Entries by Joshua Archambault

Op-ed: Health fee pinches taxpayers

Read this op-ed in the Boston Herald (September 4, 2016). Sometimes the Affordable Care Act (ACA) seems like part of history. While headlines about implementation pains persist, many changes are taking place under the radar. One such change that has received almost no attention is a new fee on Medicaid, called MassHealth in Massachusetts. The ACA contained roughly 20 revenue-raising provisions to help fund coverage expansions. One of these new fees (the Health Insurance Provider Fee, or HIPF) is assessed, in part, on companies providing coverage for those on MassHealth, but now taxpayers are funding the entire cost of the fee. It may sound odd, but the fee amounts to the federal government taxing state governments and itself. Paying it increases […]

Boston Herald: To-do List for New Governor to Fix Health Site

By Josh Archambault and Eric Dahlberg. This op-ed originally appeared in the Boston Herald on Nov. 7, 2014. Our state health insurance exchange’s failed website will be one of the major headaches that Charlie Baker’s administration will inherit. Massachusetts’ first-in-the-nation Health Connector site, launched in 2006, has been out of service since Oct. 1, 2013, the now-infamous “go live” date for its Affordable Care Act successor. What an irony that the state exchange that served as inspiration for our federal health reform law has been rendered inoperable by that law’s implementation. After over a year of taxpayer-funded rework, the Patrick administration has assured the public that the Connector will be up and running by Nov. 15, just in time for […]

Deval’s Big Dig: Responding to the Governor on Connector Report

When we talk about the Big Dig, we talk in big, round numbers. Why?  Because it cost gobs of money. You can debate whether it was worth it, and for years we did. Journalists dug into the story. Careers were dashed and fortunes were made in the process. We don’t distinguish between federal and state dollars in discussing the Big Dig. We say it cost $16 billion, not $XX for the state and $YY for the Feds. And rightfully so: The question has always been about value and how the associated costs spiraled out of control. [quote align=”right” color=”#999999″]We join that call on the Administration to release a full and detailed response to the report, so we all can settle […]

Massachusetts to Default to Healthcare.gov, After Hail Mary to Save Its Exchange

Yesterday Massachusetts officials announced plans to default to Healthcare.gov, but also announced a quixotic sprint to try first try to rebuild the entire site in five months with a brand new, no-bid taxpayer-paid contract to health care software developer hCentive. This move comes eight months into open enrollment, after launching the worst performing exchange in the country, spending most of the $180 million from Washington and announcing that original contractor CGI would be fired—even though it is still working on the project. The announcement should leave taxpayers and policymakers scratching their heads and wondering about the lack of accountability, government management and procurement.  A “Dual-Track” Strategy Kyle Cheney at Politico broke the story: Massachusetts is taking steps this week to […]

100+ Unanswered Questions about the Failed Connector ACA Website

As a result of the failed Connector website, 160,000 Massachusetts residents are on temporary public Medicaid coverage even though they don’t qualify for MassHealth. Failure at the Connector will cost Massachusetts taxpayers over $100 million dollars this year. So, Pioneer has questions about how Massachusetts went from having a well-functioning Exchange to one of the worst performances of any state in the Union: 102 questions to be exact. This week legislators on Beacon Hill are finally convening a second hearing in the seventh month since open enrollment started under the ACA, on the failures at the Connector. This follows a recent Congressional hearing featuring the executive director of the Connector, and a February hearing in Boston where legislators simply vented […]

Fall River Herald News: Guest Opinion: Mass. Health Care Connector’s failures show disconnect of ACA exchanges

By Josh Archambault Date: April 10, 2014 Read it here. Seven months after open enrollment began under the Affordable Care Act, Massachusetts’ online health insurance exchange doesn’t work, and the state government is just firing the primary contractor CGI, without a final plan for how to fix it. Since we can’t change the past, the commonwealth must immediately focus on how to make the best of an exceedingly bad situation. Massachusetts’ Health Care Connector should give up the idea of running its own website and partner with the federal exchange. The state should only keep control of what functions are unique to Massachusetts, but rely on the systems recently fixed by some of America’s brightest tech minds. This could offer […]

