Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Wednesday, January 28, 2026

School Committee get preview of FY 2027 school budget with 2.5% increase, assuming health costs transfer to Town account (video)

The Franklin School Committee met as scheduled on Tuesday, Jan 27, 2026. All 7 members were present in the Council Chambers.

Franklin TV video is available for replay -> https://www.youtube.com/watch?v=2-UxhayAn6s



Quick recap
  • The committee and community got a preview of the FY 2027 school budget. Excluding the health care costs ($8.8M), they presented a 'level service' budget that stays within a 2.5% increase
  • The discussions with the Town to transfer the health care costs to the Town account 910 are in process. A Memo of Agreement (MOA) is being prepared to cover the details of the transfer. The Committee will schedule a special meeting to vote to approve the transfer next week

A copy of the presentation via photos captured during the presentation

FY 2027 school budget with 2.5% increase, assuming health costs transfer to Town account
FY 2027 school budget with 2.5% increase, assuming health costs transfer to Town account


Sunday, January 18, 2026

Governor Healey Takes Nation-Leading Action to Make It Easier, More Affordable for People to Get Health Care

Eliminates prior authorizations for essential care; announces Health Care Affordability Working Group to Further Lower Costs 

Continue reading the details in the full press release
Continue reading the details in the full press release
Today (1/14/26), Governor Maura Healey announced nation-leading action to make it easier and more affordable for Massachusetts residents to get the health care they need. The Division of Insurance (DOI) is issuing updated regulations to streamline prior authorization practices in the state, including eliminating prior authorization for many routine and essential services. These changes will reduce unnecessary delays and cut administrative burdens to make it easier, cheaper and faster for people to get the medications and care they need. Governor Healey also announced the creation of a Health Care Affordability Working Group charged with advancing proposals to reduce health care costs across the system, ultimately reducing costs for people and businesses across the state.

“Health care is too difficult and too expensive for far too many people,” said Governor Healey. “So we are taking the most comprehensive action in the country to make it faster, cheaper and easier to get the care you need. This is a moment of urgency, and today we are bringing together leaders from across health care, business and labor to find every possible step we can take to lower costs and improve health care in Massachusetts.” 


“This initiative is cutting unnecessary red tape that has delayed care for too many patients and drives up costs for our families and businesses,” said Lieutenant Governor Kim Driscoll. “If we are serious about lowering costs, we have to take on the waste and unnecessary barriers that are driving up the cost of health care.”

Prior authorization requires doctors to get approval from a patient's health insurance plan before providing a service or medication, which often causes long delays and increases administrative costs, which can be passed down to patients. DOI’s updated regulations streamline and standardize prior authorization practices across the health care system, reducing red tape and unnecessary barriers to care. The changes will eliminate prior authorization requirements for a wide range of services, such as emergency and urgent care services, primary care, chronic care, occupational and physical therapy and certain prescription drugs. The regulations also eliminate duplicative claims submissions and simplify approval processes, reducing administrative costs and burdens on doctors, hospitals and insurers and helping the system operate more efficiently while keeping the focus on delivering care.

For patients, these reforms mean faster, more reliable access to care and fewer delays caused by insurance paperwork. By eliminating prior authorization for many routine and essential services, requiring insurers to respond to urgent requests within 24 hours, and ensuring continuity of care when patients switch plans, the regulations reduce disruptions that can delay treatment or send patients unnecessarily to emergency rooms. Greater transparency and fewer administrative errors will also ease the burden on providers, allowing more time to focus on patient care, helping ensure people receive timely treatment when they need it most.

Some examples of how these updated regulations will impact patients include: 
  • A patient with diabetes will no longer need a prior authorization for any services, devices and drugs associated with their chronic disease.
  • A patient with rheumatoid arthritis who has an existing authorization for his treatment but recently switched to a new insurer will have that prior authorization honored for at least 3 months.  
  • An insurer will be required to respond to a prior authorization request from a multiple sclerosis patient experiencing a relapse and needing steroid injections to prevent permanent nerve damage within 24 hours.
  • A provider who recently diagnosed their patient with a new condition will more easily be able to identify if a prior authorization is required for a particular course of treatment.
Continue reading the details in the full press release -> https://www.mass.gov/news/governor-healey-takes-nation-leading-action-to-make-it-easier-more-affordable-for-people-to-get-health-care

Tuesday, January 6, 2026

Boston Globe: "Mass. municipalities & school districts hit hard by rising health insurance costs"

"Escalating health insurance costs turned into a budget nightmare this academic year for Pioneer Valley Regional School District Superintendent Patricia Kinsella. Between July and October, her district got hit with two double-digit increases, totaling nearly 40 percent.

