The Massachusetts health reform experience is often cited as a model for key aspects of the federal health reform law – the Affordable Care Act. To gain some insight into the origins of the Massachusetts health reform law, and to explore current experience with implementation, I spoke with Rep. Ruth Balser, a legislative leader and supporter of the health reform laws in Massachusetts.
The audio file of my interview with Rep. Ruth Balser (about 25 minutes long) is available for listening or download.
A full transcript is at the end of this post (and in the linked Massachusetts State Rep. Ruth Balser interview transcript).
David Harlow: This is David Harlow on HealthBlawg, and I have with me today Representative Ruth Balser, a state legislator in Massachusetts. Representative Balser is a clinical psychologist by profession. She’s a former Alderman in the City of Newton, Massachusetts and a leader in Massachusetts when it comes to health reform.
She’s a state house veteran. She’s been on Beacon Hill for over ten years and has held leadership positions in the state legislature in various key committees and has been a prime mover behind Massachusetts health reform legislation.
Rep. Balser: Well thank you. I’m happy to be here. Thank for that nice introduction. I think it’s more fair to say that I was one of a number of people who supported health care reform efforts. The leaders at the time of course were the Speaker of the House at the time and the Senate President and the Governor, but I was a committee chair on the Joint Committee on Mental Health and Substance Abuse at the time. I did pay particular attention in fact to protecting mental health and substance abuse within the health care reform efforts.
David Harlow: Yes. So that’s often an area that is ignored or left behind or gets short shrift in the discussion.
David Harlow: I wanted to start off with a question about how the legislation in Massachusetts came to be. How it came to focus on access. There are really three key issues that people keep talking about, the three-legged stool of health reform: access, cost, and quality.
A decision was made early on in Massachusetts to address access first. I’m wondering why did we start there? How are we doing in terms of addressing access and also the other areas of cost and quality?
Rep. Balser: The fact that we focused on access had to do with reapplying for a Medicaid waiver to the federal government. We actually had to address access in reapplying for the Medicaid waiver, in my memory, so that became the initial, really financial reason for addressing the access issue.
But once the state embraced that, it really did embrace it. There was a shared goal on the part of the legislature and the governor to try to get as close to 100% health insurance coverage as possible.
We’ve been really successful. We have 97% of the people of Massachusetts who have health insurance plans. I believe we lead the nation. I believe that’s the best rate across the country. So from that point of view, our efforts were tremendously successful.
David Harlow: So that was based on the legislation in 2006 that’s led to that rate of coverage which I very believe that is the highest rate nationally. And then there was another bill two years later that was intended to address cost and quality issues as well. How has that bill been implemented? Or what can you say about that?
Rep. Balser: Well, first of all, there were some quality issues which we addressed in 2006 as well. We can get back to that a little later in the conversation if you’d like. And the more recent legislation on cost which we actually also just did this session.
In 2010, we just did some cost measures but I think it’s agreed that it’s only the beginning. I think there’s a pretty universal agreement that the rising cost of health care is the biggest challenge that we face. There’s a lot of discussion about trying to grapple with that going into next session.
There were some market reforms this past session. For instance, allowing small groups, small businesses to associate in groups which might help bring down the cost. The governor actually did some capping of rates. But I think it has been agreed in Massachusetts that we’ve been much more successful on the access side so far than on the cost side.
David Harlow: Yes. So in the small group reform legislation, there were some provisions that also address moving in the direction of bundled payment rates. It’s really sort of, from my perspective, it looks like baby steps in that direction.
Following up on some of the agency and legislative hearings and reports that were issued over the past year, how do you think that will be going? Do you see that as a direction that we need to move in – the bundled payments?
Rep. Balser: Well, I guess to be frank, I haven’t weighed in on a particular strategy yet. I think first of all, your reference to baby steps would be agreed. I think people at the legislature know that they’ve only just begun to tackle this. I know if you listen closely to the gubernatorial race that’s going on, there’s debate going on about payment reform which I think will be the hot topic next session.
One of the reasons why our health reform of 2006 was as successful as it was and why passage was so much easier here in Massachusetts than what happened nationally, was because all the stakeholders were brought to the table. The insurers, the providers, consumers, and legislators all came together and developed a plan which eventually they could all buy into.
