These are strange days in healthcare. Even the Boston Globe is starting to push back on and question the one-size fits all approach of the ACA. See the editorial from Sunday’s paper below. First it was the problem of Massachusetts being forced to switch our rating factors to new federal rules. (Read here for more background.) This led to the recent decision by federal HHS to unilaterally grant the state a phase-in for these new rating factor rules. Of course, this doesn’t fix the problem, it jus[...]

Much as been written this past week about the second year results of the Oregon Medicaid lottery experiment. (See Avik Roy’s post at Forbes for a clear and full background.) I believe the results from this study will drive many future decisions about Medicaid and how it is structured given the methodological uniqueness of the program. While the results have largely been spun in the direction of how one views the ACA, the real debate in the Medicaid program should be how to best use public [...]

A recent decision by HHS illustrates the arbitrary nature by which some implementation decisions are being made at CMS while highlighting the problem of a top-down approach in Obamacare. After months of small businesses anxiety in surrounding the impact of fewer rating factors due to an ACA mandated one-size-fits all policy, the Federal government recently pulled a piecemeal delayed implementation of the regulations out of thin air. (Background on the rating issue can be found in this post). One[...]

The revelation that the Obama Administration will delay the roll out of the “choice option” for small business until 2015 came as a huge surprise to many, including Joe Klein at Time, however anyone familiar with the Massachusetts experiment will feel a strong sense of déjà vu. In a 2010 paper I authored for the Heritage Foundation, I documented the delayed and failed effort by the Massachusetts public exchange (Connector) to offer real choice and savings to small businesses. My report suggested[...]

I have written numerous times about the impact that the ACA will have on small businesses in Massachusetts, and the predicted “extreme premium increases.” According to a recent InsideHealthPolicy.com story, the state is discussing unmerging the individual and non-group markets to avoid this unintended consequence of the ACA. States had to let CMS’ Center for Consumer Information and Insurance Oversight know by Friday (March 29) if they plan to merge their small group and indivi[...]

As the Patient Protection and Affordable Care Act (ACA, aka ObamaCare) turns three this week, states and employers are feeling the weight and complexity of the early stages of implementation. Pioneer reflects on how the nation can best move forward. 5 recommendations to move ahead on health reform: Respect the states.  The Obama administration should give states the flexibility they need to implement reforms that are uniquely tailored to their needs and should extend the timetable for implementi[...]

In a feared (put predicted) outcome, the newly formed Health Policy Commission is off to a bad precedent of picking winners and losers in the healthcare marketplace. Yesterday they adopted final regulations that exclude certain Medicaid Managed Care Organizations from paying a one-time $225 million assessment that is part of Chapter 224. Putting aside the questions of whether taxing those in the medical field is a good policy to reduce medical spending, I think this move only foreshadows the inc[...]

It often goes unreported, but Beacon Hill does have a wide revolving door into lobbying firms and non-profit advocacy groups that are politically active. While the trend receives much more ink in D.C., it is important given the amount of money being spent on lobbying on laws like the massive healthcare “cost containment,” Chapter 224.   The latest example appeared in SHNS ($) for the chief of staff of the committee that wrote the House version of Ch 224. His new employer represents s[...]

This week, Pioneer hosted its annual Hewitt Health Care Lecture, again bringing together influential leaders in medicine, business, and public policy to hear nationally recognized experts discuss our most pressing health care policy challenges. This year,  Harvard economist David Cutler and Manhattan Institute Senior Fellow Avik Roy discussed issues relevant to both the ACA (ObamaCare) and the new Massachusetts law (Chapter 224) that attempts to control costs and implement payment reform. The sp[...]

CHIA, the healthcare data agency for the Commonwealth, finally released a very late version of the 2011 employer survey. (The two reports can be found here and here.) Recently I blogged on the data neglect I observed at the agency as they are  delivering numerous regular reports late, and questioned if they were ready for even greater responsibility under Chapter 224 (the so-called payment reform and cost control law). So what can we learn from the latest survey? I decided to pull a few graphs t[...]