Sellers Dorsey & Medicaid News Archive

Nine Percent in South Dakota Lack Coverage

admin@sellers-feinberg.com (Terry Woster) — Fri, 15 Jun 2007 12:00:00 GMT

State Task Force Studies Health Reform Options

The Zaniya Task Force, created by the last session of the South Dakota Legislature, is working to extend access to health insurance to every South Dakotan. Sellers Feinberg's suporting role to the Task Force, as it looks at healthcare and health insurance reform, is highlighted in this recent article.

To read the article, click on the link above.

Colorado Healthcare Commission Selects SEIU Proposal

admin@sellers-feinberg.com (A Project of SEIU and CAPE) — Fri, 08 Jun 2007 12:00:00 GMT

A message from Martin Sellers, CEO

The Colorado Blue Ribbon Commission for Health Care Reform recently selected a proposal submitted by the Service Employees International Union (SEIU) as one of four proposals, from 31 submitted to the Commission, for further review and analysis. From this review, the Commission will propose a final plan for consideration by the Governor and the state legislature. SEIU's project partner is the Colorado Association of Public Employees (CAPE).

We commend SEIU for leading the way in Colorado healthcare reform. Sellers Feinberg is excited to have been part of this important work and to have served as consultants to SEIU in the development and preparation of its proposal.

As the final four proposals undergo detailed modeling and analysis over the next six months and then are sent to the 2008 General Assembly, we will eagerly await the outcome and are grateful to be a part of the process.

To access the full SEIU proposal, you may click on the link above.

Martin D. Sellers
CEO
Sellers Feinberg LLC
msellers@sellers-feinberg.com

Governor Gregoire Signs Legislation on Healthcare Reform

admin@sellers-feinberg.com (Martin Sellers, CEO ) — Mon, 07 May 2007 12:00:00 GMT

Governor Gregoire Expands Health Insurance
and Reduces Healthcare Costs

A message from Martin Sellers, CEO

On May 2nd, Washington State Governor Christine Gregoire signed into law a bill aimed at expanding health insurance coverage and reducing healthcare costs. For being a champion of the health interests of the citizens of Washington, and for taking this important step in accomplishing comprehensive reform - Governor Gregoire we congratulate you.

The governor's reform measure, based on recommendations made by the Blue Ribbon Commission on Health Care Costs and Access, will give more state residents improved access to quality healthcare - and offer new and better ways of providing and paying for it. Sellers Feinberg is privileged to have been able to serve as consultants to the Commission in the development of its recommendations for a sustainable five-year plan.

Because of the commitment and excellent work done by the Governor and the state legislature, the State of Washington now joins the ranks of a select few at the leading edge of state-based solutions to the nation's healthcare situation.

With such resourcefulness and creativity, the Governor moves toward fashioning a state-based approach that can serve as an effective national model for covering the uninsured and improving the quality and efficiency of America's healthcare system.

We at Sellers Feinberg are committed to working with states and the federal government to dramatically reduce our nation's number of uninsured and again express our appreciation to the Governor for including us in the process.

Martin D. Sellers
CEO
Sellers Feinberg LLC
msellers@sellers-feinberg.com

BNA's Health Care Policy Report: The Impact of Massachusetts Medicaid Reform Throughout the Nation

admin@sellers-feinberg.com (Martin D. Sellers) — Mon, 11 Dec 2006 12:00:00 GMT

The Impact of Massachusetts Medicaid Reform throughout the Nation

By Martin D. Sellers, CEO, Sellers Feinberg & Associates

In the not too distant past, health care reform, real reform aimed at radically increasing access to affordable health insurance for all, seemed to be at an impasse. Over the years, some well-intentioned attempts to revise the health system have been made with varying degrees of success (including Hawaii, Minnesota, Vermont, New Hampshire, Maine and California), but all came short of the transformational change states so desperately need.