I think what’s going to happen – that has not yet happened on the payment issue. I think that’s what’s goi
ng to have to happen next. There’s going to have to be some real leadership in pulling together the stakeholders.
Right now, you have a blame game going on with the insurers blaming the medical community, and the medical community blaming the insurers. I think we are going to need to see some kind of process similar to what happened a few years ago when everyone came to the table and reached a plan that they could all buy into.
David Harlow: Is there a need, do you think, for an external crisis? You mentioned in ’06, the issue was a deadline for getting a Medicaid waiver from federal government. Is there some external crisis or are we in the presence of one already given the cost?
Rep. Balser: I’m not aware of something analogous to the Medicaid waiver but yes, I think everyone agrees we’re in the middle of a crisis. I think the cost of healthcare is unsustainable. It’s breaking government. I mean at the municipal level, you hear about it. At the state level, you hear about it. Small businesses complain that it’s breaking them. It has a huge impact on the economy. So I think there is definitely a sense of crisis. Although there isn’t a deadline they way there was and I guess that was helpful. It’s always helpful to have a deadline.
David Harlow: Sure. So one deadline that recently came and went was the end of the federal and hospital fiscal year and that seems to have brought the dispute between Boston Medical Center and the state forward, and resulted in some resolution. I don’t know if that’s going to be a final resolution or how it affects other hospitals and their debates with Medicaid. But there’s some additional federal Medicaid money now available for Boston Medical Center, Cambridge Health Alliance.
It seems to me that’s not a sustainable way of addressing these issues with stop-gap additional funds. Do you have any sense about that being a step in the right direction? Impetus for more structural change? Or what can we take away for other providers from this experience with Boston Medical Center?
Rep. Balser: You know, I’m not such an expert on that, but I think what everyone’s talking about is payment reform. That’s the news: changing from fee-for-service to global payments. That’s one thing. Well actually that’s one thing Governor Patrick is talking about.
Then you hear candidate Charlie Baker talking about transparency. He’s talking about just revealing the different payments that insurers and different provider groups are negotiating. He’s saying that if you just laid all that out on the table, that would lead to some change. Part of it is what’s going to make a difference is who’s elected governor which we’re in the middle of the campaign about.
David Harlow: Now Charlie Baker, a couple of decades ago, was involved in working to dismantle the rate setting structure in Massachusetts.
David Harlow: Do you see his current stance as being consistent with that? Is transparency going to be there just for the goal of developing more of a market for health care?
Rep. Balser: Well, I’m certainly a supporter of the governor, so I don’t know if I’ll give a fair- but I think you’re right. He was part of breaking that down and that certainly has contributed to the problems that we’re facing.
David Harlow: So I take it you see this is not necessarily something that could be solved by throwing it to the free market?
Rep. Balser: Oh, no, absolutely not. The government is going to have to play an active role in negotiating some changed relationships between the payers and the providers. That’s going to have to change.
David Harlow: Do you see that role and that relationship leading to any resolution in the cost inflation side? We talked a little bit about different types of approaches to payment. Is that something that you see as being developed by regulation? Will there be a menu of approaches to payment that could be offered by the state government to the provider?
Rep. Balser: Perhaps. You know it’s interesting when, you know, this is clearly a tougher problem to solve than the access problem. In 2006, there was actually explicit conversation about how we were not going to tackle the cost problem yet. It’s interesting and at that time, what we were debating, I mean it’s funny because the model we set up obviously had implications for cost.
There were a few different models one could choose from to set up a healthcare — we might talk about the old Dukakis model. Maybe we should walk through the steps of the model so that we can, to get to the cost question because what had been tried in years past was this Dukakis model which was an employer mandate, requiring employers to pay. And that never got implemented. The business community rejected responsibility.
Then there were many years where there were, at least on the liberal side of the political spectrum, people advocating for a single payer system. In other words, government taking the responsibility for who would pay because the debate was always who would pay, not how much we would pay.
Rep. Balser: So first, it was going to be the employers. Then there were some folks who try to argue that the government should pay. And there were hopes that at least maybe on the national level, we could expand Medicare. That issue got revisited with the public option debate.
