Senate Passes Sweeping Healthcare Reform and Cost Containment Bill with Senator Jason Lewis’ Support

The Massachusetts Senate passed sweeping healthcare reform legislation S. 2022, An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care. The HEALTH Act, which passed by a vote of 33-6, focuses on both short and long terms goals regarding how to strengthen our healthcare system by lowering costs, improving outcomes, and expanding access. The legislation is the result of an effort by the Special Senate Committee on Health Care Cost Containment and Reform to address the healthcare system by analyzing the best practices in other states and engaging stakeholders in a series of meetings over the last year. Senator Jason Lewis, who serves as Senate Chair of the Joint Committee on Public Health, serves on this Special Senate Committee, as well.

Healthcare costs are continuing to strain the budgets of working families, businesses, and municipal and state governments. The Senate has continued to push for reforms to the current system through diligent research, stakeholder engagement, and legislation. The working group of Senators, with logistical support from the Milbank Memorial Fund, spent the last year meeting with officials from seven states, healthcare experts, and stakeholders to examine best practices regarding lowering costs and improving outcomes.

The bill implements more effective care delivery such as telemedicine and mobile integrated health, in order to reduce emergency room visits and expand provider versatility, while also addressing price variation between larger hospitals and their smaller community hospital counterparts. A recent study by the University of California Davis Health system estimates that “by using telemedicine for clinical appointments and consultations, its patients avoided travel distances that totaled more than 5 million miles. Those patients also saved nearly nine years of travel time and about $3 million in travel costs.”

The bill aims to reduce hospital re-admissions and emergency department use through mobile integrated health and telemedicine as well as expanding access to behavioral health. The Massachusetts Health Policy Commission has estimated that 42 percent of all emergency department visits are avoidable.

The bill aims to tackle provider price variation, the variation between providers for similar procedures, by implementing a floor for providers while also setting a benchmark for hospital spending. If hospitals exceed the benchmark the state will implement fines or penalties on those institutions.

“This important legislation takes meaningful steps to both improve healthcare quality and outcomes, as well as contain costs,” said Senator Jason Lewis. “More deeply, this legislation furthers efforts to address the social determinants of health that are responsible for many health inequities in our system; and, innovative steps are taken to make prevention a more central component of our healthcare system, which will improve our quality-of-life and save money.”

This bill takes a number of important steps to further our efforts around prevention and wellness – to continue to move our healthcare system from a “sick care” system to a “well care” system, central to Senator Lewis’ approach to public health. The bill will further strengthen and encourage efforts to move our healthcare payment system away from fee-for-service and toward a system that rewards better health outcomes. It reauthorizes and updates the successful Prevention and Wellness Trust Fund, and will provide new sources of funding for population health efforts that seek to prevent costly and preventable chronic health conditions. It expands access to basic preventative health services, including physical health, behavioral health, and oral health. And, it supports greater access to supportive housing services and other efforts to address the social determinants of health.

Post-acute care in an institutional setting and long term care and supports (LTSS) cost the state an estimated $4.7 billion in 2015, a major cost driver for MassHealth. The bill increases transition planning for patients into community settings and strengthening coordination between providers.

Pharmaceutical costs have been a driver of increased healthcare costs for a number of years. The Center for Health Information and Analysis (CHIA) reported a 6.4 percent growth in pharmaceutical spending in 2016. Drug costs are making families choose between filling prescriptions and paying for other essentials like housing and food. The bill implements greater oversight and transparency in drug costs and encourages Massachusetts to enter into bulk purchasing arrangements, including a multistate drug purchasing consortium like other states, to lower costs and protect consumers.

The legislation encompasses the whole system from Medicaid to the commercial market, addresses price variation, increases price transparency for consumers, leverages better federal funding opportunities, and expands scope of practice for many practitioners including dental therapists, optometrists, podiatrists, and nurse anesthetists.

The bill now heads to the House of Representatives for consideration.

Senator Jason Lewis to Host Community Conversation in Winchester on Mental Health and Wellness

Continuing his “Community Conversations” issue discussions, Senator Jason Lewis is excited to announce an upcoming conversation he will hold on challenges in our communities pertaining to mental health and wellness. Held in every community of the district, “Community Conversations” are issue discussions delving into a different topic at each forum, with ample opportunity for residents to share feedback and have their questions answered by experts on the given topic.

This upcoming event – Community Conversations: Strengthening Mental Health and Wellness in Our Schools and in Our Communities – will take place on Tuesday, December 5, at 6:30pm. The event will occur in the large meeting room at the Winchester Public Library, 80 Washington Street, Winchester, and is free and open to the public. Attendees will hear from: Joan Mikula, Commissioner of the Massachusetts Department of Mental Health; Dennis Mahoney, Principal at Winchester High School; and, Dr. Barry Ginsberg, M.D., Chief Medical Officer at Lahey Health Behavioral Services.

This forum will offer the chance to hear directly from experts offering a variety of perspectives on a range of mental health and wellness issues. Commissioner Mikula will discuss state priorities in addressing mental health challenges; Principal Mahoney will highlight trends among our student-aged population; and, Dr. Ginsberg will offer the healthcare provider’s perspective in identifying key challenges. There will be ample opportunity for Q&A from attendees. The forum is co-sponsored by State Senator Patricia Jehlen, State Representative Michael Day, the Winchester Coalition for a Safer Community, and the National Alliance on Mental Illness – Massachusetts (NAMI-MASS).