Today, states all across the U.S., both red and blue, still desire the kind of marketplace revolution that brings real-world, practical results. They are looking to reduce their number of uninsured and protect employer-sponsored insurance through a variety of approaches that combine Medicaid options, insurance reform, market-based competition, better managed care and improved consumer responsibility.

Without major changes to the health care system, low-income Ameri¬cans' access to affordable health insurance is at risk. And as most health care experts and thought leaders will acknowledge, when addressing big issues and policy challenges, effective reform (i.e. sustainable long-term solutions) must be driven by sound public policy that deftly balances public sector mandates with private industry objectives.

As governors and state legislatures are and have been passionately interested in expanding health care coverage, the advent of Massachusetts' recent plan now offers proof that universal coverage is indeed possible. With the serious need to address Medicaid and health care reform remaining, the Massachusetts-style reform has sparked a reemergence of state-based solutions to a pervasive, complex problem.

States are eager to understand how Massachusetts' bipartisan legislation combines the concept of personal responsibility through an individual mandate on the purchase of health insurance with government subsidies to ensure affordability. Governors and their top staff are certainly curious to see if - whether in part or in whole - the big idea emerging in the Northeast can be adapted to their situations and effectively work in tandem with policy solutions tailored to their own unique circumstances.

The action taken by the Commonwealth of Massachusetts this year has encouraged a vigorous national debate not just throughout federal and state governments but among industry stakeholders and the general populace about how to successfully address the country's problem of the uninsured.

ENTER MASSACHUSETTS
With health care costs skyrocketing and the nation's uninsured population swelling to 46 million, frustrated states have taken matters into their own hands, not willing to adopt a "wait and see" attitude with regard to ongoing efforts in Washington. Massachusetts, like many states, has been continually working to find a way to provide access to affordable health care for its uninsured population.

In April 2006, Massachusetts announced that through determined work and inventive thinking it had discovered a breakthrough solution that would allow the Commonwealth to expand health coverage to nearly all those who need it and to realize innovative changes in Medicaid, transforming it into a more impactful program.

This caught the attention of the Centers for Medicare & Medicaid Services (CMS), which allowed the Commonwealth to keep $385 million in federal funds (through its s. 1115 waiver). Expertly navigating through all aspects of the Medicaid financing component was critical to the identification of alternate terms under which these dollars could be retained.

Simply put, the Massachusetts solution provided a new approach to achieving universal coverage by incorporating sound thinking from government policymakers, public & private sector providers, advocacy organizations and industry stakeholders.

Due to the nature of the political dynamics within the Commonwealth and the potential risks for the main safety net providers - Massachusetts' major hospitals, any discord between these parties would have derailed the proposal.

In fact, it is this broader vision that grabbed the interest of the federal government and encouraged it to help Massachusetts redirect funds away from hospitals providing unmanaged care directly to uninsured individuals and reformulate these dollars as subsidies to purchase private health insurance.

Now, Massachusetts is promising to deliver universal coverage (with individual mandates) in an environment where government ensures the availability of affordable coverage for all and provides subsidies through Medicaid, relying on the private market and competition to suppress costs and increase quality.

Governor Mitt Romney, his administration, a team of state and federal lawmakers from both parties and the lead consultants at Sellers Feinberg were able to develop a plan designed to reduce the growth in overall health care costs, increase provider reimbursements and improve coverage and care for a large portion of the Commonwealth's uninsured people, approximately 420,000.

It is important to note that all participants in the process understood this reform effort with its promise of universal coverage would not succeed unless the final plan was truly comprehensive. Therefore, Massachusetts worked to ensure that certain efforts were made to contain provider costs, modernize the health delivery system and improve the mandates placed on insurers and employers.

While employers remain the primary source of insurance for individuals and families, the architects of the new law made certain a key principle - the individual mandate - was an integral component of the reform. As such, all residents must obtain health insurance by July 1, 2007.

The individual mandate requires that people who can afford insurance buy it. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they will have to pay a penalty that could be as high as 50 percent of what an affordable health care premium would cost.