Even here in Massachusetts, people were saying perhaps we needed to do a single payer first at the state level. What we did in 2006, was decide to develop a hybrid system that would have three payers. One would be employers, another would be government, but the third and this was really the Republican contribution which the Democrats embraced, was the individual mandate.
So when we talked about who was going to pay, the model that we developed was that again, a three-legged stool, which is often the image. It was going to be employers, government, and the individual. That was the breakthrough was that we broke out of this argument, would it be employers or would it be government or would it be a combination? But the final breakthrough was actually to add the individual mandate as part of that. And that’s the Massachusetts model that then got embraced nationally.
I should just mention for those who don’t remember, this was debated when Hilary Clinton and Barack Obama were competing for the Democratic nomination. It was actually Senator Clinton who was pushing for the Massachusetts model and the individual mandate. Senator Obama at the time rejected it. Although later when he became president, he embraced and supported that. So now we have that at the national level.
But fast forward now, I think this is what makes the cost argument so complicated because the cost on individuals has gone up. The cost on businesses…I mean businesses got off easy in our Massachusetts health plan. We in the House had wanted a larger employer contribution. The Senate and the governor, the former governor actually didn’t want employers to have to make a contribution at all. We settled on a compromise where the employers pay a much smaller contribution than we in the House would have liked.
But I think someone will have to — maybe you’ll help me figure this out. But I think that model that we set up, made it all the more complicated to now tackle the problem of cost.
Rep. Balser: Yeah, well and then each sort of resisting taking the full responsibility. Yeah, you’d think maybe it would make it easier because you had different people contributing or different forces contributing. But you know, let’s say the government was responsible like with Medicare or whatever, well, then you would just tackle it as a federal budget problem. The businesses certainly feel they can’t in this economy afford to manage to this rising cost and individuals certainly feel they can’t.
David Harlow: The Massachusetts experience has been both praised and vilified nationally as the national debate continues. I guess I’m wondering whether there are particular areas of the Massachusetts experience that you would highlight as being praiseworthy. We spoke briefly about the fact that we’ve achieved near-universal coverage…
David Harlow: …and an uninsurance rate on the order of two or three percent of the population which is a vast improvement. One of the criticisms of the plan early on was that we had not anticipated how many people would sign up for the various types of programs and that the cost was too great for the state to bear.
Rep. Balser: But the state has maintained its commitment and has covered the cost. Well, there were a few problems from my point of view. We always knew once we embraced this model of the individual mandate, we always knew that would only work so long as there were sufficient resources and commitment to subsidizing those individuals who couldn’t afford the mandate.
So one reason for the individual mandate was because a significant portion of the uninsured were healthy – one group amongst the uninsured for instance were healthy young adults, people who could afford it actually. Forget the percentage but significant numbers of relatively young adults who are healthy and who had good jobs and were making good money but just didn’t choose to buy health insurance because they [overlap]
Rep. Balser: Yeah, that’s right. So that was the model for why it would make sense to have an individual mandate. Someone’s making a young, single adult who’s making $60-70,000 or something about like that. They can afford to pay for some health insurance. Plus, it helps the risk pool if you have more healthy people in it. And that the idea was that it would also bring down the cost for everyone.
But it was also clear there would be people whose employers did not provide health insurance for them and had made more money than allowed them to be eligible for Medicaid, but who would not be able to pay the full amount of a private health plan. So the idea was that the state, the public sector would subsidize part of the cost of their health plan.
We always knew the success or failure of the program would sort of rise or fall with whether we could appropriately subsidize those folks because otherwise, the individual mandate becomes really unfair. You force someone to pay for something they can’t afford.
So what happened was the numbers the first year or so really didn’t work totally and so the state ended up exempting a bunch of people from the mandate which of course defeated the point of universal coverage but we knew it wouldn’t be fair to require them to pay what they couldn’t pay.
But there’s still the devil in the details. The premium’s cost has gone up and there are a lot of folks, the working poor who are out there working two full-time jobs and raising kids and who can’t afford. So that’s a problem.
I do remember during the presidential debate when Senator Clinton defended basing the national model on the state. She pointed out that the federal government would have more resources available and probably could do the right thing as far as subsidizing people who couldn’t fully afford it. We’ll see how that ends up playing out with what the Congress did.