Boston Globe: "Mass. municipalities & school districts hit hard by rising health insurance costs"
Boston Globe: "Mass. municipalities & school districts
 hit hard by rising health insurance costs"
The double whammy forced the district to lay off a librarian and eliminate three vacant positions. Paychecks for teachers and other employees who earn below statewide averages also shrank as they shouldered their portion of the premium increases.

“These were heartbreaking cuts to make,” Kinsella said. “None of us felt good about it.”

Across Massachusetts, school districts and municipalities are grappling with hefty health insurance increases, typically between 10 and 20 percent, and sometimes even more. The higher costs are pushing up annual health insurance spending by hundreds of thousands of dollars or millions of dollars."

Continue reading the article with this "share" link -> 

Tuesday, December 23, 2025

Rep. Auchincloss introduces bipartisan, bicameral legislation to force Pharmacy Benefit Managers to act in employees’ best interests

U.S. Representatives Jake Auchincloss (D, MA-04) and Ryan Mackenzie (R, PA-07), alongside Senators Roger Marshall (R-KS), Tim Kaine (D-VA), Chuck Grassley (R-IA) and Maggie Hassan (D-NH) introduced the bicameral PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act. This legislation would establish fiduciary responsibilities for pharmacy benefit managers (PBMs) – the middlemen of drug pricing – requiring them to act in the best interests of employees relying on employer-sponsored health plans, while keeping plan costs low.
U.S. Representatives Jake Auchincloss
U.S. Representatives Jake Auchincloss

Currently, PBMs that provide drug benefits for employer health plans often get away with price-gouging because they are not legally required to put employees’ interests first. The PBM FAIR Act would ensure these middlemen are classified as fiduciaries under law, which will help curb hidden fees and practices that drive up what employees pay for their medications.

PBMs are directly responsible for:
  • Marking up generic drugs at prices hundreds of times higher than actual cost,
  • Limiting patient choice, and
  • Denying claims with no or misleading explanations.
This bill reins in bad PBM practices and helps ensure employer-sponsored health care plans are affordable and accessible to all families.

“Instead of looking out for the best interests of employees, pharmacy benefit managers have been hitting them with prescription drug mark-ups, inconvenient pharmacy options, and wrongful denials,” said Congressman Jake Auchincloss. “This legislation puts force of law behind the best interest standard. The PBMs either improve access and affordability, or they'll pay out in lawsuits.”
                                                                                                                    
“Pharmacy benefit managers play a major role in determining what patients pay for their prescriptions, yet they often operate with little accountability,” said Congressman Ryan Mackenzie. “The PBM FAIR Act brings transparency to the system by requiring PBMs to act as fiduciaries under ERISA, ensuring that patients come first. By holding middlemen accountable we can also deliver lower healthcare costs to policyholders."

“For too long, middlemen have used opaque pricing and misaligned incentives to line their own pockets at the expense of employers,” said Senator Marshall. “PBMs shouldn’t profit by steering plans toward higher‑cost drugs or practices that drive up prices. This bill holds them accountable and ensures that every decision they make prioritizes the health and financial interests of the plans and people they serve.”

“Pharmacy benefit managers should be held accountable for their role in raising costs of prescription drugs,” said Senator Kaine. “This bipartisan legislation is critical to ensuring that PBMs are doing what’s best for Americans who rely on lifesaving medication.”

This legislation is supported by the ERISA Industry Committee (ERIC).