“Confronting challenges around mental health and wellness can be difficult conversations, but are absolutely vital conversations that must be had to safeguard public health in our communities,” noted Senator Lewis. “I look forward to discussing with this distinguished panel how we can identify and address the challenges we face in our schools and more broadly across our region. I am also eager to hear feedback on this from local residents, as the conversations I have directly with constituents across the district are the best source of information and guidance to help me do my job in the legislature.”

“Community Conversations” forums have been held in all six communities of the 5th Middlesex district on topics including: public education; public transportation; small business and entrepreneurship; challenges facing senior citizens and caregivers; veterans’ issues; housing; energy policy and environmental priorities; and, efforts to combat substance abuse and opioid addiction in our region.

Senator Jason Lewis Receives Public Health Award

Senator Jason Lewis gave the plenary address at the recent 50th annual conference of the Massachusetts Health Officers Association (MHOA), which represents over 600 local public health officials and associates across Massachusetts and serves as the leader, partner, and voice for local health departments in the Commonwealth. At the conference, the MHOA presented Senator Lewis with the Curtis M. Hilliard Award for Dedicated Service and Outstanding Achievement in Public Health, which is given annually to an individual who demonstrates concern for the advancement of public health programs to the benefit of the citizens of the Commonwealth and has assisted in the delivery of health programs.

Senator Jason Lewis’ Remarks to the Massachusetts Health Officers Association 50th Annual Conference
November 15, 2017 – As prepared for delivery

I’m delighted to be able to join you this morning and deeply honored to be kicking off the 50th Annual Conference of the Massachusetts Health Officers Association, the largest annual public health conference in New England!

When most people think of Paul Revere, what comes to mind no doubt is his historic ride from Boston to Concord on the eve of the American Revolution. We remember the famous words from the poem by Henry Wadsworth Longfellow: “One, if by land, and two, if by sea.” But, I bet you — as public health officials — know something else about Paul Revere. Back in 1799, Paul Revere was named the first health officer of the City of Boston’s brand new Board of Health. This was the first public health department in the nation. Under Paul Revere’s leadership, officials ran an innovative public information campaign, including neighborhood meetings and signs on lampposts, to reduce deaths due to cholera, a very dangerous but highly preventable disease.

In the years since, public health has made innumerable contributions to improving the health and wellbeing of Americans. According to the CDC, public health is credited with adding 25 years to the life expectancy of Americans in the 20th century. The CDC has a top ten list of greatest public health achievements in the last century: immunizations; motor vehicle safety; workplace safety; control of infectious diseases; declines in deaths from heart disease and stroke; safer foods; healthier mothers and babies; family planning; fluoridation of drinking water; and reducing tobacco use. Here in the Commonwealth of Massachusetts we have continued to lead the way on many of these great public health achievements.

Today, however, I know many of you are probably frustrated that public health, and particularly local public health, does not get the attention or the resources that it rightly deserves. According to the Blue Cross Foundation: 20% of our health is determined by our genetics, and of course there is not much we can do about that; another 20% of our health is determined by the access we have to quality healthcare services; and, the remaining 60% is determined by social, environmental, and behavioral factors. In other words, the social determinants of health are absolutely critical to health outcomes.

So Ben Franklin was right when he observed that “An ounce of prevention is worth a pound of cure.” But, the reality today is that only a very small fraction of the total resources that we invest in health are actually spent on public health and prevention.

The good news is that I believe this is slowly starting to change. There is a growing recognition among policy makers, healthcare providers, and other stakeholders that a greater focus on population health is critical to reducing rates of preventable chronic diseases, which, in turn, would dramatically improve health outcomes and reduce high healthcare costs.

Take, for example, the epidemic of Type 2 diabetes. Since 1990, the percentage of Massachusetts residents living with diabetes has risen from 3.8% to almost 9%. According to the American Diabetes Association, the medical costs of treating a person with diabetes is 2-3 times greater than for somebody who does not suffer from the disease. It’s estimated we spend more than $3 billion annually in Massachusetts in direct medical costs to treat diabetes, and we also suffer an indirect cost of more than $1 billion in lost productivity. So, the need to take action is urgent, and we are starting to respond with innovative prevention programs in our communities — like the Diabetes Prevention Program that many YMCAs across the Commonwealth are now offering and that, increasingly, health insurers are actually willing to pay for.

As you may be aware, last week the state Senate debated and passed the most significant healthcare legislation on Beacon Hill in five years. The overarching goals of this sweeping legislation are to maintain our highest-in-the-nation access to health insurance coverage, improve quality of care for patients and health outcomes, and lower healthcare costs. In order to help accomplish these goals, the bill takes a number of important steps to further our efforts around prevention and wellness: it strengthens and accelerates efforts already underway to move our healthcare payment system away from fee-for-service and toward a system that rewards better health outcomes; it reauthorizes the groundbreaking Prevention and Wellness Trust Fund, and provides new sources of funding for the public health investments made by the PWTF that seek to prevent costly and preventable chronic health conditions; it expands access to basic preventative health services, including physical health, behavioral health, and oral health; and, this legislation supports greater access to supportive housing services and other efforts to address the social determinants of health.

In other words, we are pursuing strategies that can start to move our healthcare system from a “sick care” system to a “well care” system — from a system where public health plays a supporting role to where public health is front and center. That, at least, is my vision, and I imagine it is also shared by many of you.