You were asking how has it worked out. So that’s still a problem is that the resources aren’t there to really get the right amount of subsidy for people who are struggling to pay, the individual.
The other problem was that to keep plans affordable, we ended up supporting and by we, I’m being generous because I actually opposed this. But we ended up allowing high deductibles. I actually had filed some amendments during the debate to limit the increase in the deductibles and those failed because that seemed like a way to bring down the cost of the plans. But when you have very high deductibles, people end up not really getting services because they can’t afford the outpatient care to get up to the level of the deductible. So that’s been another problem.
David Harlow: Right. There’s some research that has shown that people who could use the combination of high-deductible health plans and health savings accounts the most are the people who don’t use them. They aren’t able to put the money away or are unwilling to pay those first dollar expenses for services that would be helpful, maybe preventive services. So that does seem to be a problem.
Rep. Balser: Right. But I will tell a story if you’re interesting in a role I played that I’m actually particularly proud of which is when the process first began, and we were talking about how to get to universal coverage, of course different people had different ideas. Just like now we’re going to have different ideas about how to manage the cost. Then we had different ideas about how to provide access.
Governor Romney at the time, released his bill first. One of the sentences in his bill was that all new health plans created under his plan would be exempt from all the current state mandates. And so in other words, he wanted to insure people by creating what I would call cheaper and less adequate health plans because they would be exempt from the mandates.
I was particularly concerned about the mental health and substance abuse mandates but there was a whole list — I think there’s more than 20 mandates that over time have passed. You know, that the legislature at one point or another felt it was important that all health plans be required to cover these different aspects of healthcare. So there was this little sentence in his bill that would have set all these new plans could be created that would really result in people being under-insured.
So I was watching for this and the Senate then came out with their plan and it had the same language in it. And then the House and it goes to the House and the House came out with a plan that initially had that same sentence in it which I was watching for. I was chairing the mental health and substance abuse committee at the time and I was watching for this issue because I wanted to make sure that the insurance would be comprehensive and include good mental health and substance abuse coverage.
So when I saw that same language was being mirrored, I filed an amendment in the House to remove it and to say that any new plan created under health reform would have to live up to the same mandates that all our previous plans had. And that was quickly supported in the House. The chairperson of the health care finance committee who was mainly overseeing this supported me in that. Speaker DiMasi also very quickly supported it. So the House went on record saying that if were going have universal health care, we wanted to make sure that health care would be comprehensive.
-legged access, cost and quality, we were trying to deal with both access and quality. And the House led the way on that saying if we’re going to cover everyone, it’s got to be comprehensive, quality insurance. And the Senate then embraced it and Governor Romney did sign it that way.
David Harlow: And now we’re facing a similar issue in the national front as some large employers and others are trying to find exceptions to allow for these mini-plans to be seen as adequate under the national rules. So the conversation continues.
Rep. Balser: Right. You know it’s tough. It’s always tempting I guess for people to cut cost by reducing quality. What we were trying to say around that issue was we got to try to cut the cost through perhaps market reforms or changes in the way you know, payment reform but not in terms of reducing quality.
David Harlow: As you said, that remains front and center and that’s the next set of issues to be addressed here.
David Harlow: Well thank you very much. I’ve been speaking with Representative Ruth Balser, state legislator in Massachusetts on the question of health reform and the Massachusetts experience and what we can hope to see in the future in Massachusetts and on the national stage. Thank you again Representative Balser.
Filed Under: Health care policy, Health Law, Health Reform, Interview, Massachusetts, Podcast, Universal Health Care
A Massachusetts health reform reading list from RWJF VP David Colby; Massachusetts payment system reform recommendations up next
Let’s get one thing straight. There is no cure for addiction. If you have suffered its physical and mental perils, and its catastrophic effect on your life, know this: that addiction will always be with you, sitting in the background to your life, waiting on your possible relapse. Recovery is not about beating it or getting an “all clear” from medical professionals. It’s about learning to live your life abstaining from the alcohol or drugs that brought such harm and misery, in the first place, to you and those around you.
Addiction has many definitions. This is one of the clearest: “A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works.”
In case you were wondering, the word chronic, in medical terminology, means a disease or condition that lasts longer than 3 months. So, in the definition of addiction given above, chronic is the least of your problems – the “relapsing” part is what needs to concern you.