The central mechanism by which health insurance is purchased and provided, the Commonwealth Care Health Insurance Connector, will be a clearinghouse linking groups of people and businesses to pools of private insurance plans and products. The Connector, a quasi-governmental entity that is state-appointed (but independently run), will help make insurance more affordable by banding people together to secure discounted group rates.

To further encourage the purchase of insurance, the plan provides public subsidies for low-earning families on a sliding scale according to income level. Residents making less than 300 percent of the federal poverty level, who are currently not eligible for Medicaid, will receive government-funded premium assistance to aid their purchase of private insurance plans. Those with incomes above 300 percent of the federal poverty level will be able to purchase new lower-cost policies from private health insurance companies through the Connector.

The Massachusetts' reform agreement has caught the attention of elected officials and health care stakeholders across the country, and many are engaged in new efforts to determine what is possible in their states. Since Massachusetts revealed its plan, many want to know if this dramatic reform can be recreated in their state or even nationwide.

Not only is the significant restructuring of health care good social policy, but as it now has the potential to drive the market in a new direction, it engenders good economics as well. With its sweeping proposal for comprehensive Medicaid and health care reform, the success of Massachusetts' plan has launched the Commonwealth into the spotlight - leading many to wonder if Massachusetts' approach will emerge as a national model for states seeking similar reform initiatives.

WHAT ABOUT OTHER STATES?
While Massachusetts continues to move forward with its ambitious plan to provide health coverage to its uninsured residents, other states are trying to find answers to the same problem. Could the effort being undertaken in the Northeast work in other areas of the country? Each with its own distinct challenges and obstacles to overcome, states are being inspired by the Commonwealth's all-encompassing compromise and are examining whether elements of the Massachusetts model will work in their own states.

MICHIGAN
Since taking office in 2003, recently re-elected Governor Jennifer M. Granholm has worked to reduce health care costs and expand access to health care in Michigan. Through her administration's efforts, she has extended affordable prescription drug coverage and health care coverage to more than 292,000 people and streamlined the State's Medicaid system, allowing for greater coverage at significantly reduced costs.

Governor Granholm announced earlier this year that she wants to dramatically reduce the number of uninsured individuals in the State. For Michigan, this means insuring the State's 1.1 million uninsured through the Governor's proposed Michigan First health care Plan, and providing subsidized premiums to enable improved access to affordable health care coverage.

The Governor's plan would establish an Exchange (a Connector-type entity) to help to provide access to affordable private insurance products for individuals and small businesses. Her proposal would provide premium subsidies for people to buy private insurance through the Exchange and would cover adults with incomes up to 200 percent of the poverty level.

WASHINGTON
Governor Christine Gregoire is also considering major health care reform for Washington State. Currently, the Governor co-chairs the Washington Blue Ribbon Commission on health care Costs and Access, which is exploring ways to deliver accessible, affordable, quality health care for all Washingtonians. Today, the State believes its health care system does not sufficiently meet these quality-of-life concerns.

By the end of December 2006, the Blue Ribbon Commission must recommend a sustainable five-year plan to substantially improve access to affordable health care for all Washington residents. Over the course of the next five years, the Legislature will move to implement the vision of the Commission to create a health care system that provides every Washingtonian the ability to obtain needed health care at an affordable price.

Presently, Washington provides health care to about 1.3 million children and adults. The State's projected cost for health and health-related programs will be $4.5 billion in 2006, which is nearly 28 percent of all State expenditures. One of many reasons to reform the State's system is to enable it to provide high-quality health care at lower costs. Many hope such reform will also positively impact the manner in which private sector health care systems operate in the Washington marketplace.

By 2012, the Commission envisions a system that will provide every Washingtonian the ability to receive necessary health care at an affordable price (all children should be covered by 2010). To realize this vision, both public and private sectors in Washington will need to significantly improve access to affordable health coverage while advancing the overall well-being of citizens through preventive medicine and wellness programs.

