for the time of day and you for your interest in this topic. and we'll bring it to a close now. thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> no look at the massachusetts health system used as a model for national health care. from this morning's "washington journal," this is about 30 minutes. host: dr. judyann bigby joins us from washington. she is the massachusetts health and human services secretary. good morning. welcome to the program. guest: good morning. thank you for having me. host: tellus about the parallels

between what you have it in massachusetts and what has passed through congress? guest: the massachusetts plan which is based on a 2006 health care reform bill that gov. mitt romney in the legislature worked very hard to get together is based on providing universal coverage to people in the massachusetts. the way it accomplishes that is by expanding medicaid eligibility, providing state subsidies to people who are low- income and not eligible for medicaid. and also has provisions that requires to do not make a fair share contribution toward covering their employees to pay an assessment. it has an individual mandate for people who have access to affordable health insurance to

take it up or either pay a tax penalty. many of those features are part of the national plan. the other thing about massachusetts is we do have an exchange we call "connector." many years ago massachusetts started passing laws that protect people from provisions in the policies that would not allow them to drop people because of coverage or pre- existing conditions. many of those figures are part of the national bill. host: in "the christian science monitor" they had an article last week with the headline, who is the father of healthcare reform? obama or mitt romney? the massachusetts bill included a moment such as the individual

mandate. it is deeply unpopular among conservatives. mr. obama emphasized similarities. he did that partly to appear less radical and more bipartisan himself. in doing so he has also made problems for mr. mitt romney. is it realistic for the former governor to try to run away from this healthcare plan that he put together because it is so similar to what the president has signed into law? guest: i do not think that it is realistic. the reason the reform has worked in massachusetts is because of the four elements i laid out, including the individual mandate. the governors from the supported the individual mandate. host: we will talk about massachusetts' health care with dr. judyann bigby, the health

and he missehuman services secrf massachusetts. here are the phone lines if you would like to get involved. we have a special line for massachusetts residents. another article in "the new york times" -- massachusetts insurance regulators reject most requests for higher rates. dr. judyann bigby, tells a bit more about that and how works? guest: one of the things we have seen is that the cost for small business, grew premiums, --

group premiums -- have continued to rise. the insurers filed on march 2 the rates they were proposing for implementation on april 1. the division of insurance looked at the ritz, compared them to the data the health plan submitted -- they live r at theates, -- they looked at the rates and found for the most part that they were too high. they rejected them, and asked for the companies to re-file and look for a more reasonable increase. host: the next call comes from atlanta, ga., on the line for democrats. kenny? all right. the next call comes from boston

on the line for republicans. caller: yes, i would like to hear your guest to respond to the fact that there are fewer doctors now in massachusetts since this bill has been passed and prior. do you agree or disagree? host: bob, before you go -- and before you answer -- do you think that if in fact there are fewer doctors, the think it is because of the health care plan put in place by gov. mitt romney? caller: absolutely. guest: i actually disagree with that statement. if you look at massachusetts, we have more doctors per capita than any other state in the country. not by just a little, but by a significant amount. we also have more primary care providers then any other state

in the country per capita. what has happened since health reform is actually we have implemented some initiatives to attract more primary-care physicians to commit to working in the state, especially at community health centers. there are public and private initiatives that have been successful in attracting primary-care providers to come and work under this reform bill. it is not true that we have fewer doctors in massachusetts since reform. host: next up, the oak grove, md., on the line for independents. caller: dr. judyann bigby, i'm very concerned because just a whisper of health reform in missouri -- i was immediately drop from my insurance to pick

up another advantage to be told, when this goes through, i will lose it, and my sisocial securiy will be damaged thdown the road. you did not have this happen. i have dementia, bipolar come of back surgery i never healed from. my doctor says that i will probably have to stand in line for months afterward to get my pain medication which they only give 30 days at a time. could you help me to understand that a little? guest: think you are referring to the provisions in national reform that deal with medicare advantage. just remember, medicare advantage is the program where private insurers were paid a bonus to take medicare-eligible individuals, mostly elders.

they the to keep the bonus as part of their profit margin. so when the national bill was passed, one of the things they are trying to do is find ways they pay for it. one of the savings identified was to decrease the bonuses that private health-care plans get for taking medicare advantage. frankly, this is not something the plans must pass on to the medicare members. they could agree to take a lower profit margin, but continue to cover these people in exactly the same way that they are. but they may not choose to do that. it is unfortunate. host: massachusetts ,vince.

