How Nutrition in MassCare May Put The ‘Health’ Back in ‘Universal Health Coverage’

by Ayten Salahi & Hattie Brown

Including local incentives for food equity and nutritional status may boost momentum and potential of the MA Right to Health movement. Members of budding student group – the Friedman Food Policy Action Council (FFPAC) – met with Massachusetts State Senator Jamie Eldridge to discuss the need to include nutrition in a proposed cost analysis of a single payer health system (S.2202).

Pictured left to right: Ayten Salahi (MS/RD Candidate), Kurt Hager (MS/MPH Candidate), Senator Jamie Eldridge, Alana Davidson (MS Candidate). 22 NOV 2017

In thousands of American households, the prohibitive cost of healthcare has forced families into an impossible position: choose between financial ruin or the health decline and possible death of a loved one. In Massachusetts, this bleak reality has motivated both the state legislature and its constituents to revive a movement in favor of a single payer healthcare system. However, the degree to which nutrition interventions and food access will be covered in the proposed model remains largely unknown.

The central tenet of a single payer scheme under universal health coverage (UHC) is that health care is a human right. The proposed legislation in Massachusetts seeks to offer and protect healthcare for all residents through a publicly-financed program that provides comprehensive care and coverage under a single insurance plan. The single payer public option would serve as an alternative to employer-sponsored healthcare, in which premiums are paid through payroll deductions, coupled with co-pays and out-of-pocket deductibles. For middle- and lower-income beneficiaries, a single payer system means lower cost for better access to care.

In Massachusetts, the single-payer campaign has reached unprecedented support with 120 co-signers under a 2017 proposal colloquially called MassCare (H. 2987, S. 619). Though neither of the proposed legislation were passed this year, an amended bill (S. 2202) was passed with overwhelming support by the state Senate on November 10 by a 33-6 vote (all six Republicans in the chamber being against). S.2202 authorizes a cost analysis of a state-wide single payer system, and will be reviewed by the House in early 2018.

While MassCare holds promising potential to reduce healthcare spending for both the state and per capita, the proposed legislation does not explicitly or implicitly include nutrition interventions as a line item for consideration in the single payer costing analysis. Historically, UHC policy-makers have deemed nutrition-related services as non-essential, and therefore not covered by insurance. The World Bank refutes this trend, and reports that to accelerate progress towards affordability and access of care requires a “fundamental rethinking of how to keep people healthy.” The recommendations go on to cite regulatory measures targeted to improve diet-related behavior as seminal to the public health agenda. Just last year, the International Food Policy Research Institute (IFRI) further urged policy-makers to include access to adequate nutrients as an essential service in all UHC programs.

To learn more about how nutrition might fit into the proposed single payer costing analysis, three members of the nascent, student-run Friedman Food Policy Action Council (FFPAC) took to the Massachusetts State House in late November to meet with single payer champion and state Senator Jamie Eldridge. FFPAC emphasized that, as Massachusetts prepares to analyze the cost effectiveness of single payer models as outlined in S.2202, additional resources should be allocated to determine the efficacy of funding nutrition therapy programs within the model. To achieve this, FFPAC proposed that the MA single payer costing analysis include: 1) medical nutrition therapy coverage for patients with, or at risk for, hypertension, obesity and cardiovascular disease (CVD); 2) enteral nutrition coverage as outlined in MassHealth; 3) food insecurity screenings for all patients; and 4) tailored food prescriptions for low-income patients.

State Senator Jamie Eldridge, lead Senate sponsor of An Act Establishing Medicare For All in Massachusetts, said, “I was excited to meet with graduate students from the Friedman School of Nutrition, to discuss how preventative health, including nutrition interventions, would be a key component of single payer healthcare, and would help reduce healthcare costs in Massachusetts.”

As the proposed bill continues to undergo revision and review into 2018, FFPAC will continue to advocate that Massachusetts – home of the healthcare law that led to the Affordable Care Act –should again lead by investing in nutritional therapy programs in a single payer model as a method to improve the health of its citizens, lower healthcare costs, and lower the tax burdens of its residents.

The Friedman Food Policy Action Council (FFPAC) is a developing student-run organization of the Friedman School of Nutrition Science and Policy at Tufts University. The group will be formally established in December 2017, with a mission to advance evidence-based nutrition and agricultural policies in support of public and environmental health, by equipping students with the skills and relationships necessary to impact policy through advocacy. FFPAC will host its general interest meeting in the early 2018. For further information, please contact friedmanfpac@googlegroups.com. Stay tuned for opportunities to join us and amplify the voice of food advocates in 2018!

Ayten Salahi is a first-year FPAN MS/RD candidate, co-founder of the FFPAC, and is dedicated to the future of policy, programming, and clinical practice in sustainable diets. Ayten came to Friedman after working as a molecular and clinical researcher in neuropharmacology and diabetes management for nearly 8 years.

Hattie Brown is an MS candidate in the FPAN program, and a co-founder of FFPAC. Her interests at Friedman are in the economic implications of food systems, with a focus on the intersection of sustainable agriculture and access to nutritious food. Before coming to Friedman, Hattie worked as a researcher in various capacities, including legal, for a public finance firm, and clinical, for a study analyzing phytochemical compounds in cocoa and their impacts on satiety.

 

 

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Comments

  1. So happy to see Friedman folks’ consideration of local government policies, all the better for making Massachusetts a leader in healthcare (and nutrition-related services)!

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