Everybody has their own story when it comes to addiction. Briefly, that is why treatment of addiction can vary greatly from person to person, sufferer to sufferer. However, the steps towards a recovery are clear for all, regardless of personal story, grounded in medical research that has continued as long as the effects of alcohol and drugs were first discovered and then subsequently abused.
There are 5 clear steps along the path of your addiction recovery. Every step needs to be taken, and some need to be continually repeated. Each one of them is essential in you never becoming subjected to your addiction again, each of them is necessary in order to live a life of abstinence.
This article details those 5 essential steps that you need to take towards addiction recovery. How essential? The statistics related to addiction death rate make grim reading, wherever you are in the world and whatever your drug of choice. Estimated deaths in the U.S., for example, just from alcohol abuse are approximately 88,000 every year. The cost of this? $249 billion. We haven’t even mentioned the many forms of drug misuse, and the fatalities that result from that. Yes, it’s clear – addiction kills, and it kills plenty.
As mentioned earlier, recovery is about abstinence, and that cannot be achieved through simple determination. That is why it is so important for the addict to know the 5 steps they need to take, to get the help they desperately need, and to access the support that is vital. The first step? Simple-sounding, but hard for many addicts to accept – admitting you are powerless over your addiction.
A solution to a problem can only be found if the problem is acknowledged and accepted. For an addict, this can vary. It can come from within, from oneself, or it can be through the process of intervention. However, the result for the addict is clear, as hard as it is. Addiction is the problem, one that could ultimately prove fatal if left untreated, and, alone, you are now utterly powerless in its hands.
Clearly, there are issues in your life that need to be addressed, the fundamental reasons for your addiction. Things need to change and to change for the better.
Admitting your addiction to yourself is one thing. You now need to admit to others. Your friends, your family, and your doctor. By doing so, you are making that change happen. You are asking for help, and you are now not alone in your recovery.
A whole host of services are available; sadly, the demand is a high one. There is residential rehab, out-patient treatments, and other medical services and therapy. Remember, you also have meetings (such as those provided by Alcoholics and Narcotics Anonymous) to speak and listen to other sufferers. Whatever is decided, the need to closely examine the truth behind your addiction is a strong one, and one you need to face.
Your addiction recovery doesn’t get easier now that you’ve reached this point. Part of your treatment involves your health, which has surely suffered. The stress upon your body and mind can be partly reversed by continuing to lead a healthier lifestyle from now on, one of abstinence.
Building up both your emotional and physical strength is vital. Being unsure and weak will only lead to possible relapse. As part of this step, you must, with professional guidance, formulate a relapse prevention plan for yourself.
Additionally, and this may be the hardest part, you need to recognize and address the damage your addiction has caused to others, those who share your life. An essential part of the Twelve Step Program, making amends with loved ones and rebuilding your relationships with them is vital in your achieving and maintaining sobriety.
There is no real ultimate step in your recovery, as there is no cure for addiction. However, being able to acknowledge how far you’ve come, to celebrate even, is the ongoing last of these 5 steps. At this point, when you can recognize an anniversary of sobriety, you will become more resolute, more determined to continue.
Now you know what to expect from embarking on your personal journey of addiction recovery. These 5 steps towards that goal, that prize, are so very necessary for you to be able to live a second life, one free from the hellish nightmare of addiction, one of sobriety and abstinence. Admitting you’re powerless, seeking changes, finding treatment, making a commitment to the future, and acknowledging your progress – all need to be gone through, to be lived.
Perhaps this will soon be your journey. If you have any comments on what is written here, please tell us with a comment below. Is there something you feel is missing from these steps? Or something you feel other readers may benefit from? Let us know.
With five different people in the house, all with different dietary needs, it's sometimes a challenge to make something on a regular basis that we can all eat.
Mum is a pescetarian too. She also has a minor and major gene for haemochromatosis...which means that even though she doesn't need to have blood drawn regularly, she still has to watch her iron intake (Do you know how many things are iron fortified these days??) On top of that she's also salt sensitive and pre-diabetic.
I'm often low in iron, need adequate protein to ensure my muscles stay healthy as long as I can, and other than that am an omnivore.