caller: a couple of years ago i was not working. due to the economy and stuff like that. i did not have health care, did not look for, and did not use it. the year after that the state charged me $292 because i did not have health insurance. i did not like that. guest: and what this caller is referring to is the individual mandate, also part of national reform. the reason this mandate is so important is that there are many people who could get health insurance and do not, when they are healthy. if they only use it when they're sick, they drove up the costs -- they drive up the costs of premiums. if we have everyone who is eligible with access to affordable health care in the insurance pool, it brings down

the costs for everyone. host: if you were not injured, how often is that fine assessed against you? guest: once per year. you must file with your income tax to demonstrate whether or not you have health insurance coverage. host: and the guy said the bell $259? guest: i believe he said $292, the penalty in the first year of the implementation of health reform. right now i believe it is about $900. host: still, the thing that would be enough of an incentive? some folks might say $900 for health insurance premiums and the first three months of the year -- and spend way more than that on health insurance premiums were they could just knocked out the $900 and be done with it. guest: right.

there are many people who suggested the penalty is not steep enough. . . all the smaller percent who did not have that, about half of those did not have access to affordable coverage, so the number of people who are being assessed a penalty are pretty small. host: how does this factor into the story from the "boston globe" this morning, health insurers to raise rates. the showdown is near and regulatory power. guest: this refers to the regulation of the rates of the

insurers. last week on the premium rates that the insurers requested to go into effect on april 1. whenever revision -- when they were reviewed, they found that they were too high given the data that was presented to the state to justify those rates and they ask them to go back and refile of they are waiting to go through the process to review the rates again. the rates that they had back in 2009 are in effect. what this lawsuit suggests is that the division is it -- has overstepped its authority by rejecting these rates, but it is clear that the division has the authority to review rates before they go to -- into effect. and if they find they are

unreasonable, that is what the division has done. host: we're talking about the massachusetts health care system and its comparison to the national ones assigned in the wall with dr. judyann bigby, an m.d. from harvard medical school. washington, d.c. on our line for democrats. wayne, you are on the "washington journal." . >caller: i am glad that they finally have the backbone to get something done in congress. i don't have health care before this obama plan, but now it is wonderful. we could have cancer or anything and have no health care. i think that is irresponsible. we are bunch better in this

country. people need to stop whining. thank you. guest: i appreciate that perspective from someone who is one of the nearly 40 million people in this country without health insurance. and you raise very good points. number one, we are a country that should be able to make sure that everybody does have access to health care. we have among the best institutions in the world and we know that when people have access to health care, we deliver the health care of any nation. it is true that often times when people do not have insurance and then develop a condition that warrants treatment, they cannot get insurance because of pre- existing conditions. this bill gets rid of that.

i think a lot of people will benefit and a lot of people in massachusetts will come forward first few years of implementation. many people had cancers that were discovered simply because for the first time in 20 years there were some long period of time that they had access to insurance. and they went to the doctor and they got a check of, or had their symptoms evaluated, when before they were afraid to go because they did not think they could afford it. it. host: gainesville for the -- gainesville, florida. our line for republicans. caller: dr., thank you for coming on the show. i have two questions. i am fiscally conservative. i think it is fiscally

responsible for universal health care. i know that i am at odds with my party. i believe it brings the best benefits for americans. my two questions are, what kind of changes will take place in states like yours that have set -- that have similar systems set up, and my second question is have you personally seem mitt romney sit on the death penalty? > -- , mel. there are no death penalty. no one is sitting on them. massachusetts will actually benefit a lot from the national bill. there were provisions in the bill that actually increased subsidies for low-income individuals. right now, in massachusetts, we provide state subsidies for

individuals of 23 green% of federal poverty level. -- of up to 300% of the national -- of federal poverty level. those people now will be eligible for tax credits and will pay less out-of-pocket to have affordable health insurance. we have also seen a benefit to our state medicaid program. that will get more subsidies for the children's health insurance program and other provisions. one of the biggest benefits of this bill will be seen by seniors. we have about 88,000 individuals in massachusetts who, right now, have to pay for their drug benefits during that time called

the doughnut hole where medicare does not cover right now prescription drugs and seniors have to pay that out of their pocket. this bill closes that gap over time. we know that about 80,000 seniors will benefit from that in massachusetts. host: the caller made a joke about the death penalty. explain where that came from and what in this bill or the massachusetts health care plan might be misconstrued as 8 "address panel." -- "death panel." guest: one of the tenants of reform was that it was tried to address that if a physician were having a conversation with a patient about what they wanted