“Employers, workers, and families should be able to rely on those who provide services to employer-sponsored group health plans, such as pharmacy benefit managers, to adhere to the same fiduciary duties the employer is held to. That means working to save money for patients, and doing what is right for the plan’s beneficiaries. Today’s unregulated, “honor system” approach is not working. When PBMs are performing services on behalf of the employer, they are standing in the shoes of the plan sponsor and should be held accountable. ERIC applauds Representatives Auchincloss and Mackenzie, and Senators Marshall, Kaine, Grassley, and Hassan for leaving politics at the door and taking a bipartisan approach to clarify this important extension of current law,” said James Gelfand, President and CEO, ERIC.

The full text of this legislation is available ->   https://auchincloss.house.gov/imo/media/doc/pbm_fair_act.pdf

Monday, December 1, 2025

Boston Globe: "Massachusetts considers regulations for home care agencies caring for elderly"

"Doug Hano has struggled for years to find reliable care for his wife, Kirsten, who has early-onset Alzheimer’s disease.

Once a “rock star” in the advertising industry, Kirsten, 58, now needs help with most basic tasks, including dressing, taking a shower, brushing her teeth, and eating. A string of inexperienced or unreliable home care workers, one of whom was present when Kirsten tripped on a curb outside and fell, leaving her requiring stitches, have left Hano frustrated and heartbroken.

“Here I am trying to spend extra money for peace of mind or better service,” he said, “but it’s very clear that the availability of good folks is limited.”
Doug Hano helped his wife, Kirsten, in the kitchen of their home. Doug has struggled to find home care for Kirsten, who was diagnosed at age 53 with early onset Alzheimer's. Suzanne Kreiter/Globe Staff
Doug Hano helped his wife, Kirsten, in the kitchen of
their home. Doug has struggled to find home
care for Kirsten, who was diagnosed at
age 53 with early onset Alzheimer's. 
S
uzanne Kreiter/Globe Staff

In a state where barbers, manicurists, and massage therapists must be licensed, home care agencies providing nonmedical support are subject to shockingly little oversight, despite the profound vulnerability of the people who rely on them.

Massachusetts is one of only four states without a licensing process for private, nonmedical home care agencies, said Harrison Collins, director of legislative affairs for the Home Care Alliance of Massachusetts, an industry group representing about 200 agencies that provide help with the tasks of daily living, including bathing and toileting, household chores, and basic companionship."

Continue reading the article online with this link -> 


Sunday, November 23, 2025

Congressman Jake Auchincloss Introduces ACA Copay Cost and Affordability for Patients (CAP) Act

Congressman Jake Auchincloss (D-MA) introduced the ACA Copay Cost and Affordability for Patients (CAP) Act to limit annual prescription drug cost-sharing for patients enrolled in health insurance plans through the ACA Marketplaces. Millions of Americans with ACA Marketplace coverage struggle to afford necessary medications, often facing thousands of dollars in out-of-pocket costs before reaching their plan's maximum limit. 

A 2025 analysis by No Patient Left Behind found that health exchange plans have increased patients' prescription drug costs by an average of 36 percent since 2021. The same analysis estimated that 5.6% of enrollees had annual pharmacy out-of-pocket costs greater than $2,000, significantly higher than the $560.75 average in 2023. 

Congressman Jake Auchincloss
Congressman Jake Auchincloss

The ACA Copay CAP Act would allow health plans to retain the majority of their plan benefit design flexibilities, while patients and taxpayers receive greater value from their premium subsidies and improved access to lifesaving medications. 

The ACA Copay CAP Act would: 

  • Establish new out-of-pocket caps for prescription drugs: 
  • Starting in 2027, self-only coverage on the ACA would include a $2,000 cap per year for prescription drugs. 
  • Starting in 2027, family coverage on the ACA would include a $4,000 cap per year for prescription drugs. 
  • Increase the annual cap as premiums increase each year: 
  • Starting in 2028, the cap amount would increase each year based on the premium adjustment percentage set by the Secretary of Health and Human Services. 
  • Annual increases would be rounded down to the nearest $50 increment. 

"Insurance doesn't work if the co-pays and deductibles are unaffordable," said Congressman Jake Auchincloss. "When people pay premiums to insurance companies, they should be able to trust that the insurer will cover them when a doctor prescribes a drug they need. My bill is a step towards repairing that trust."

