might lose, or if they would continue at all. And even though the state's secretary of health and human services said Massachusetts will remain committed to providing affordable and high-quality health care, experts said that if the law is overturned, cutbacks of some form would probably be necessary.
 

The Supreme Court health care ruling is now expected to come down this Thursday, June 28. While we all drum our fingers, law expert Renée Landers reviewed the four possible scenarios and explains the ramifications of each. 

 
BOSTON — The federal government has approved the use of $628 million to implement cost-saving reforms at seven Massachusetts hospitals that treat many of the state’s poorest residents.
 
A little more than half of the money — $381.3 million — will come from the federal government and will be phased in over 3 years.
 
The hospitals, which include Boston Medical Center, Cambridge Health Alliance and Holyoke Medical Center, serve a disproportionately large number of low-income and Medicaid patients, who are often the most expensive to treat.
 
JudyAnn Bigby, secretary of the state Executive Office of Health and Human Services, said the funds will be used to develop and implement large cost-saving reforms.
 
"Some of the types of things that hospitals have been working on and will be working on with their proposals are better diabetes management, better collaboration to try to decrease length of stay of people with mental health problems, those types of things," she said.
 
Bigby added that in the current economic environment, many so-called "safety-net" hospitals are in dire financial straits and struggle to provide care to growing numbers of low-income, uninsured and Medicaid patients. For instance, they often don’t have the money on hand to shift to electronic medical records, even though that change is expected to bring down costs in the long run.

> > READ: The mass.gov press release.

John Clarkson sits in his apartment in Nantucket. (Sean Corcoran/WGBH)

 
NANTUCKET, Mass. — Nantucket is getting ready for summer — a busy time not just for vacationers but for the island's labor force. But there's a serious side to island living, especially for those residents who aren't employed all year round: a gap in health insurance that leaves some people without crucial coverage.
 
A $500 gap
 
The refrigerator in John Clarkson's small, one-bedroom apartment is adorned with magnets and to-do lists, while the cupboard above it is a virtual medicine cabinet.
 
"I got five different pill medications; my insulin, which is Atlantis; and another one for high sugar level; it lowers it real quick," Clarkson said. "That I don't have to take very often. I can't pronounce these names of the pills, but there are five different ones."
 
Even if he can't pronounce the names, Clarkson knows how much they cost — just under $500 a month. And that's a lot of money for a man who was out of work for nearly 2 years. When he got a job last December, Clarkson paid for his medicines out-of-pocket as he moved off unemployment insurance and on to the state's Commonwealth Care program.
 
"My biggest concern was my medication," he said. "I need my medication to stay alive."
 
Clarkson is 56 years old, and he grew up on Nantucket. He worked as a nurse's aide and then 5 years at a lumberyard before being laid off when construction slowed down. Clarkson put aside some money for retirement when he was making 19 dollars an hour at the lumberyard. But he said he can't afford too many more $500-a-month gaps in insurance coverage. 
 
"As I said, I was a year and 10 months looking for a job and I couldn't find one. I couldn't find one. I finally had to settle for working at Stop and Shop. Which is, it's work I guess. But I still don't have enough to pay rent. I still have to fall back on my savings," he said.
 
On Nantucket, where the labor force more than doubles from winter to summer, folks are going several weeks — and in some cases months — without health insurance as they switch from one government program to another.
 
The application process — and delay
 
Kathy Butterworth and Alex Rosenberg are health care advocates at Nantucket Cottage Hospital. They assist islanders as they navigate the various state and federally sponsored health insurance programs. They say the state is failing to live up to its goal of "health care for all," as coverage gaps of weeks or even months are common when people move from unemployment insurance to the state's Commonwealth Care programs.
 
"Oftentimes what happens is, people who are on unemployment, say they get a job. That unemployment insurance, that medical employment insurance plan, runs out like that. Snap. It just is gone," Butterworth said. "And suddenly the person is like, 'oh my goodness, I have no health insurance.' They come in to do an application. Those applications have taken as many as 68 days this year to be processed. They're a little bit quicker now, but over the winter, the time frame was somewhere between 60 and 68 days for many of our applications."
 
If coverage is approved, applicants like Clarkson must then meet strict deadlines or face more weeks of delay.
 
"Now you have to make a phone call that says, 'Yes, I do want that insurance.' You have to send in a payment. That takes another month, maybe two, depending upon how quickly you do that," Butterworth said.
 
The government perspective
 
Stephanie Chrobak is the director of program management at the Health Connector, the agency responsible for state-sponsored health insurance programs. Chrobak said she isn't surprised there are gaps in coverage. What surprised Chrobak was the length of time Nantucketers reportedly are without coverage.
 