NEW MEXICO
This summer, New Mexico Governor Bill Richardson proposed a major Medicaid expansion and possible universal coverage for all residents of his State. Depending on the findings of the commission he appointed to explore universal insurance coverage options, expected next year, New Mexico may embark on a proposal to provide universal health care by 2008.

In addition to appointing the task force, Richardson's proposal included four other major elements. First, New Mexico would phase in employer-sponsored health insurance benefits for companies doing business with the State. Second, the State would determine the number of State government employees who lack health coverage. Currently, if employees decline enrollment, the State doesn't check to see if they have coverage through a spouse or other entity.

Next, New Mexico would look to maximize its Medicaid coverage. For fiscal year 2008, Richardson will seek funding to increase coverage for adults through a two-year, phased-in approach. The initiative will be specifically designed to help low-income adults earning up to 100 percent of the federal poverty level.

And finally, Richardson would expand the State's insurance coverage program to help more working adults, raising coverage to those individuals under 300 percent of the poverty level with cost-sharing based on income. Expanding this public/private partnership with small employers will help cover working New Mexicans who currently do not have access to reasonably priced insurance.

INDIANA

This month Governor Mitch Daniels of Indiana proposed a simple yet original health plan that would provide health insurance coverage for more than 100,000 Hoosiers, reduce smoking rates and immunize more Indiana children. The health initiatives would be funded by an increase in the State's cigarette tax.

An estimated 14 percent of Indiana's population, more than 550,000 individuals, currently has no health insurance. The proposed plan would be funded by an increase in the State's cigarette tax - which is the 36th lowest rate in the country - and a variety of federal funds.

The governor has suggested an increase of at least 25 cents but will ask the legislature to determine the precise amount. The number of uninsured who could receive coverage would increase based upon the size of the cigarette tax increase. With a 25-cent increase, it is estimated up to 120,000 people could receive coverage. With a 50-cent increase, about 200,000 could receive coverage.

The governor's three-part health insurance coverage plan would help Hoosiers who can least afford coverage. It would be available to those who earn less than 200 percent of the federal poverty level and who are without employer-sponsored health insurance. If the plan receives approval by Indiana's General Assembly, the proposed effective date would be January 1, 2008.

STATES CONTINUE TO LEAD REFORM
Medicaid is rapidly changing, and Governors are leading state-based Medicaid and health care reform across the country. Even as Congress enacts major changes at the federal level, including the new opportunities provided in the Deficit Reduction Act of 2005, the pace of reform is likely to accelerate in the coming years.

Now that the 2006 mid-term election results are in, so is the very real possibility that come January the Democratic-held Congress may work to reinvigorate its own brand of national health care reform - even as many states pursue their own initiatives. It will remain to be seen whether any such movement at the federal level will work in tandem with the states' efforts.

Following Massachusetts' health care transformation, states across the country have been taking bold and creative steps to improve health care for their own residents. Governors, operating as the country's agents for change just as they did with welfare reform, are modeling different, effective ways to expand health coverage to specific groups of people who need insurance but cannot afford it.

In the past, "state health care reform" meant expanding public programs to cover tens of thousands of uninsured. Now, Governors are considering reforms that would cover hundreds of thousands of previously uninsured persons by using a combination of public and private sector approaches.

Oftentimes, states have been the ones to develop and implement new policy solutions. The current health reform environment is no different. As state legislatures convene in 2007, the challenge may well become balancing their desire to move forward with waiting to see if transformational change will be adopted at the national level. Many will argue that it is the states that must continue to lead.

Reproduced with permission from BNA's Health Care Policy Report, Vol. 14, No. 48 (Dec. 11, 2006).

Top State Officials Join Sellers Feinberg

admin@sellers-feinberg.com () — Thu, 07 Dec 2006 12:00:00 GMT

Firm Adds Industry Experts from Pennsylvania and Wisconsin

PHILADELPHIA (December 7, 2006) ~ Sellers Feinberg & Associates announced today the addition of two former state healthcare officials to its staff. Patricia Brady - former deputy secretary for Pennsylvania's Office of Long Term Living, and Margaret Kristan - former director of Health Information and Policy for Wisconsin have signed on as senior consultants at one of the leading healthcare consulting and government relations firm in the United States.