"While Republicans fail to extend the Affordable Care Act premium tax credits for working families, Congressman Auchincloss is working to reduce the cost of health care in the ACA," said Darbin Wofford, Deputy Director of Health Care at Third Way. "Thanks to the Inflation Reduction Act, seniors now pay no more than $2,000 a year in out-of-pocket drug costs. Third Way applauds Congressman Auchincloss's introduction of the ACA Copay Costs and Affordability for Patients (CAP) Act to extend that same protection to people in the ACA Marketplaces."

"This bill will provide life-saving financial relief to millions of families. As prescription drug prices in the United States continue to spiral out of control, forcing families to choose between the medication they need and putting food on the table, Big Insurance's pharmacy benefit manager subsidiaries are profiting handsomely," said Wendell Potter, President of the Center for Health and Democracy and Founder of the Lower Out-of-Pockets NOW Coalition. 

"Over the past decade, the seven largest publicly traded health insurers have reported more than $500 billion in profits, including $146 billion spent on stock buybacks—profits extracted in part from unaffordable cost-sharing requirements that patients face at the pharmacy counter., Health care should be about patients, not profits. Which is why Congress should advance this vital legislation without delay." 

"Though ACA enrollment is up nearly 80% since 2021, too many health plans offer 'coverage' in name only. Prescription drugs comprise just 10 cents of every dollar spent on health care. Yet from 2021 to 2023, insurers increased pharmacy copay costs for the average enrollee by 36%, and 5.6% of people had more than $2,000 in annual drug costs,"  said Peter Rubin, Executive Director of No Patient Left Behind. 

Patients and taxpayers expect premiums to pay for actual treatments. It is time to improve health plan quality. Thanks to Rep. Auchincloss and the ACA Copay CAP Act, we're one step closer to real truth in insurance by requiring health plans and their vertically integrated PBMs to provide meaningful consumer protections from unaffordable out-of-pocket drug costs."

The following organizations support the ACA Copay Cost and Affordability for Patients (CAP) Act: No Patient Left Behind, Third Way, Center for Health and Democracy, Grady Legal, PA, California Physicians Alliance, A Healthier WE, Health Action New Mexico, Triage Cancer, Courage California, Hemophilia Federation of America, Coalition of State Rheumatology Organizations, Arnall Golden Gregory LLC, Small Business Majority, Boomer Esiason Foundation, Doctors for America, Society of General Internal Medicine, Progressive Coders Network, and Patients Rising.

The full bill can be found HERE. 

Tuesday, March 4, 2025

SAFE Coalition: Exploring Collaborative Care


My Ombudsman Hosts In-Person Office Hours at Chris’ Corner – Recovery Resource Center in Milford on Mar 11 & Mar 20, 2025

My Ombudsman is pleased to announce upcoming in-person office hours at Chris’ Corner – Recovery Resource Center in Milford, MA. These office hours will take place on March 11, 2025 and March 20, 2025, from 10 AM to 2 PM. 

Community members will have the opportunity to receive direct assistance with their healthcare benefits, ask questions, and address any concerns related to their MassHealth plan.
My Ombudsman Hosts In-Person Office Hours
My Ombudsman Hosts In-Person Office Hours

At My Ombudsman, we work with individuals to help them access the benefits and services covered by their MassHealth plan. Our team listens to your concerns, gathers necessary information, and works with healthcare providers and MassHealth to resolve issues. We support anyone enrolled in MassHealth, offering assistance in over 165 languages upon request, including American Sign Language.

Event Details:
📍 Location: Chris’ Corner – Recovery Resource Center, 12 Main Street, Milford, MA
📅 Dates: March 11, 2025 and March 20, 2025
⏰ Time: 10:00 AM – 2:00 PM

To Schedule an appointment, call 508-552-8080/ walk-ins are welcome!
For more information about My Ombudsman and our services, visit myombudsman.org or contact us at our helpline at 855-781-9898 or videophone for Deaf and hard of hearing at 339-224-6831.

About My Ombudsman
At My Ombudsman, we help MassHealth members understand their healthcare rights and ensure they receive the care they need. We offer free, confidential support, including assistance in multiple languages, and work closely with providers to resolve concerns.

