As you enjoy a very nutritious helping or two of Thanksgiving dinner this week, here's some interesting happenings in Massachusetts public health law for you to chew on (haaa).
This week, the Commonwealth of Massachusetts became the first state in the nation to ensure that most health insurance plans cover birth control without cost-sharing to patients. Technically, this provision already exists federally in the still-good-law Affordable Care Act. However, in October, the federal government issued rules to roll back that requirement by allowing any employer to avoid such coverage by invoking religious or moral objections to contraception. The Massachusetts law still contains religious exceptions, including for churches and "qualified church-controlled organizations" as employers; it also does not cover any employers who insure themselves and are thus subject solely to federal, rather than state, regulations. This law was intended as a direct rebuke to Trump and his Cabinet; the fact that it was drafted, passed, and signed within a matter of weeks is actually quite a remarkable feat for the Massachusetts state government. Both the health insurance industry and the reproductive rights community supported the bill and helped to negotiate the resulting language. In addition to the birth control access without cost-sharing, the bill also expands coverage by allowing a one-year supply of birth control pills, by increasing the types of birth control covered, and by covering the so-called “morning after” pill without a prescription.
Massachusetts also took a significant step toward criminal justice reform recently when both branches of the legislature passed comprehensive bills addressing issues like repealing mandatory minimum sentences for drug crimes and considering 18-year-olds juveniles rather than adults. While now in reconciliation talks, one provision that went mostly unnoticed in both bills would require prisons and jails to offer approved substance use disorder medication to inmates. Currently, the only medication-based treatment available to inmates is Vivitrol, a monthly shot that “blocks” opioid receptors in the brain. And even that shot (provided for free from a drug company accused of questionable tactics), is given to inmates only immediately pre-release. Though a recent study suggests that Vivitrol is an effective treatment for opioid use disorder, the corrections system currently prohibits use of established medications like buprenorphine (Suboxone) and methadone, even for inmates who have valid prescriptions upon incarceration. Corrections officials object to changing that status quo, claiming that such medications are simply contraband that would “caus[e] people to be assaulted. It’s causing people to have hits put on them.” Yet knowingly withholding effective treatment from inmates in a state with one of the highest opioid-related death rates in the country because unauthorized use of medicine could cause security issues not only ignores the public health implications, but it assumes a controlled medical approach to such treatment would fail without actually trying it. The Commonwealth’s neighbors in Rhode Island instituted medication-assisted therapy in their correctional institutions last year and, at least anecdotally, have actually seen a reduction in contraband.