No easy cure for health care costs

A big goal in health care reform is to figure out ways to deliver care as well or better than it’s now provided at lower cost. It’s something everyone can get behind, but it turns out to be much easier said than done.

The latest example may be how we pay for personal care attendants who assist the elderly and those with disabilities.

The low-paid workers are an indispensable lifeline to such patients, providing care that allows them to remain in their homes. A recent federal appeals court ruling upheld a Labor Department rule saying the country’s two million home-care attendants are covered by federal workplace protections, including eligibility for overtime pay. The Baker administration, looking for ways to limit spiraling state health care spending, has effectively imposed a 40-hour work week limit on personal care attendants in response, writes Joan Vennochi.

Limiting the attendants’ ability to earn overtime pay may be one thing, but Vennochi says the move has the further effect of disrupting care for patients, who won’t be able to have the same attendant cover as much of their care. Patching together a week of coverage with more home-care attendants means disrupting longtime relationships between caregivers and patients and being forced to develop new ones.

Advocates have raised similar concerns regarding the administration’s pending application for a federal waiver related to the Medicaid program that would direct more MassHealth patients into plans that would cut access for some of them to providers with whom they have longstanding relationships.

One of those speaking out against the personal-care attendant rule change at a State House rally on Monday was state Rep. Susan Gifford, a Wareham Republican. Vennochi says the “self-described fiscal conservative” told her, “I think this administration is doing a good job of trying to find a way to save money and cut costs, but this is not the way to do it.”

The problem, of course, is that so many ways of trying to save money or cut costs will seem to be a poor way of achieving efficiencies to someone or some group.

The devil is always in the details.

–MICHAEL JONAS

BEACON HILL

Joe Battenfeld reports that an official in the Executive Office of Environmental Affairs is alleging she faced harassment and retaliation when her fiance announced a Democratic campaign to challenge Republican state Sen. Donald Humason. (Boston Herald)

An aide to Gov. Charlie Baker is transferring to the Department of Conservation and Recreation. (Politico)

MUNICIPAL MATTERS

Thousands of people flock to Immaculate Conception Church in Lowell to see the encased heart of St. Padre Pio. (Lowell Sun)

A wayward moose walking on Route 9 in Westborough causes a three-car crash that sends one driver to the hospital and the moose to the graveyard. (Telegram & Gazette)

Plans for a boutique hotel in downtown Salem are unveiled. (Salem News)

An investigation into whether the part-time assessor in Swansea was double-dipping as he worked for two other communities was unable to make a determination. (Herald News)

Mayor Marty Walsh will unveil new branding of the long-criticized Boston Redevelopment Authority next week. (Boston Herald)

Alex Green laments the demise of Harvard Square. (WBUR)

WASHINGTON/NATIONAL/INTERNATIONAL

Telegram & Gazette columnist Dianne Williamson weighs in on the “Hands up, don’t shoot” mantra.

Rome may be the third city to pull out of contention for the 2024 Summer Olympics. (New York Times) Keller@Large says the Games have lost their luster for host cities because of the track record of unsustainable cost overruns.

The suspect in the New York bombings was flagged twice in 2014 by Customs agents when he returned from a year-long trip to Pakistan. (New York Times)

The mayor of Charlotte, North Carolina, has declared a state of emergency after the second night of protests over the police shooting of a black man. (New York Times)

ELECTIONS

Eric Fehrnstrom says all the pressure is on Hillary Clinton in Monday’s first presidential debate, with expectations for Donald Trump so low that he could do well by simply not committing any huge gaffes. (Boston Globe)

Celebrities against Trump. (U.S. News & World Report)

The Boston School Committee is poised to join with more than 120 other school boards across the state that have voted to oppose the ballot question raising the cap on charter schools. (Boston Globe)

John Connolly, who faced off against Marty Walsh for the open Boston mayor’s post in 2013, says he’s not mulling another run. (Boston Herald)

Republican-aligned outside groups are on pace to outspend their Democratic counterparts in every Senate in the country except New Hampshire and Pennsylvania, where the two incumbents are at risk of losing. (National Review)

BUSINESS/ECONOMY

The Fed will hold interest rates steady for now, despite dissent from Boston Fed president Eric Rosengren. (Boston Globe)

The state approved a $700,000 tax break for Cambridge tech company Akamai Technologies to help underwrite its Kendall Square expansion. (Boston Globe) One member of the state council that approves the awards, however, UMass Dartmouth professor Michael Goodman, questioned why the firm needed a state handout to expand in one of the hottest real estate markets in North America. (Boston Herald)

A survey by a nonprofit coalition finds more than 75 percent of voters want charities to have a say in policymaking. (Chronicle of Philanthropy)

EDUCATION

Mixed grading: Boston school superintendent Tommy Chang earned middling grades from the school committee on his first year on the job, reports the Boston Herald. The Globe casts the review, which rated Chang “proficient,” the second of four categories, in more positive light, saying he received “favorable marks.”

Worcester’s recovery high school has only 14 students, half as many as last year. (Telegram & Gazette)

A new statewide history assessment  is in the works. (Lowell Sun)

The US Justice Department has cited Wheaton College for multiple areas in which it fell short of legal obligations in cases of campus sexual assault. (Boston Globe)

HEALTH/HEALTH CARE

A proposed medical marijuana dispensary and cultivation center on Martha’s Vineyard has been granted a provisional license by the state but there are questions over how the facility will transport the still-illegal plant across federally controlled waters for testing. (Cape Cod Times)

TRANSPORTATION

Boston is poised to see testing of self-driving cars, but state law has no provisions for how they will be regulated. (Boston Globe)

A section of Route 128 in Needham will be closed for two days during an early November weekend to allow the demolition of a bridge that runs over it. (Boston Globe)

The state’s largest private jet operator decides to locate its maintenance base at the Worcester airport. (Masslive)

ENERGY/ENVIRONMENT

The US and Canada have reached an agreement on sharing the dwindling number of cod in the Atlantic, settling on a catch quota of 730 metric tons with US fishermen getting 146 metric tons and the remainder set aside for Canadian boats. (Associated Press)

Vermont prepares to cut subsidies for solar power. (Governing)

Federal fish and wildlife officials expressed disappointment over a bill filed by US Rep. William Keating that would end a dispute over management of submerged land off Monomoy National Wildlife Refuge and make it subject to local control. (Cape Cod Times)

The Hingham harbormaster and town health officials are trying to determine why hundreds of Menhaden — a bait fish commonly called pogies — were found floating dead in shallow waters near the Hingham Yacht Club. (Patriot Ledger)

CASINOS

A new study estimates there are 88,000 problem gamblers in Massachusetts. (State House News)

CRIMINAL JUSTICE/COURTS

The spotlight is getting brighter on US Attorney Carmen Ortiz over her judgment in pursuing criminal charges for actions that have rarely drawn prosecution. (Greater Boston)

Lawrence police say they plan to seek a child endangerment charge against a woman who apparently overdosed in a store and collapsed in front of her 2-year-old daughter. (Eagle-Tribune)

Attorney General Maura Healey says it’s a “scary time” to be in law enforcement. (Masslive)

The attorney general’s office is investigating the sale of surplus State Police weapons to a Greenfield gun dealer and whether three suspended troopers received free weapons for their personal use in exchange. (Boston Globe)

The trial of a 66-year-old Cohasset lawyer charged with vehicular homicide in the June death of a Brockton man who was standing on a sidewalk has been transferred from Brockton to Wareham District Court because of an unspecified conflict of interest. (The Enterprise)

Two are charged with stealing more than $600,000 from Peter Pan Bus Lines. (Masslive)