Since 2004, Pat Brady has served in several key positions under Pennsylvania Governor Edward G. Rendell - most recently as the Deputy Secretary for the Office of Long Term Living in the Department of Public Welfare. Prior to her latest appointment by the governor, Ms. Brady was the director of the Bureau of Longer Term Care (LTC) Programs for Pennsylvania where she established herself as a top state authority on providing cutting-edge LTC solutions to the Commonwealth. While there, she integrally supported Pennsylvania's extensive efforts to significantly address the specific needs of its residents requiring long term care.

Under Ms. Brady's strategic guidance, the Commonwealth initiated a number of data-driven, LTC initiatives including a benchmark study on demand and supply to help PA prepare for the aging baby boomer generation. This first-of-its-kind study and projection model will be an invaluable long-term planning tool for the Commonwealth's home and community-based nursing facilities.

In anticipation of PA's growing LTC population, further state program enhancements achieved during Ms. Brady's tenure include the development of an infrastructure for home and community-based services, budgetary oversight and efficient use of state resources, seeking federal financing participation and negotiating nursing facility reimbursement changes to support efforts that provide consumers with the choice between receiving care at home or in a nursing facility.

Ms. Brady looks forward to the opportunities ahead of her as part of a national healthcare consulting firm also keenly interested in bringing innovative solutions to the healthcare marketplace. She will be based in Sellers Feinberg's Harrisburg office and support both the firm's public and private sector clients. "I am excited that I will now be able to use my public and private sector experience to help other states and private businesses tackle their healthcare challenges," states Brady.

Marty Sellers, CEO of Sellers Feinberg agrees. "As we work with governors and others in modifying their strategies for Medicaid and covering the uninsured, we see that they are increasingly willing to creatively accomplish healthcare reform that provides real-world results. People like Pat Brady and Margaret Kristan typify those with the exceptional talent to originate solutions that successfully combine public policy mandates with private sector objectives."

Margaret Kristan, with more than 20 years of experience administering state healthcare programs and policy for both Republican and Democrat Administrations in Wisconsin, is an industry expert proficient in the design, development and implementation of state-level programs that serve low-income or uninsured individuals. Before joining Sellers Feinberg, Ms. Kristan was the director of the State of Wisconsin's $200 million high-risk health insurance program, the Health Insurance Risk Sharing Plan (HIRSP).

HIRSP provides health insurance to Wisconsin residents unable to obtain health insurance through the commercial market because of pre-existing medical conditions, who are on Medicare because of disability, those who have HIV/AIDS and those who qualify for coverage under federal Health Insurance Portability and Accountability (HIPAA) regulations. There, she directed all aspects of plan operations, including state and federal regulatory compliance, benefit design and administration, pharmacy benefit management and administration, financial management, claims processing and customer service. She was instrumental in saving the program millions of dollars by taking advantage of the opportunity to establish the plan as a state pharmacy assistance program under Medicare Part D.

In addition, Ms. Kristan also served as the Director of the Wisconsin's Bureau of Health Information and Policy. During her tenure, she directed the state's vital records system as well as the collection and analysis of all public data on the uninsured.

Sellers Feinberg is a market-leading U.S. healthcare consulting firm specializing in creating transformational change in public healthcare programs. Sellers Feinberg professionals strategize the design and implementation of original and inventive solutions for the healthcare industry, government, private sector and advocacy clients. The firm provides innovation in five key areas: Medicaid reform, revenue maximization, healthcare purchasing/cost containment, strategic consulting and government relations.

In addition to its headquarters in Philadelphia, Sellers Feinberg has offices in Austin, Texas; Harrisburg, Pennsylvania; Madison, Wisconsin and is located online at www.sellers-feinberg.com.