"To me, the times you quoted seem to be much, much longer than I expect," she said. "Have I heard in general that there are these times when a member may be caught with a gap? Yes, I have. And certainly we currently try to minimize that, and I think the most important thing to know, as we move forward with federal reform — as we plan for federal reform in 2014 — there's a lot of work there to eliminate those gaps."
 
It's hard to say just how many Nantucket residents are experiencing month-long delays in insurance coverage. Unemployment ebbs and flows with the seasons on Nantucket, swinging from a low of about 3.4 percent in July to nearly 15 percent in the winter. Butterworth said it's often the same clients experiencing the same types of delays over and over again.
 
"This week we've probably both gotten at least 60 phone calls so far," she said. "At least. And we're busy. And part of the reason we're so busy is because we live in a community where people's jobs come and go constantly."
 
Months on insurance, months off
 
Miriam Lemus is a Nantucket mother of two young children, and she works 8 months of the year at a landscape company. She said she is constantly submitting pay stubs and paperwork, making phone calls and waiting for coverage to start.
 
"In December, I had to fight with them that they don't take it off, but they took it off," she said. "And now I have to do it again. I have to fight again for them to give it back to me. It's kind of hard for me, you know. Right now I think it's like 3 months already without insurance."
 
Rosenberg said she was helpless as she watched Lemus and other clients follow the state's procedures and do everything they can to get back on the Commonwealth Care program, but still experience months of costly delay.
 
"I sort of describe it as like they are both pointing at each other — so that when you're receiving benefits from one place to the other, they are both saying, 'Oh, no, sorry, I can't cover you. There are other federal or government or state-based funds that are supposed to cover you at this time period,'" Rosenberg said. "It seems to me you could combine them into one area that is health insurance and cover people who don't have other options for health care."
 
State officials said short coverage gaps as people move from unemployment insurance to the Commonwealth Care plan was a problem across the Commonwealth. But federal changes coming in 2014, they said, offer another opportunity to address coverage gaps and ensure continuous health care for all.

 
BOSTON — The Massachusetts Senate opened debate Tuesday on a sweeping bill to control the cost of health care in the state.
 
State Sen. Richard Moore (D-Uxbridge) kicked off a lengthy debate on the Senate floor, saying the cost of medical care is out of control.
 
"It’s certainly hurting individuals and their families by eating up so much cost and threatening medical bankruptcy, making hard choices between food and fuel and health care,” he said.
 
The bill would allow health spending to grow at a rate equal to or slightly above growth in the gross state product. Right now, health care costs have been growing at twice that rate. The bill would also set up a regulatory authority to oversee health care spending.
 
Republican minority leader Bruce Tarr of Gloucester said the bill was an example of government overreach.
 
"Why do we need to have bureaucracy blossom this spring faster than the apple trees around the State House?" he said. "I’m wondering why do we have these new agencies, these new authorities, these new reporting requirements?"
 
The House has yet to debate its version of the bill, which would be costlier to the health care industry. It would impose a somewhat tighter cap on overall health spending, and it would levy a tax on pricey hospitals. The Senate bill doesn’t include this penalty.
 
A final version of the health cost containment measure is not expected to emerge before July.
 

 
BOSTON — Massachusetts state Senate leaders released a proposal on Wednesday to drastically rein in the cost of health care. The House released a similar measure last week.
 
Both bills would impose a cap on overall health care spending and both would establish a regulatory authority to help doctors, hospitals and insurers meet the limits. If the bill passes, lawmakers say family premiums will fall by nearly $2,000 compared to forecasts in the next 5 years. 
 
The spending limits in the Senate bill are slightly less aggressive, but both bills would keep growth in health care spending in line with annual increases in the gross state product. That could mean deep cuts: Health care spending has been growing at least twice as fast as the state’s overall economy. 
 
Sandra Fenwick, the president of Children’s Hospital Boston, said hospitals are already bringing down costs on their own.   
 
“The question is, is this really much more proscriptive than it really needs to be rather than being supportive and encouraging of what’s already in place," she said. "That’s really what we were hoping government would do — is just encourage the progress that’s already underway as opposed to creating a mandated solution set.” 
 
Senate Ways and Means Chairman Stephen Brewer (D-Barre) expected some version of the bill to pass, despite pushback from hospitals, saying, "The plan the Senate has come out with has been worked out at tables, very large tables, for 2 years. At the end of the day, I expect we will get a bill on the governor’s desk and move forward." 
 
The Senate plans to debate the health care cost containment bill the week of May 14. The House could vote on its version of the bill around the beginning of June.