I would like to now provide you with a brief update on some other important public health issues on Beacon Hill.

As most of you are hopefully already aware, the Special Commission on Local and Regional Public Health is busy at work. This Commission was created as a result of legislation that I filed last legislative session and was signed into law by Governor Baker in 2016. The purpose of the Special Commission is to “assess the effectiveness and efficiency of municipal and regional public health systems and to make recommendations regarding how to strengthen the delivery of public health services and preventive measures in the Commonwealth.” This presents an excellent opportunity to understand the many responsibilities of our local boards of health and the challenges that you face in fulfilling these responsibilities. It is my hope that the findings and recommendations of the Special Commission, which are expected next year, will lead to further action from our state government. I will stop there since I expect that Commissioner Bharel will speak in more depth about the work of the Commission.

Next, let me address the opioid epidemic. Our communities are continuing to be ravaged by addiction and tragic overdose deaths, although it appears that efforts by state and local government, healthcare providers, law enforcement, and other stakeholders is finally starting to turn the tide. Some of the steps that the state legislature and the Baker administration have taken in recent years include: requiring expanded insurance coverage for addiction treatment; increasing funding for treatment and other services; strengthening the prescription monitoring program; improving prescriber training to reduce the number and quantity of opioid prescriptions and encourage the use of other pain management strategies; efforts to reduce stigma; and more. I believe we must also significantly step up our efforts around education and prevention, particularly for our young people.

Even though much of our focus, understandably, is on fighting the opioid epidemic, tobacco and nicotine products still remain the #1 preventable cause of illness and premature death in Massachusetts. Smoking rates among adults and teenagers are at their lowest levels in decades, thanks to sustained public health efforts over many years. However, Big Tobacco continues to innovate with new products and marketing on social media. I’m very concerned about the explosive growth in e-cigarettes, or vaping, among teenagers. According to the CDC, the percentage of high school students who reported using an e-cigarette at least once during the month the survey was taken was 4.5% in 2013. As of 2016, this number had increased to an astonishing 23.7%. Anecdotally, I have heard from some high schools in my district that the vaping rate may now exceed 40%. Many teens and their parents don’t understand the health harms of e-cigarettes and the risk of nicotine addiction. Thanks to the great work of our local boards of health, many cities and towns have taken strong steps to fight Big Tobacco, including raising the minimum legal sales age to 21 and regulating e-cigarettes. Along with Representative Paul McMurtry in the House, I have filed legislation in the Senate known as An Act to protect youth from the health risks of tobacco and nicotine addiction. This bill would raise the legal sales age for all tobacco products to 21 statewide; prohibit the use of e-cigarettes in schools, workplaces, and wherever else smoking is not allowed; and ban the sale of tobacco products in all healthcare facilities including pharmacies. The bill passed the Senate last session by a vote of 32-2, and I’m hopeful that we will be successful in getting it signed into law this session.

Lastly, let me touch on what I know is a hot topic: marijuana. As you know, legalization of adult-use marijuana passed at the ballot last November. Then, earlier this year, the legislature passed a bill to fix many problems in the ballot question, and to strengthen public health and safety protections. The Cannabis Control Commission has been formed and is developing regulations that will govern the new marijuana industry in Massachusetts. At the same time, many cities and towns are deciding whether to opt out of allowing marijuana businesses within their borders. As public health experts and advocates in your respective communities, you have a very important role to play as we move forward. Right now, I would urge you to make sure that your voices are being heard by the Cannabis Control Commission so that local public health issues get the attention they deserve as regulations are being written. Just like with tobacco, local boards of health will play a critical role in pursuing policies that protect the public health, including: decisions about time, place, and manner of sale for marijuana products in those communities that don’t opt out; ensuring home growing is done safely; dealing with complaints about odor and other issues; and stepping up youth education and prevention efforts. I’m sure you are concerned about where you will get the resources to do this important work. The law that we passed in July directs some of the funding from marijuana taxes and licensing fees to support local public health and prevention efforts. Also, communities that don’t opt out will be able to charge a local excise tax of up to 3% on marijuana sales, and this revenue could be used for investments in local public health and safety. I imagine you have many questions, some of which I may be able to answer shortly during the Q&A period. But others will need to be answered over time as we move forward and figure things out together.

In closing, I want to encourage each of you to reach out to your own state legislators. Make sure they know who you are and the vitally important work that you do in local public health. Share with them your input and feedback. Make the case for increased investment in local public health. Here’s one example from my own experience of why this matters. Back in 2012 when I was serving as a State Representative, Winchester health director Jennifer Murphy approached me about an issue that I previously knew nothing about. She explained to me that it had become very difficult for municipal public works employees and seasonal workers to treat catch basins where mosquitoes breed since the Department of Agriculture had changed pesticide regulations in 2010. This was seriously hampering efforts to prevent the spread of West Nile virus. Together with David Henley of the East Middlesex Mosquito Control Project, we wrote and filed legislation to solve this problem. And, a few years later, the bill passed and was signed into law by Governor Deval Patrick!

Thank you. And now, I’m eager to take your questions.

Senate Passes Bill to Establish Climate Change Adaptation Management Action Plan with Senator Jason Lewis’ Support

Taking another step toward responsible long-term environmental management, the Massachusetts State Senate passed S.2196, a bill to establish a comprehensive adaptation management action plan (CAMP) in response to climate change.