Saturday, January 11, 2025

Senator Rausch Makes Important Additions to Health Care Cost Containment Legislation

Today (Jan 8, 2025), State Senator Becca Rausch (D-Needham) joined legislative colleagues, health advocates, and members of the administration as Governor Maura Healey signed into law a pair of critical health care cost control bills, one aimed at pharmaceuticals and the other providing major health care sector oversight to protect Massachusetts residents from soaring health care costs. 

The laws respond directly to the Steward Health Care collapse and will offer patients financial relief by capping the prices of certain drugs, erecting guardrails against private equity in health care, and giving the Attorney General and state health regulators more oversight authority.  

"This health care cost containment legislation will help hundreds of thousands of Bay Staters avoid the stress and uncertainty of rapidly rising health care costs," said Senator Becca Rausch, lead sponsor of several bills included in the final package. "More than 40% of Massachusetts residents have trouble paying for health care for themselves or their families. That is unacceptable. The strong oversight and reporting measures signed into law today will improve affordability and accessibility to Massachusetts' world-class health care. I'm so proud that my legislation to give the Health Policy Commission more tools in its cost oversight toolkit was part and parcel of this package. I am truly grateful to Senate President Karen Spilka, Senator Cindy Friedman, and our partners in the House for persevering on this legislation until it crossed the finish line, and to Governor Healey for signing these two bills into law."  

The Health Policy Commission (HPC) is an independent state agency that monitors health care spending growth annually and sets a reasonable target for that growth. Senator Rausch's language allows HPC to exercise its oversight authority if a provider's total health care expenditures grow at a faster rate than the benchmark and streamlines the oversight of providers who significantly expand their scope of care. Providers will have to issue advance notice of material changes, including mergers and acquisitions, so HPC can assess whether they may substantially impact health care spending.  

Additionally, the suite of bills that became law today expand the scope of data collection and public review of health care and related transactions by regulators, increase visibility and accountability for transactions involving private owners of health care resources, enhance data sharing requirements to improve transparency around health care entities and their ownership, and begins the process of improving access to primary care statewide. Today's legislation reemphasizes the Commonwealth's commitment to prioritizing patients over profits. 

Gov Healey "signed two bills to cut prescription drug costs and make sure patients always come before profit"
Gov Healey "signed two bills to cut prescription drug costs and make sure patients always come before profit"

Friday, September 13, 2024

Catching up with Franklin's Health Director Cathleen Liberty (audio)

FM #1279 = This is the Franklin Matters radio show, number 1279 in the series. 


This session of the radio show shares my conversation with Health Director Cathleen Liberty  September 4, 2024. We had our conversation via the Zoom conference bridge.


The recording runs about 36 minutes, so let’s listen to my conversation with Cathleen Audio link -> https://franklin-ma-matters.captivate.fm/episode/fm-1279-franklin-ma-health-director-cathleen-liberty-09-04-24/



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Health Dept page  https://www.franklinma.gov/health-department


Metacomet Health page -> https://www.metacometpha.org/


Health Dept Homeless Resource page -> 

https://sites.google.com/view/homeless-resources-services/home 


Sign up for Health alerts via Regroup -> https://franklintown.regroup.com/signup 


The Topic podcast ->  https://www.franklinma.gov/health-department/pages/topic-podcast-links 


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We are now producing this in collaboration with Franklin.TV and Franklin Public Radio (wfpr.fm) or 102.9 on the Franklin area radio dial. 


This podcast is my public service effort for Franklin but we can't do it alone. We can always use your help.

 

How can you help?

  • If you can use the information that you find here, please tell your friends and neighbors

  • If you don't like something here, please let me know


Through this feedback loop we can continue to make improvements. I thank you for listening.

 

For additional information, please visit Franklinmatters.org/  or www.franklin.news 


If you have questions or comments you can reach me directly at shersteve @ gmail dot com


The music for the intro and exit was provided by Michael Clark and the group "East of Shirley". The piece is titled "Ernesto, manana"  c. Michael Clark & Tintype Tunes, 2008 and used with their permission.


I hope you enjoy!