to have happened to them if they became severely ill and it looks like there were no other treatments available, medicare does not pay for a visit where a physician has that conversation with his or her patient. someone simply wanted to allow medicare to pay to have a conversation where people were able to expect -- expressed preferences periodically, over time. the misinterpretation of that i think was purposeful and misleading. from my perspective, i do believe we need to move away from a system where physicians are paid for each think they do and move toward a system where they are actually paid to take care of the patient. it should be up to that physician and the patient what

happens inside the room, what that means in terms of an individual patient's medical condition, their preferences, the input from their family is important, and we need to move toward a system where providers now they will get paid for taking the best care of patients and provide what is needed for that individual. host: we're talking about massachusetts' health care and how the national law uses the massachusetts plan as a model. our guest is dr. judyann bigby. our next call comes from springfield, massachusetts. david, go ahead. caller: it is a privilege to talk to you. i and a recipient of commonwealth care. i am really pleased that -- with all of the services that i receive. i see the doctor of my choice.

i also ride the bus for free. i am a student at a community college. i am actually impressed with the system here. i think our health care should be run by the government. i would like to pay with my taxes to a system in which the government gives me what i need to live. i think that is the way it should be. i am glad that is the way it is now in the united states host: sorry about that, david. thank you for weighing in. guest: i think you raise an important point. we believe that healthcare is a right. every american is entitled to it. we no longer live in the days where madison was not really that effective. we know, right now, that we can do a lot for individuals, both

from treating diseases and chronic conditions, but we also know a lot more about prevention and how to keep people healthy by working together with family and their community to maintain health. the commonwealth care program the caller referred to is the state-subsidized program for people that are not eligible for medicaid that is offered through the connector. we know there are about 160,000 individuals who currently receive health insurance through that program. this is a new program that did not exist before health care reform. what this program does is provide people with insurance so that they can go to the doctor for checkups and treatment when they needed, prior to the

health care reform, these people were not covered. they can get care only when they came to the hospital when they were al. they could not participate that easily in preventive care. host: our next call comes from rebecca in glen burnie, maryland. see tell -- caller: you mentioned that your commission denied a recent request from health insurance companies. can these companies pullout from operating in your state? a lot of insurance companies to not wish to recover -- to cover florida residents after storms and hurricanes. also, if insurance companies

went bankrupt or did not wish to continue businesses that are not profitable, who will give us health insurance? did you see a day were the government will be the only health insurance company, so to speak? caller: -- guest: we do not want a situation where health insurance plans do not operate in massachusetts. most of the plants that operate in massachusetts are based in massachusetts. we do have plans that come in from out of state and interestingly, the number of rates that were rejected by the division -- it was the out-of- state programs that refiled and proposed different rates. we recognize that we want health insurance plans to be successful in massachusetts, but we cannot

have it at the expense of small businesses who are seeing double-digit increases. many businesses were ready to start hiring, but when they get their insurance bill, they decided they could not afford to take and any new employees. what we are trying to do is make sure there is a balance between supporting the health plans and making sure that they are successful and making it possible for small businesses to take advantage of the economic recovery. to get health care costs down. . et costs down. providers need to also be at the table. we are, unfortunately, we have only this one regulatory mechanism right now, looking at the rates that insurers charge.

we all providers will work closely with us and the insurance plans to get cost down so that we have more affordable plans for small businesses. host: in this morning's host: in this morning's "financial times" this headline -- it highlights continued difficulties. millions have lost jobs. _ the challenge for president barack obama in overhauling health care actors' timing -- after signing the bill last month. tell us about the situation in massachusetts. as the time put stress on the availability and the distribution of pharmaceuticals in massachusetts?

guest: that is an excellent question. one place where we have seen the growth level out as the cost of prescription drugs. before health reform, many of the insurers and the state actually took measures to try to encourage people to use lower- cost drugs that are just as effective as the most expensive ones, and therefore, the rate of growth of prescription drug cost in massachusetts has been relatively small, relative to the cost of other parts of the health-care system, and also relative to what is happening in other parts of the united states. prescription drug coverage is one of the benefits that the connector board required as a part of minimal credible coverage, and that is a minimal standard for which individuals

need to show that have coverage. hopefully, in this day and age no one believes that prescription drugs are not an important part of coverage. my belief is that by mandating coverage for prescription drugs, we have better mechanisms for monitoring the cost of those drugs and making sure that people have access to them. while others will continue to struggle with this until the national bill is completely implemented, one of the areas we >> something about energy policy would like to talk about on your blog? you can