More than a million low-income Massachusetts residents covered by Medicaid will be required to pay more for doctor visits and receive prior approval for some medications under a plan announced today by the Patrick administration to begin to close a $307 million shortfall in the state's MassHealth program.

Some of the biggest changes will come in dental care for adults, who will no longer receive dentures or other oral care except for cleanings, X-rays and emergency services. That change, alone, is expected to save about $15 million this fiscal year, said interim Medicaid director Terence Dougherty.

The state will also stop paying for personal care attendants for patients requiring these in-home aides less than 15 hours a week.

By Kay Lazar, Globe Staff

Insurers would not be allowed to cap prescription drug benefits or deny maternity coverage for their customers' dependents under proposed regulations that would tighten minimum state standards for health plans.

The rules, given initial approval today by the panel that oversees the state's pioneering health insurance law, will undergo a public hearing in November before a final vote scheduled for December.

The Connector Authority deferred action, however, on a proposal to limit how much residents pay out of their own pockets each year for medications.

Governor Deval Patrick makes the case for fashioning a new national health-care system based on what Massachusetts has accomplished and what remains to be done.

Writing in the opinion section of today's Wall Street Journal, the Democratic governor recalls cooperation among a Democratic senator, Republican governor, and Democratic legislature working with partners in health care, labor, and business to pass a 2006 law mandating near-universal health insurance coverage. He disputes the impression that the "Massachusetts experiment" comes with costs that are too high, citing Massachusetts Taxpayers Foundation data on only moderate increases to the state budget.

"As more of our residents have become insured, there has been a decrease in demand for costly emergency-room care. Even in the midst of the current economic downturn, our state budget was balanced," he writes. "But the real issue is not the incremental costs of expanding coverage. It's the fact that medical costs even for those who have always had insurance are rising too fast."

That's where alternatives to traditional fee-for-service payments can help, he says, pointing to a state commission that recently proposed global payments as a way to reduce medical spending.

"As we work to translate this vision into practice, health care in the state will just get better," Patrick writes. "At the national level, nothing will happen if we fear change. But innovation can work for everyone if we give President Barack Obama and congressional leaders a chance to do what we have done in Massachusetts."

The state agency charged with helping people gain health insurance after a landmark law mandated near-universal coverage has won a national award from a Harvard institute, the university announced today.

The Commonwealth Health Connector Authority has won one of six 2009 Innovations in American Government awards, an annual competition administered by the Ash Institute for Democratic Governance and Innovation at Harvard's Kennedy School of Government. The Connector will also receive a $30,000 grant.

The Connector is a public-private entity that offers Commonwealth Care, which subsidizes health insurance for people who cannot afford individual insurance plans, do not have employer-sponsored coverage, and are not eligible for Medicaid. The Connector also offers Commonwealth Choice, which helps consumers and small businesses to find commercial insurance plans.

Since the Massachusetts health insurance law passed in 2006, uninsured adults have dropped from 10.4 percent to 2.6 percent in 2008, according to the Connector.

The other winners are:

Data Feeds: Democratization of Government Data, Washington, D.C.
Higher Education Initiative, Kingsport, Tenn.
Mapping Evapotranspiration, state of Idaho
New Leaders for New Schools, Chicago Public School District
Wraparound Milwaukee, Milwaukee County, Wisc.

Here's the Ash Institute's YouTube site for more on the winners (the Connector is second).

Two and a half years after Massachusetts passed a law mandating near-universal health insurance coverage, the number of working-age adults with insurance has continued to climb, employer-sponsored insurance has gone up, and approval ratings remain constant, according to a new report by the Urban Institute with implications for the national debate on revamping the country's health care system.

The study, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, found that 4 percent of adults under age 65, or about 162,000 people, were uninsured in the fall of 2008, compared to 7 percent in fall 2007 and 13 percent in fall 2006. Uninsured people tended to be under 35, male, single, and healthy. Most said they had trouble affording insurance.

Despite fears that employers would drop insurance plans for their workers when public coverage was offered, adults covered by employer-sponsored plans rose to 71 percent in 2008, up slightly from 69 percent in 2007 and 67 percent in 2006.