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States Taking on Battle

admin@sellers-feinberg.com (Martin D. Sellers) — Wed, 25 Oct 2006 12:00:00 GMT

I would like to compliment USA TODAY for undertaking an important topic with its "Prescription for change: Fixing American health care" series. But the series did not accurately reflect the dynamic efforts among states to cover uninsured populations, reduce health care costs, and make health insurance more affordable and accessible for individuals and small businesses ("Consumer unease with U.S. health care grows," Cover story, News, Oct. 16).

Following Massachusetts' example, governors across the country are taking dramatic and creative steps to improve health care in their states, operating as laboratories for change, just as they did with welfare reform. They are not willing to wait for Washington to provide a national solution.

Governors are expanding health care coverage to targeted groups who need it but cannot afford the available insurance. By using a combination of public and private funding, states are beginning to shrink the number of uninsured and improve the system for everyone.

In the past, "state health care reform" meant expanding state programs to cover tens of thousands of uninsured. In the wake of Massachusetts, reform can mean covering hundreds of thousands of previously uninsured persons.

Martin D. Sellers
Philadelphia

Audio Briefing: Federal Medicaid Update

admin@sellers-feinberg.com () — Tue, 17 Oct 2006 12:00:00 GMT

In this edition of Sellers Feinberg's audio briefing to state and federal policy makers, we brief you on (1) efforts on Capitol Hill to prohibit CMS from issuing rules to reduce state use of provider taxes to fund Medicaid and (2) early work on the President's budget for FY 2008.

Washington Healthcare Commission Selects Sellers Feinberg

admin@sellers-feinberg.com () — Thu, 12 Oct 2006 12:00:00 GMT

National Healthcare Consulting Firm to Assist State's Blue Ribbon Commission

PHILADELPHIA (October 12, 2006) ~ Sellers Feinberg & Associates, a leading U.S. healthcare consulting and government relations firm headquartered in Philadelphia, signed an agreement last month to provide services to the Washington Blue Ribbon Commission on Healthcare Costs and Access as it gathers industry information, reviews presentations and evaluates proposals submitted by interested individuals and organizations addressing healthcare reform.

Governor Chris Gregoire, with State Senator Pat Thibaudeau, co-chairs the Blue Ribbon Commission, which is exploring ways to deliver accessible, affordable, quality healthcare for all Washingtonians. Today, the state's healthcare system does not adequately meet these quality-of-life concerns. The Commission (which held its first meeting this summer) must recommend by December 1, 2006, a sustainable five-year plan to substantially improve access to affordable healthcare for all Washington residents.

Currently, Washington provides healthcare to about 1.3 million children and adults. The state's projected cost for health and health-related programs will be $4.5 billion in 2006, which is nearly 28 percent of all state expenditures. The most simple reason to reform the state system is to enable it to provide high-quality care at lower costs. Such reform also may positively impact the manner in which private sector healthcare systems operate in the Washington marketplace.

As Sellers Feinberg assists the Blue Ribbon Commission in the development of recommendations for its five-year plan, including proposals for the 2007 legislative session, the firm will provide a broad range of consulting services, as needed, to facilitate, guide and support the Commission. Sellers Feinberg activities include, but are not limited to:
Identification, evaluation and recommendation of options for Washington to realize the Blue Ribbon Commission goals; and working with the Blue Ribbon Commission, executive agency staff and legislative staff to make optimal use of Commission meetings and findings.

By 2012, the Commission envisions a system that will provide every Washingtonian the ability to receive necessary healthcare at an affordable price. The Commission hopes to have all children covered by 2010. To realize this vision, both public and private sectors in Washington will need to significantly improve access to affordable health coverage while advancing the overall well-being of citizens through preventative medicine and wellness programs. Governor Gregoire and the Commission hope to fashion state government's approach as an effective national model for how all Americans can find, obtain and use healthcare.

In addition to its headquarters in Philadelphia, Sellers Feinberg has offices in Harrisburg, Pa.; Austin, Texas; Madison, Wis.; Washington, D.C. and is located online at www.sellers-feinberg.com.