A comprehensive adaptation management action plan would be established through a collaboration led by the Secretary of Energy and Environmental Affairs and the Secretary of Public Safety and Security. The plan would codify for the Baker Administration and all future administrations the goals, priorities, and principles for resiliency, preservation, protection, restoration, and enhancement of the Commonwealth’s built and natural infrastructure, based on data around existing and projected climate change impacts including temperature changes, drought, inland flooding, and sea level rise. The plan would go into effect in 2018 with an update every five years.

“The science behind climate change is well-established; but, while climate deniers slow responsible action to address climate change, our climate features more and more extreme weather incidents,” said Senator Jason Lewis. “This legislation will empower our state government to be better prepared to address the challenges of an environmental future affected by climate change.”

Through the legislation, a CAMP Advisory Commission would be established through the Executive Office of Energy and Environmental Affairs and the Executive Office of Public Safety and Security. The committee would be charged with producing a report that documents the preparedness and vulnerabilities in the Commonwealth’s emergency response, energy, transportation, communications, health, and other systems. The group would also put forth a proposal that establishes and commits to sound management practices while compiling data on existing and projected sea-level rise using the best available science.

The legislation also establishes a regional, comprehensive climate change adaptation management plan grant program to aid in the development of regional adaptation plans. The program consists of financial assistance to municipalities for the development and implementation of comprehensive cost-effective adaptation management plans; technical planning guidance for adaptive municipalities through climate vulnerability assessments and adaptation strategy development; and, development of a definition of impacts by supporting municipalities conducting climate vulnerability assessments. The grants shall be used to advance efforts to adapt land use, zoning, infrastructure, policies, and programs to reduce the vulnerability of the built and natural environment to changing environmental conditions that are a result of climate change. The secretary of energy and environmental affairs shall also develop and implement an outreach and education program about climate change and its effects in low-income and urban areas.

The bill also creates a coastal buy-back program authorizing the Executive Office of Energy and Environmental Affairs to acquire, by voluntary purchase, property abutting areas subject to tides or barrier beaches or located in velocity zones of flood plain areas that contain structures repeatedly damaged by severe weather. Prior to the acquisition of land under this section, the executive office shall, after consultation with the municipality in which the land is located, develop a conservation and recreation management plan and a coastal erosion mitigation and management plan.

The bill now goes to the House of Representatives for consideration.

Massachusetts Senate Passes Sweeping Criminal Justice Reform Bill, with Senator Jason Lewis’ Support

The Massachusetts Senate passed, by a vote of 27-10, a comprehensive criminal justice reform package that updates decades old criminal sentencing laws to improve outcomes of our criminal justice system. The bill is designed to strengthen public safety while improving outcomes in our justice system. Among the provisions included in the bill are repealing ineffective mandatory minimum sentences for low level drug offenders, reducing and eliminating overly burdensome fees and fines, reforming the bail system, allowing for compassionate release for infirmed inmates, and reforming the juvenile justice system.

The bill, An Act Relative to Criminal Justice Reform, is the result of lengthy work researching best practices, common sense solutions, and procedures and policies that have been effective in other states, in order to produce legislation that will enhance diversion from the criminal justice system, repeal outdated mandatory minimums for low level drug offenders, lower costs, and produce better outcomes.

“These reforms will help address racial injustice, reduce recidivism, improve public safety, lower the taxpayer-funded costs of incarceration, and significantly improve the quality of life in many of our most disadvantaged communities across the Commonwealth,” said Senator Jason Lewis.

According to the Southern Poverty Law Center, “roughly 2.2 million people are behind bars in the United States, an increase of 1.9 million since 1972. We have the world’s largest prison population – with one-quarter of its prisoners but just 5 percent of the total population.”

As part of a nationwide trend in addressing the inequities in the bail system, the bill reforms the current bail system of the Commonwealth by setting strict guidelines for judges when setting bail for a defendant. The bill rewrites the existing bail statute to create a clear road map for decision-making consistent with the Supreme Judicial Court’s recent ruling that cash bail must be affordable. The bill goes beyond that guidance to further strengthen the procedural barriers to setting bail that is higher than a defendant can afford, to ensure individuals are not held solely because they are unable to pay.

Often times, defendants who cannot afford bail are incarcerated before trial with no ability to work, take care of their families, or receive important services such as addiction counseling. In addition, the bill makes dangerousness hearings available in more cases and allows longer detention of defendants on a dangerousness finding, strengthening the mechanism for holding people who are actually dangerous.

The bill also addresses the issue of “fine time” where the state incarcerates individuals who are unable to pay court fines and fees, equivalent to a modern day “debtor’s prison.” In November 2016, the Senate issued a report highlighting how these fees, including $150 fee for legal counsel even if a person has been ruled indigent, starts a vicious cycle of incarceration and punishing low income defendants. The bill sets a schedule to reduce and eliminate these fines and fees over time to protect indigent defendants. In addition, the bill reduces and eliminates monthly parole fees for individuals on parole.

The bill would also make several changes to limit unnecessary entanglements with the criminal justice system through sentencing reform and the expansion of diversion. Massachusetts law currently uses the term “trafficking” to refer to the wholesaling of drugs and distinguishes trafficking based on the weight of the material sold. Differentiating between drug retailers and wholesalers, the bill repeals mandatory minimum sentences for all retail drug-dealing offenses, and repeals existing mandatories for low-weight cocaine sales. Under the bill, one would have to sell over 100 grams of cocaine to be subject to a mandatory minimum sentence.