Approval ratings have stayed about the same at 72 percent of adults, up from 61 percent in 2007 and 68 percent in 2006.

Many of the features President Obama mentioned in his speech about remaking the nation's health care system have parallels in the Massachusetts model enacted in July 2006.

In addition to the Blue Cross Blue Shield Foundation, the study was also funded by the Commonwealth Fund, and the Robert Wood Johnson Foundation.

Two new reports on what the Massachusetts health coverage law has meant for consumers were released in Washington today at a forum held by the Kaiser Family Foundation.

Consumers’ Experience in Massachusetts: Lessons For National Health Reform and In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts look at the availability and affordability of coverage after a 2006 state law mandated near-universal coverage.

Researchers from the Boston-based Access Project working with Kaiser found that although more people have insurance coverage, many people ineligible for state-subsidized insurance are struggling to pay for insurance offered by their employers. Out-of-pocket payments are a burden, particularly for people with chronic conditions, the researchers also found.

By Stephen Smith, Globe Staff

Massachusetts Governor Deval Patrick announced this morning that 31,000 legal immigrants whose state-subsidized health insurance was set to expire this week have received a last-minute reprieve -- although their coverage will not resume until October.

Using $40 million in emergency money designated by the Legislature, Patrick's health and insurance czars reached an agreement with CeltiCare Health Plan of Massachusetts, a subsidiary of Missouri-based Centene Corp., to provide basic medical care for the immigrants through its health care network.

"It's been a daunting challenge to preserve the promise of health care reform for this constituency," Patrick said in a conference call with reporters.

Massachusetts and its health coverage law continue to be under the national spotlight during the debate on revamping the country's health care system.

The Wall Street Journal's Health Blog decided to ask John Auerbach, commissioner of the state Department of Public Health, whether he thinks health has improved here since the law mandating near-universal coverage was passed in 2006.

Yes, Auerbach answers, and gives three reasons why: Smoking rates have gone down, colonoscopies have gone up, and more flu shots were given than ever, all signs that people were getting care they might not otherwise have received without being insured.

By Michael Paulson, Globe Staff

Caritas Christi Health Care, the financially challenged Catholic hospital system founded by the Archdiocese of Boston, is abruptly ending its joint venture with a Missouri-based health insurer at the insistence of Cardinal Sean P. O'Malley, who has decided that the relationship represented too much of an entanglement between Catholic hospitals and abortion providers.

The dramatic development, just days before the joint venture was scheduled to start providing care to low-income residents as part of the state's efforts to establish near universal health coverage here, is a vindication of sorts for a variety of very conservative Catholic critics of the cardinal, who have been arguing angrily and loudly that it would be "evil" for Caritas to partner with a health provider that covers abortion services.

The development is also a setback for Caritas, because it represents the undoing of one of the most significant steps its new chief executive, Dr. Ralph de la Torre, had announced as part of his efforts to turn around the hospital system's finances. It was not immediately clear last night what the financial impact of the change is on Caritas, but the decision is a stark and public reminder from O'Malley to de la Torre and the general public that moral concerns will trump monetary concerns at the Catholic hospitals.

By Elizabeth Cooney, Globe Correspondent

CAMBRIDGE -- Massachusetts will use $764 million from the federal stimulus package to shore up healthcare services and prevent further job and program cuts at hospitals that serve large numbers of poor patients, Governor Patrick said today.

The money, which is coming to the state through the Medicaid program, will also enable the state to preserve current benefits and eligibility levels for MassHealth recipients, and for residents who get subsidized health insurance under the 2006 law mandating insurance coverage. A reserve fund will be set up to meet anticipated increases in demand for the programs driven by the economic downturn.

Other programs for people with mental illness and disabilities will also see an infusion of funds, as will public health, youth services, and agencies serving children and families, the administration announced.

"We've had to make cuts, that's true. But thanks to the recovery funds, we have softened some of the blow," Patrick told an overflow crowd yesterday afternoon at Cambridge Hospital. "We can't avoid every tough decision in health and human services .... But we are doing everything we can to minimize the impact on the populations that depend on you and your government more in times like these."