With our dog Scruffy only dying two days ago--she ate kibble, cooked meat, often alternating with whatever we ate--I also still find myself thinking of things for her to eat. {sad}
Add in not only the dietary needs but also our differences in taste..for several foods there's at least one person in the house who dislikes something that the others adore; Coriander/cilantro, blueberries, pineapple, strawberries, lemons and corn, among others.
For awhile now we've been plodding along, making the same-old-same-old. We try to allow for everyone's needs, but that often gets chucked in the too hard basket and we go with easy things to make. So we've come to realise we're lacking in the things we really should be eating and eating more of the things we shouldn't. We've been shopping healthily, but eating too few veggies or fruit so they end up chucked in the bin.
Nearly a month ago we had someone come to the door wanting us to purchase something that's been a dream of mine for YEARS! As those of you who know me could guess, I was highly excitable for days as I waited in an agony of anticipation for my other family members to see how fabulous it would be...to have a box of fruit and veggies delivered to our door once a week.
However, they weren't excited one little bit. They couldn't be arsed with any of it. With their unwillingness to change the way things have always been--despite me making a case for it saving me time with grocery shopping and loving the challenge of cooking seasonally--they complained about how much it would cost...cue Yul Brynner, "Et cetera, Et cetera, Et cetera!"
So, in the sense of team spirit, I set aside the pamphlet and moped for a bit, but then tried my best despite it all, until I got to the point of finding out about my codependency and thought "Fuck 'em!" I'm the stay-at-home part of this communal family, so I'll do what suits me! And what suited me was to sit back and not cook for a week. If I was hungry, I ate, but if Kiddlywink was hungry and there were people home other than us two, I said "see someone else, Mummy's not cooking this week."
And it really opened my eyes. I didn't realise how much of my self worth I was placing on making other people happy with food. And if they didn't respond with an appropriate level of enjoyment, I got depressed. When I got depressed the frenzy of making things to tempt them was over and they had to fend for themselves...and eventually they'd get sick of it and I'd be needed once more and I'd go off in a flurry of ecstatic cooking and the cycle would repeat itself all over again.
Me going on strike probably wasn't healthy either, but it was different to other times I'd done it merely for throwing a tantrum's sake. I sat back and watched how we all reacted. What really stuck it to me was when Kiddlywink said in a very confused tone of voice, "Why isn't Mummy cooking?" and when I realised how uncomfortable I felt waiting for someone else to prepare meals. a) would the food be ready for when I was hungry and b) Now what did I do with myself with all that free time?
I took over Alaskaboy's "domain" of doing the washing/laundry...and the uncomfortable realisations went down the line. We all had our pet household tasks that we used to avoid other chores/conversations/stuff that made us uncomfortable and to build up our egos with how we do it "better" than others. So the whole family is in flux trying to figure out how to work better together as a team.
First thing up was that I ordered the CSA fruit and veggie box because I wanted it. (Alaskaboy said, "It's like Christmas, I'm looking forward to next week's delivery of the mystery box.")
Second thing was I announced to everyone, "I won't be cooking dinner every night, nor will there always be leftovers for those nights I don't cook."
Above all is my desire to stop taking people's crap, including my own. I'm figuring out what I need and going after it. I'm finally learning that I can't change anyone else. Change comes from within. As my Gramps always said, "You can lead a horse to water but you can't make it drink."
Have you seen the Radura symbol on fruits or vegetables in your supermarket? If so, do you know what it means?
This symbol indicates that the food has been irradiated, a method of food preservation approved for use on produce by the Food and Drug Administration. Irradiation kills microorganisms that spoil food. Irradiated food isn’t radioactive. Irradiation leaves no residue on food and it doesn’t affect flavor. Proponents of irradiation say it reduces the need for chemicals typically used to keep food fresh longer.
Those who oppose irradiation say essential nutrients in food may be destroyed, that eating food that’s been irradiated may cause cancer or other debilitating conditions, and that irradiation may be hazardous to the employees and residents of the area surrounding a food irradiation site. But studies haven’t conclusively identified any harmful effects of food irradiation.