Recent polling has shown overwhelming public support for repealing mandatory minimums. In a 2016 nationwide poll by the PEW Charitable Trusts found that nearly 80 percent of people support the repeal of mandatory minimums for non-violent drug offenders and nearly three-quarters support repeal of mandatory minimums for all offenses. In two separate Massinc polls, one in 2014 and one in 2017, “just 8 percent of voters prefer mandatory minimums, while the vast majorityare split between having judges refer to sentencing guidelines (46 percent) or giving judges complete discretion in sentencing (41 percent).”

The bill does not repeal mandatory minimums for opioid trafficking and provides that trafficking in higher weights of emerging, highly potent, synthetic opioids like fentanyl should be subject to the same mandatory minimums as natural opioids like heroin and morphine. The mandatory minimums that would not be repealed by this bill, including those for heroin trafficking and high-weight cocaine trafficking, account for approximately 2% of the sentenced drug cases resulting in incarceration.

In addition to sentencing reform, the bill would make diversion to a program, as an alternative to the criminal process, more available for young adults and for people with substance use disorders, while supporting the expansion of restorative justice approaches in appropriate cases. Through these proposed reforms, the bill seeks to help drug users access the treatment they need, increase the availability of meaningful diversion opportunities, and reduce preventable contact with the criminal justice system.

The bill also updates various areas of the law related to juvenile justice, to encourage rehabilitation and positive future outcomes, reduce recidivism and ensure fair treatment for young people. The bill raises the age of juvenile jurisdiction to include 18 year olds, holding young adults accountable for their mistakes while ensuring access to developmentally appropriate rehabilitative and educational services.

Recognizing that juveniles have not reached full adult maturity, the bill expands opportunities for the sealing and expungement of records, including the creation of a process for the expungement of juvenile misdemeanor records. The bill also decriminalizes in-school disorderly conduct, to reduce the use of arrest as a tool of school discipline.

In addition, the bill codifies the constitutional right of indigent juvenile offenders to counsel and expert assistance for parole hearings, as established by the 2015 Supreme Judicial Court decision in Diatchenko II. The bill creates a parent-child privilege to allow parents to help their children in the court system without being forced to testify about these conversations.

Senator Lewis was able to secure two amendments to the Senate’s final bill. The first amendment pertains to “civil forfeiture,” a process by which the government can take and sell a person’s property without ever convicting, or even charging, the person with a crime. Because these cases are technically civil actions, property owners receive few, if any, of the protections that criminal defendants enjoy. This amendment requires law enforcement agencies to document all instances of civil forfeiture to ensure that the process is not being abused. The second amendment pertains to “huffing.” Recognizing that individuals may inhale various substances in order to get high, the amendment replaces “vapors of glue” in the driving under the influence (DUI) statutes in favor of a broader definition that includes other substances such as chemicals found in aerosol can products like airduster and whipped cream. Inhaling or “huffing” these vapors is not only injurious to the person’s health, but it also inhibits the person’s motor skills, which, in turn, impairs driving.

Since 2007, thirty-three states have reformed or revised their criminal justice system to reduce incarceration rates, cut costs, reduce recidivism, and improve outcomes. Massachusetts reformed some sentencing provisions in 2012.

The bill now goes to the House of Representatives for consideration.

Joint Committee on Public Health and Massachusetts Caucus of Women Legislators Co-Host Informational Hearing Highlighting Domestic Violence as a Public Health Issue

The Joint Committee on Public Health, on which Senator Jason Lewis serves as Senate co-Chair, and the Massachusetts Caucus of Women Legislators co-hosted an informational hearing at the State House on the topic of domestic violence as a public health issue. The purpose of the hearing was to examine the prevalence of domestic violence in the Commonwealth, its impact on the health of Massachusetts residents, current efforts addressing the issue, and recommendations for future actions.

“Domestic violence is a serious public health problem that harms the health and livelihood of too many residents across the Commonwealth,” said Representative Kate Hogan, House Chair of the Joint Committee on Public Health. “I hope that, using the information provided by testifiers at the hearing, we in the Legislature can determine how to enhance support for those working in prevention and response services and identify new policy initiatives to end domestic violence in Massachusetts.”

The U.S. Centers for Disease Control and Prevention (CDC) reported in July 2017 that 55 percent of female homicides in the U.S. from 2003 to 2014 were related to intimate partner violence and in Massachusetts, using 2010-2012 data, the CDC estimated that over one in four women and one in ten men have experienced victimization by an intimate partner during their lifetime. Jane Doe Inc., Massachusetts’ statewide coalition against sexual and domestic violence, reported that between 2003 and 2012, 177 people in the Commonwealth were killed by their intimate partner, with 87 percent being female; additionally, 25 children of those affected by domestic violence also lost their lives during this period.

“The hearing emphasized the importance of addressing domestic violence through a public health lens,” said Senator Jason Lewis. “We heard more evidence of how critical it is to do everything possible to prevent this type of violence from occurring in our communities.”

Seventeen experts testified at the hearing, representing a range of backgrounds including those personally affected by domestic violence, state and county officials, researchers, prevention and response experts, advocates, and service providers serving a variety of different constituencies. In April 2015, Governor Charlie Baker signed Executive Order 563 elevating the Governor’s Council to Address Sexual Assault and Domestic Violence and appointing Lieutenant Governor Karyn Polito as Chair. Lieutenant Governor Polito was joined by Secretary of Health and Human Services Marylou Sudders to testify at today’s hearing.