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Firm helps states with health care

admin@sellers-feinberg.com (John George ) — Sun, 09 Jul 2006 12:00:00 GMT

While Massachusetts continues to move forward with its ambitious plan to provide health coverage to its uninsured residents, other states are struggling to find answers to the same problem.

For Martin Sellers, that has translated into new clients and a lot of time spent in airports.

Sellers is the president and CEO of Sellers Feinberg, a Center City health-care consulting and government relations firm that worked behind the scenes on the Massachusetts universal health coverage project.

The firm is now helping state governments in Michigan, Indiana and Kentucky tackle funding challenges tied to health-care costs for the poor and uninsured.

"I've been working in the Medicaid area for 25 to 30 years," said Sellers, a longtime lobbyist and former Pennsylvania Department of Public Welfare official. "In the past, a victory was holding the tide back or achieving a small incremental change. To be part of this opportunity in Massachusetts and take a huge step is a thrilling experience. ... Governors watch what other governors do. Other states want to know if this plan can be recreated in their state."

Sellers' firm is in discussions with another half-dozen states and close to signing contracts with three or four. The company does not disclose terms of contracts.

The firm has had discussions with the Rendell administration about the Massachusetts plan, but Sellers doesn't know if Pennsylvania will ever become a client. The state's Office of Health Care Reform -- led by former banking executive Rosemarie Greco -- has spent more than three years working on an ongoing project to make health insurance more affordable and more accessible.

Pennsylvania has an estimated 1.5 million residents without health insurance.

Sellers Feinberg got involved in the Massachusetts project two years ago at a time when a waiver that was providing the state with an extra $600 million in Medicaid funds was about to expire. The extra money was generated through intergovernmental transfers, which involved the temporary transfer of funds into the state's Medicaid budget in order to draw additional matching federal dollars.

In recent years the federal government's Centers for Medicare and Medicaid Services has clamped down, and placed severe limitations, on such funding strategies. In New Jersey, Gov. Jon S. Corzine has proposed a provider tax on hospitals to boost the state's Medicaid budget and attract about $430 million in additional federal matching funds.

"We were brought up to Massachusetts by two public hospitals, Boston Medical Center and the Cambridge Health Alliance, when it became clear there was no way the federal government was going to continue approving that waiver," Sellers said.

The firm had some preliminary discussions with Gov. Mitt Romney's staff and learned of the more extensive plan being developed to guarantee everybody in the state had health insurance.

"It was decided everybody would be best served if we worked directly for the state," Sellers said. "Our job was to develop answers to questions as they arose. This was all cutting-edge stuff. You'd go forward and hit a wall. We had to figure out how to get around that wall."

The Massachusetts plan, which starts next July 1, requires all 500,000 uninsured residents in the state to obtain health insurance. The program -- billed as a near-universal-access health-coverage plan -- involves expanding the state's Medicaid program, providing state subsidies for other low-income individuals and families and fining employers who don't provide health insurance to their workers.

A key component is the use of a connector, a quasigovernmental agency, that will help all state residents required to obtain private insurance by bringing people together so they can qualify for group rates.

Residents who don't obtain insurance will lose their personal state tax exemption and be fined an amount, expected to be above $1,000, equal to half of what they would have paid for coverage.

Dick Powers, a spokesman for the Massachusetts Department of Health and Human Services, said no state officials were available to comment on the role of Sellers Feinberg in the development of the Massachusetts universal coverage plan.

Sellers said his firm's toughest obstacles with the Massachusetts plan were finding an alternative to intergovernmental transfers to help finance the program, and dealing with the politics.

"You had the left saying universal coverage and a single payer is the only answer and the right saying government shouldn't be involved and the answer has to come from the private sector," he said.

Politicians from different sides of the aisle eventually came together by combining their proposals into one plan everyone could support.

The funding issue was answered by redirecting state funds designated for public health initiatives that would become less critical as most of the state's uninsured residents obtained coverage.

Sellers said what Massachusetts has proposed wouldn't work in every state, but certain elements of the plan -- such as the connector -- should.