If you are searching for the most qualified and caring audiologist in Massachusetts for yourself or your loved one, you are in the right place at Hearing & Balance Centers of New England Hearing Clinic! You should feel confident when choosing your Worcester, Massachusetts, audiologist for yourself or your family. To help you make an informed decision, Dr. Keith Darrow has written this free report: "The Top Ten Things To Know Before Choosing Your Audiologist."
Technologically advanced hearing aids are an investment for better hearing health and improved cognitive ability. At Hearing and Balance Technology, we want to make it easy for you to have access to high quality hearing aid solutions without your treatment being overly burdensome to your finances.
"Many believe magic has maintained order in Quel'Thalas. My bow would say otherwise. One shot, one kill. This is how I preserve our realm. I am Alleria Windrunner. If you stand against me, you're just another target. And I never miss my mark."[1]
"Your heart flew straight as any arrow upon the wind, sister. You were the brightest of our Order. You were the most beloved of our kin." - Sylvanas Windrunner
High elf ranger and sister to Sylvanas, Alleria Windrunner was head scout of the Alliance Expedition to Draenor. After destroying the Dark Portal, Alleria was forced to escape through a portal to an unknown world, and has not been seen since. Presumed - but not confirmed - dead, her location is an ongoing subject of speculation.
Alleria Windrunner is the eldest of the Windrunner sisters, all of whom have served Quel'Thalas and the Alliance with distinction. As well as her sisters Vereesa and Sylvanas, she also had a younger brother named Lirath. Alleria always wore a necklace given to her by her parents, an exquisite piece containing an emerald, a ruby, and a sapphire. She is also known to wield a sword with great skill.
Alleria Windrunner first earned renown due to the sheer number of trolls that she slew in order to defend her people's homeland, Quel'Thalas, during the Troll Wars. With the help of humanity, the high elves ultimately prevailed against the trolls.
Unfortunately this would not be the last time that war would come to the high elves. During the Second War, the Horde burned down the borderlands of Quel'Thalas. The rampaging orcs killed Alleria's parents, but she and her two younger sisters, Sylvanas and Vereesa, survived.
Driven by grief and hatred, Alleria vowed that she would have vengeance. Her pursuit of revenge took her into human lands, where she led an elite cadre of rangers in hunting down renegade orcs of the Bleeding Hollow clan, who had been trapped on Azeroth after the end of the Second War.
The Alliance of Lordaeron had destroyed the Azeroth end of the Dark Portal in order to cut off further orc reinforcements from Draenor. However, the orc Ner'zhul and other Horde spellcasters used magical artifacts on the Draenor end of the Dark Portal, which was still intact. In this manner the powerful warlocks reestablished the pathway between Draenor and Azeroth.
The Alliance reacted quickly to the renewed threat and sent an expedition through the portal to Draenor. Having achieved the rank of captain, Alleria was part of the expedition, which succeeded in its perilous mission and destroyed the Draenor end of the Dark Portal. Horde forces on Azeroth were cut off from reinforcements and soundly defeated, and afterwards the Azeroth end of the Dark Portal was destroyed.
Alleria and the other members of the Alliance expedition shattered the Dark Portal on Draenor just as Ner'zhul opened a series of additional portals from Draenor to other worlds. Already weakened by the orcs' abuse of fel magic, Draenor began tearing apart under the stress of supporting the newly created portals.
As the planet shuddered beneath their feet, the members of the valiant Alliance expedition realized that remaining on Draenor would be suicide. Thus, they chose one of the new portals and entered it. They have not been seen since that fateful day.
Given the low likelihood of their survival, Alleria and her comrades are presumed dead, killed in the line of duty. They are honored to this day for their sacrifice. A statue of Alleria has a prominent place in the Valley of Heroes, just inside the gates of Stormwind City.
As an alternate hero, Alleria Windrunner must be purchased using real money in order to be unlocked. Once unlocked the player can choose to use Alleria in place of Rexxar whenever playing with a hunter deck. It is not possible to purchase Alleria using gold.
Once unlocked and selected for use, Alleria replaces Rexxar whenever playing with a hunter deck. Alleria comes with her own portrait, emotes, and hero tray art, as well as featuring a special animation when using her Hero Power, Steady Shot.
One of the World of Warcraft loading screen tips is: "Nobody has seen Alleria or Turalyon in years."