“The Baker-Polito Administration has been committed to introducing tools and reforms for policymakers, providers, law enforcement, community organizations, survivor advocates and others to raise awareness, prevent violence and hold offenders accountable,” said Lieutenant Governor Polito. “As Chair of the Governor’s Council to Address Sexual Assault and Domestic Violence, we appreciate the Joint Committee on Public Health and Massachusetts Caucus of Women Legislators’ partnership on this issue and for hosting this informative discussion as the Commonwealth prioritizes all residents living a life free of fear and violence.”

Racial and ethnic minorities and low-income individuals are disproportionately affected by domestic violence. The U.S. Department of Justice reported that between 2003 and 2012, non-Hispanic Blacks and non-Hispanic multiracial individuals had higher rates of intimate partner violence (4.7 and 16.5 per 1,000 people, respectively) than non-Hispanic Whites, Hispanics, and non-Hispanic individuals of other races (3.9, 2.8, and 2.3 per 1,000 people, respectively). In addition, lack of financial resources can prevent victims from leaving abusive relationships, which may inordinately burden low-income individuals.

“A comprehensive public health approach to sexual and domestic violence must include both prevention and response, must be trauma informed and culturally responsive and inclusive” said Maureen Gallagher, Policy Director, Jane Doe Inc. “The work of JDI and our members has been driven by a public health perspective for many years and as the field has evolved, so have our perspectives. We often say ‘domestic violence can affect anyone’ and yet it does not affect everyone equally. If you are an immigrant, a person of color, a member of the LGBQ/T community, a poor person, or a person with a disability, experiences of gender-based violence will impact you differently and create more barriers to safety.”

“We must continue to work together to elevate the voices of survivors of domestic violence and put an end to the suffering too many women, men and children are still facing in its wake,” said Senator Linda Dorcena Forry. “By empowering survivors to tell their stories, working with advocates and allies, we can help those who are still facing domestic violence. We must do better to empower members of marginalized groups, like our immigrant community, who may feel they will be punished for coming forward. They must know we are here to support them as they show the courage to come forward.”

On October 2nd, the Massachusetts House of Representatives and Senate adopted a joint resolution, which was introduced by Chairs Hogan and Lewis and co-signed by 133 other representatives and senators, recognizing October as “Domestic Violence Awareness Month” in the Commonwealth and affirming domestic violence as a threat to public health.

In addition to the oral testimony delivered during the informational hearing, the Joint Committee on Public Health is accepting all written testimony on this subject; testimony can be sent to Madison.Louis@mahouse.gov.

Massachusetts Senate Approves Legislation to Address Skills Gap and Help Unemployed Workers with Senator Jason Lewis’ Support

The Massachusetts Senate voted unanimously to engross An Act to Diversify the Use of the Workforce Training Fund to Support the Workforce Competitiveness Trust Fund. The legislation, originally filed by the late Senator Kenneth J. Donnelly, and since championed by his successor Senator Cindy Friedman, will ensure a sustainable, predictable source of annual funding for the Workforce Competitiveness Trust Fund (WCTF). The WCTF provides high impact job training grants designed to support unemployed and under-employed workers while helping employers across the Commonwealth hire the skilled workers they need to grow. Furthermore, grants issued from the fund are to be re-named the Senator Kenneth J. Donnelly Workforce Success Grants.

“A reliable funding stream for workforce development and training will provide the Workforce Competitiveness Trust Fund with the predictable and stable funding to help our employers find the skilled workers they need to fill positions. We should all be proud that the legacy of our good friend the late Senator Donnelly will live on with the passage of this legislation,” said Senate President Stan Rosenberg.

“Our economy in Massachusetts is one of the strongest in the nation, but we’re nevertheless facing challenges in ensuring our workers access the skills and jobs they need to thrive”, said Senator Jason Lewis, Senate Chair of the Joint Committee on Labor and Workforce Development. “Too many working families are struggling to get by, while many employers are facing difficulty hiring the skilled workers they need, and this legislation will help address both of these challenges.”

“This bill strengthens our workforce development system where it is needed the most, providing unemployed workers a pathway to economic stability” said Senator Cindy Friedman. “Senator Donnelly was a long-time advocate for working families and it is so fitting that as we provide a reliable funding stream for workforce development grants that we honor his memory by naming the grants after him.”

This bill would allow up to 5% of the state’s Workforce Training Fund, an approximately $22M annual fund supported by employer contributions for incumbent worker training, to be used for the WCTF, a proven sector-based training model that has served hundreds of employers with qualified, skilled employees.

The WCTF was created by the economic stimulus act of 2006 and administered by Commonwealth Corporation on behalf of the Executive Office of Labor and Workforce Development. The WCTF funds regional sector training partnerships across the state with the goal of placing unemployed and underemployed workers in jobs that are in demand. Grants from the fund bring together employers in a particular sector, workforce investment boards, career centers, vocational technical schools, community colleges, and workforce training providers.

The bill also ensures that WCTF grants are performance-based, with 50% paid upon enrollment in the program and the remaining 50% to be paid contingent on job placement and retention outcomes.

A broad coalition of stakeholders has advocated for this legislation, including the business community, workforce boards, labor unions, job training providers, and advocates for low-income workers and their families.