"Massachusetts is unique in that it has a relatively low number of uninsured and fairly progressive policies on health coverage," he said. "In other states the Medicaid programs are different, the insurance market is different. Cultures are different. Politics are different."

The one constant, he said, is the struggle of smaller employers and the self-employed to secure affordable insurance.

Philadelphia Firm at the Nexus of Historic Health Reform Efforts Across the Country

admin@sellers-feinberg.com () — Mon, 12 Jun 2006 12:00:00 GMT

Sellers Feinberg Advises Governors in MA, MI, IN on Covering the Uninsured

June 12, 2006, Philadelphia, PA ~ The announcement by Michigan Governor Jennifer Granholm of a major health care reform effort several weeks ago and Massachusetts Governor Mitt Romney's historic health reform plan enacted in April each have one little-known element in common: Sellers Feinberg Associates, a Philadelphia-based health care consultancy. As the consultants to Governors Romney and Granholm, Sellers Feinberg, which was highlighted in The National Journal's June 9, 2006, cover story, has helped dramatically re-invigorate the national health care reform agenda.

"Massachusetts' reform agreement has opened the eyes of elected officials and health care leaders across the country as to what is possible," said Martin Sellers, President and CEO of Sellers Feinberg. "We have been fortunate to work, first in Massachusetts and now in Michigan with leaders who are committed to major systemic change. Previously the debate was about changing systems at the margins, since Massachusetts revealed its plan everybody wants to know if we can re-create this dramatic reform in their state or at a national level."

The enactment of Massachusetts' reform plan on April 12, 2006 was the culmination of two years of work for Sellers Feinberg, which specializes in consulting on Medicaid, publicly subsidized health insurance and other health policy issues for businesses and state governments. Originally invited into Massachusetts to work with the public hospital system, Governor Romney's team saw the value of Sellers Feinberg's counsel and sought agreement by the hospitals to allow them to work for him directly. The result was a historic deal that has sent shock waves through America's political and health care establishments.

"You cannot underestimate the effect this legislation has had on health care reform efforts across the country," said Kevin "Kip" Piper, author of The Piper Report and consultant to Sellers Feinberg. "Every elected official and health care advocate is investigating if a similar plan can be enacted in their state."

"Not only did Sellers Feinberg have a seat at the table while this deal was getting done, but they've shown their bi-partisan spirit in helping Gov. Granholm craft a plan that will dramatically expand coverage for Michigan's uninsured," continued Piper. "Their strategic ability, intimate knowledge of health care financing systems and out of the box approach have proven to be a valuable asset for elected officials contemplating reforming their states' health care needs."

In addition to its work in Massachusetts and Michigan, Sellers Feinberg recently began working with Indiana Governor Mitch Daniels and his staff to develop a significant health reform effort to extend coverage to a significant portion of the state's uninsured population.

"As a senior official in the Bush Administration, former President of Eli Lilly's North American Operations, and now as governor, Mitch Daniels understands the true cost of a large uninsured population on a state's ability to compete economically," said Sellers Feinberg's Peggy Handrich. "He recognizes that making progress on this issue will have a substantial impact on employers, employees and, most importantly, families. Sellers Feinberg is able to supplement his in-house expertise and offer insight gained from our work on major health care reform with other governors."

Sellers Feinberg's success in helping state governments and large organizations solve their health financing problems is rooted in the company's comprehensive services that allow it to develop tailored plans which utilize each entity's individual strengths. With expertise in revenue maximization, Medicaid issues and large scale health care reform, Seller Feinberg increasingly finds itself being asked to help clients achieve transformational change.

"Through our work we've found that each state or organization has unique resources that may be already directed towards health care, but either the organization doesn't realize it or hasn't considered them as a potential vehicle for change. By identifying these opportunities and fitting them into a comprehensive reform plan, Sellers Feinberg is able to work with our partners to create solutions that address their most vexing health care financing issues," said Marty Sellers.

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