------------------


You can also subscribe and listen to Franklin Matters audio on iTunes or your favorite podcast app; search in "podcasts" for "Franklin Matters"


Sunday, September 8, 2024

Chair Mercer condenses the Sep 4, 2024 Town Council meeting in this Quarterbacking session (audio)

FM #1272 = This is the Franklin Matters radio show, number 1272 in the series. 


This session of the radio show shares our “Town Council Quarterbacking” with Town Council Chair Tom Mercer. We had our conversation via the Zoom Conference Bridge on Thursday, September 5, 2023.  


ok, what just happened? 

What does it mean for Franklin residents and taxpayers?


Topics for this session

APPOINTMENTS

a. Conservation Commission: Lui Puga (term expiration correction to 2026)

b. Council on Aging: Tina Powderly

c. Finance Committee: Ken Ojukwu

d. Franklin TV Board of Directors

i. Anne Bergen

ii. William “Ken” Norman


a. Vote to reopen the June 26, 2024 Public Hearing: Transfer, Change of Location, Pledge of Collateral and Approval of Manager of a Section 15 Wine and Malt Beverages Package Store License: Rye's Wine Incorporated d/b/a Pour Richard’s Wine & Provisions Located at 835 West Central Street, Suite 2, Franklin, MA 02038

b. Vote to reopen the June 26, 2024 Public Hearing: Transfer, Change of Location and Approval of Manager of a Section 15 All Alcoholic Beverages Package Store License: Mormax Corporation d/b/a BJ’s Wholesale Club Located at 100 Corporate Drive, Franklin, MA 02038


PRESENTATIONS / DISCUSSION

a. Pete Fasciano - Franklin TV


Chapter 61B Right of First Refusal on Maplegate Country Club

https://www.franklinma.gov/sites/g/files/vyhlif10036/f/uploads/memo_-_chapter_61b_right_of_first_refusal_on_maplegate_country_club.pdf 


c. Davis-Thayer Reuse

https://www.franklinma.gov/sites/g/files/vyhlif10036/f/uploads/8c._1_-_memo_-_davis_thayer_reuse.pdf 


c. Resolution 24-55: Health Care Group Insurance Transfer

(Motion to Approve Resolution 24-55 - Majority Vote)


d. Resolution 24-56: Gift Acceptance - Recreation Department ($2,000)

(Motion to Approve Resolution 24-56 - Majority Vote)



The recording runs about 32 minutes. Let’s listen to my conversation with Tom on Thursday, September 5, 2024. Audio link -> https://franklin-ma-matters.captivate.fm/episode/fm-1272-town-council-quarterbacking-09-05-24/



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Town Council agenda Sep 4, 2024

https://www.franklinma.gov/sites/g/files/vyhlif10036/f/agendas/2024-09-04_town_council_agenda_0_0.pdf 


Franklin TV video is available for replay ->    https://www.youtube.com/live/eZ51XEq57_U?si=DnXqGMfyZU1OEX7S&t=89


Town Council recap -> https://www.franklinmatters.org/2024/09/town-council-reopens-hearing-to-approve.html 


My notes captured during the meeting and now in one PDF file ->

https://drive.google.com/file/d/1ojJYhfyLslZxv7XQ8dhevA3R0jMyHcj5/view?usp=drive_link


--------------


We are now producing this in collaboration with Franklin.TV and Franklin Public Radio (wfpr.fm) or 102.9 on the Franklin area radio dial.  


This podcast is my public service effort for Franklin but we can't do it alone. We can always use your help.


How can you help?

  • If you can use the information that you find here, please tell your friends and neighbors

  • If you don't like something here, please let me know


Through this feedback loop we can continue to make improvements. I thank you for listening.


For additional information, please visit Franklinmatters.org/ or www.franklin.news/


If you have questions or comments you can reach me directly at shersteve @ gmail dot com


The music for the intro and exit was provided by Michael Clark and the group "East of Shirley". The piece is titled "Ernesto, manana"  c. Michael Clark & Tintype Tunes, 2008 and used with their permission.


I hope you enjoy!

------------------


You can also subscribe and listen to Franklin Matters audio on iTunes or your favorite podcast app; search in "podcasts" for "Franklin Matters"



right of first refusal on the Maplegate Country Club property was previewed
right of first refusal on the Maplegate Country Club property was previewed