Senator Kenneth J. Donnelly served for 37 years as a firefighter and for 8 years as a state senator. He was a staunch believer in the role of unions and government to protect workers, and he was well known for his efforts to advance justice and equality for all people no matter their race, religion, national origin, or sexual orientation. During his time in the Senate he advocated fiercely for funding for workforce training for unemployed and underemployed workers.

The bill now moves to the House of Representatives for consideration.

Senator Jason Lewis (far right) was proud to stand beside (left to right) Senate President Stan Rosenberg, Judy Donnelly (widow of the late Senator Kenneth Donnelly), and Senator Cindy Friedman (Senator Donnelly’s successor and former Chief of Staff) as the Massachusetts Senate honored the memory of Senator Donnelly and engrossed legislation to invest needed resources in workforce development grants for our working families.

Massachusetts Senate Releases Healthcare Report and Draft Legislation to Contain Costs, Protect Consumers

The Massachusetts Senate released a report “Working Together to Improve Our Health: Right Care, Right Place, Fair Price, Recommendations from the Senate Working Group on Health Care Cost Containment and Reform,” that focuses on both short and long terms goals on how to strengthen our healthcare system to lower costs, improve outcomes, and enhance access. The report and accompanying draft legislation is the result of a collaborative effort by a group of Senators to address the healthcare system by analyzing the best practices in other states and engaging stakeholders in a series of meetings over the last year.

Healthcare costs are continuing to strain the budget of working families, businesses, and government. The Senate has continued to push for reforms to the current system through diligent research, stakeholder engagement, and legislation. The working group of Senators, with the logistical support of the Milbank Memorial Fund spent the last year meeting with officials from seven states, healthcare experts, and stakeholders to examine best practices while lowering costs and improving outcomes.

“Massachusetts should continue to lead on healthcare, and having a robust economy depends upon on lowering costs for everyone without compromising quality or access. The recommendations in this report will help working families, businesses, and our state budget,” said Senate President Stan Rosenberg. “I’m very proud of the work the Senate did to craft a comprehensive report and draft legislation that touches so many aspects of our healthcare system and meets the needs of all engaged stakeholders.”

“This important legislation takes meaningful steps to both improve healthcare quality and outcomes, as well as contain costs,” said Senator Jason Lewis, who served on the Senate Working Group on Health Care Cost Containment and Reform, as Senate Chair of the Joint Committee on Public Health. “More deeply, this legislation furthers efforts to address the social determinants of health that are responsible for many health inequities in our system; and, innovative steps are taken to make prevention a more central component of our healthcare system, which will improve our quality-of-life and save money.”

The goals outlined in the report vary from more effective care delivery such as telemedicine and mobile integrated health to reducing emergency room visits to expanding provider versatility while also addressing price variation between larger hospitals and their smaller community hospital counterparts. The report outlines a series of recommendations that will achieve these goals and lower costs as a result of implementation.

The bill takes concrete steps to expand provider versatility to increase access to lower cost providers. It expands provider treatment authority for nurse practitioners, certified registered nurse anesthetists, psychiatric clinical nurse specialists, optometrists, and podiatrists; additionally, it establishes a mid-level dental therapist (DT) certification.

A DT would be able to perform procedures including basic tooth extractions, fillings, and taking x-rays, freeing up dentists to focus on complicated cases. Currently, in Massachusetts over a half-million residents live in dentist shortage areas as defined by the US Department of Health and Human Services, and in 2014 only 35 percent of dentists treated MassHealth patients. As a result, 44 percent of children on MassHealth (over 284,000) did not see a dentist in 2015. This bill is uniquely designed to target those living in dentist shortage areas by allowing DTs additional freedoms to operate under non-profits and in a licensed mobile dentistry program. By reaching out to underserved populations, the culture around oral healthcare can begin to change.

The bill also reauthorizes and updates the successful Prevention and Wellness Trust Fund (PWTF), and provides opportunities for new sources of funding, a major priority of Senator Lewis’. The PWTF funds community partnerships made up of municipal governments, healthcare providers, and local health and human service organizations, all working closely together to achieve a community-wide focus on prevention and wellness. Early results from an assessment conducted by Harvard Catalyst indicate that “to date, PWTF appears to be a very sound investment from the point of view of improving outcomes and controlling costs.”

The report aims to reduce hospital re-admissions and emergency department use through mobile integrated health and telemedicine as well as expanding access to behavioral health. Massachusetts Health Policy Commission has estimated that 42 percent of all Emergency department visits are avoidable.

Post-acute care in an institutional setting and long term care and supports (LTSS) cost the state an estimated $4.7 billion in 2015, a major cost driver for MassHealth. The report recommends increased transition planning for patients into community settings and strengthening coordination between providers.

Pharmaceutical costs have been a driver of increased healthcare costs for a number of years. The Center for Health Information and Analysis (CHIA) reported a 6.4 percent growth in pharmaceutical spending in 2016. Drug costs are making families choose between filling prescriptions and paying for other essentials like housing and food. The report recommends greater oversight and transparency in drug costs and encourages Massachusetts to enter into bulk purchasing arrangements, including a multistate drug purchasing consortium like other states, to lower costs and protect consumers.

The scope of the report encompasses the whole system from Medicaid to the commercial market, and makes additional recommendations on how to lower costs, address price variation, increase price transparency for consumers, leverage better federal funding opportunities, and many other recommendations. A copy of the report and draft legislation can be found online at https://malegislature.gov/Committees/Detail/S61/Documents.

Column: We Need To Do More to Stop Wage Theft

Earlier this year, at the start of the new legislative session, we were pleased to be appointed by the Senate President and House Speaker, respectively, to co-Chair the Joint Committee on Labor and Workforce Development. Together, we have since immersed ourselves in a wide range of labor and employment issues in the Commonwealth. We have held committee hearings on proposed legislation, met with many different stakeholders to hear their concerns and feedback, and conducted research on policies and best practices around the country.

One particular issue that may surprise many people is the serious problem of wage theft. Wage theft is a collective term for any denial of wages or benefits that are rightfully owed to an employee. The most common wage theft violations in Massachusetts are non-payment of wages, failure to keep true and accurate records, failure to pay the proper overtime rate, child labor violations, failure to pay minimum wage or tips, and failure to pay prevailing wage. Other violations include failure to submit accurate payroll records, earned sick time violations, and improper classification of employees as independent contractors.

Just how pervasive is wage theft? It is estimated that nearly $700 million is not paid to about 350,000 mostly low-wage workers each year in Massachusetts. In addition to the harm this inflicts on struggling working families, it also cheats the state out of greater economic activity, jobs, and tax revenue.

The Attorney General’s Office (AGO) is the state’s primary enforcer of laws relating to wages. Enforcement is carried out by attorneys and investigators in the AGO’s Fair Labor Division (FLD). In Fiscal Year 2017, the FLD received 16,684 calls and 5,604 complaints, and opened 607 cases related to wage theft. The FLD ordered employers to pay more than $6 million in restitution and more than $2.6 million in penalties. This is more than double the restitution ($2.6 million) and about triple the penalties ($900,000) from Fiscal Year 2016. The FLD also cited or settled 27 earned sick time cases, totaling $160,000 in restitution and penalties. And, the FLD issued 47 citations to 46 employers and assessed more than $270,000 in penalties for child labor law violations.

Wage theft investigations spanned more than twenty different industries, with the restaurant and construction industries having the highest percentage of violations cited. Perpetrators of wage theft and worker exploitation typically target vulnerable populations like low-wage workers and immigrant workers.

Vigorous enforcement of our labor laws is critical to ensure that workers are paid what they are owed, the playing field is level for the majority of businesses that follow the law, and to protect the Commonwealth from lost revenue in the form of taxes and unemployment insurance contributions.

To be proactive, the AGO has also worked with community partners to put on Wage Theft Clinics for workers. More than 230 workers have received free consultations at these clinics so far, and more than $65,000 in stolen wages has been recovered. Volunteer lawyers, law students, interpreters, and workers’ rights advocates are on hand to educate workers about their rights, draft demand letters, or prepare small claims court complaints. For questions about upcoming Wage Theft Clinics or other inquiries about the AGO’s enforcement of laws relating to wages, contact the FLD at (617) 727-3465.

In the legislature, the Joint Committee on Labor and Workforce Development, is considering several bills to help combat wage theft, including An Act to Prevent Wage Theft and Promote Employer Accountability, sponsored by Senator Sal DiDomenico and Representative Aaron Michlewitz. This important legislation would further strengthen the enforcement powers of the AGO, and would hold lead contractors accountable for wage theft violations of their subcontractors as long as there is a significant connection to their business activities.

Through education, enforcement, and legislation, we must do more to stop wage theft in Massachusetts.

Senator Jason Lewis
Senate co-Chair, Joint Committee on Labor & Workforce Development

Representative Paul Brodeur
House co-Chair, Joint Committee on Labor & Workforce Development

Senate Releases MassMoves Report to Create a 21st Century Transportation Vision for Massachusetts

The Massachusetts State Senate released its MassMoves report highlighting residents’ priorities for a forward-thinking 21st century vision for the Commonwealth’s transportation system. The Senate launched the MassMoves initiative as a part of the Commonwealth Conversations Tour in order to collect feedback directly from residents to help envision a better transportation system across Massachusetts.

The MassMoves executive summary and full report, entitled MassMoves: A Vision for the Commonwealth’s 21st-Century Transportation System, can be accessed online at https://MALegislature.gov/CC/. This work was supported by the Barr Foundation.

“A reliable, accessible, and affordable public transportation system is vital for robust economic growth and a sustainable quality-of-life across our region,” said Senator Jason Lewis. “Those who rely on public transit span demographics and geography, from a commuting workforce, to students and senior citizens, to families traveling to recreation spots across the region and state. Feedback directly from residents locally and statewide was integral to guiding the Senate’s planning on transportation to ensure that the Commonwealth meets its residents’ public transit needs in the years ahead.”

Over 700 citizens were engaged during nine transportation-focused workshops held during the Commonwealth Conversations Tour across Massachusetts. Participants agreed that transportation needs to run efficiently, especially rail and bus. Participants expressed favor for additional investment in transportation through broad-based general taxes over targeted user fees. All nine transportation workshops support allowing local government to raise money for local transportation projects. The report also highlights transportation priorities in nine regions of Massachusetts.

The Commonwealth Conversations Tour, not to be confused with Senator Jason Lewis’ local Community Conversations series, is a statewide listening tour spanning nine regions across the state, giving the Senate the opportunity to meet with local residents, businesses, and interest groups in every corner of Massachusetts to hear their concerns directly on issues of importance to every resident.