Mass Connector Called Before Congress To Explain Failed Rollout

Chris Cassidy at the Boston Herald is reporting that Jean Yang, the executive director of the Massachusetts Health Connector, will be called before two Congressional committees to explain the failings of the exchange under the ACA on Thursday April 3rd at 10am. It should be noted that Yang will be the only executive director who has not been fired or resigned due to the poor performance of their state based exchange of the states invited that are likely to testify. These states include Hawaii, Maryland, Minnesota, Nevada, and Oregon. As I have written about before, Massachusetts has the distinction of currently being the worst performing exchange in the country. Meanwhile, Governor Patrick has expressed his support for the current leadership […]

ACA Spiking Premiums in Massachusetts, More Than 300 Cancellations of Plans

The Patrick Administration has been publicly touting that health care premiums are only going to go up 2% this year in the Commonwealth. However the anecdotal evidence fails to back up that assessment, and in a future post I will explain the intentionally misleading nature of that number. In short, the Division of Insurance asked the insurance companies to restate 2013 rates as if the ACA was in effect, to make the premium difference seem lower for 2014 under the ACA. I have written numerous times on this blog about the changes come to the Bay State under the ACA, and the roller coaster effect we can expect small companies to experience, and now we have some evidence. I asked […]

General Court Silent On Connector Meltdown: Connector Playing Whac-A-Mole With Enrollment

Due to poor project management and failing IT contractors, the Connector has been forced into a very expensive game of whac-a-mole for enrollment under the ACA. Even after a tense Connector Board meeting last week, what remains unclear is how quickly the IT issues will be resolved, how much it will cost taxpayers, and why the public was told everything was functional up until the first day of open enrollment Oct 1st. Thankfully the media is finally turning up the spotlight on the major breakdown at the Massachusetts Connector over the past few months. Coverage last week included the  Boston Globe, Boston Herald, Springfield Republican and WLLP Channel 22. I will be writing about the depth of the problems in the near […]

One Small Step Toward Consumer-Oriented Reform in Massachusetts Healthcare

Last week a little noticed but highly significant healthcare policy decision was made in the Commonwealth, and Pioneer Institute is proud to have been a long-time advocate for this consumer-friendly reform. Building on our research on the low cost, high-quaity care that can be offered at convenient care/limited service clinics, the state moved to allow more basic services to be offered in these settings. (Think CVS, Wal-Greens, Shop & Shop, and dozens of other retail based locations.) Last summer, Pioneer Institute joined with Associated Industries of Massachusetts, National Federation of Independent Businesses/Massachusetts, and the Retailers Association of Massachusetts in submitting written testimony to the Massachusetts Department of Public health in support of regulatory changes to expand services available at limited service clinics to include […]

“Barrier-Free Care”: An Idea That Should Hit the Wall in Committee

House Bill 2084, “An Act Relative to Keep People Healthy By Removing Barriers to Cost-effective Care,” joins the list of well-intentioned, but ill-conceived healthcare reform ideas in Massachusetts. No one likes paying money when they visit the doctor, and certainly those with chronic conditions should be able to receive the care they need, but is making some services “free” the answer? While I give the non-profit Health Care for All (HCFA) credit for trying to think creatively about how to make care affordable, they missed the mark with this bill. It ignores basic economics and fails to fix the problem it claims to address. The bill received a hearing last month in front of the Joint Committee on Public Health, […]

In Pictures: 15 Facts Pres. Obama Needs To Know About Mass.’s Healthcare Reform

During President Obama’s Boston visit to talk about the ACA and the Massachusetts experiment, it is important to remember some context. Here are a few pictures that help to illustrate the successes and failures of Mass reform. However, caution should be used when expecting the same results under the two laws, since the laws are different, and Massachusetts is not the same as Arizona, or Texas, or Alabama, or Ohio, or etc…. For example, read five reasons why employer behavior will not be the same under the ACA as it was under RomneyCare, Part 1 and Part 2.  But before we begin, let’s pause to recognize that the ACA will impact Massachusetts in some significant ways. ACA Comes to Massachusetts 1)     ACA Increases Costs […]

ACA Comes to Massachusetts: Post #1: 40% Premium Increase and Higher Co-pays On the Connector

Paul Levy has a compelling post over at his must-read blog, Not Running a Hospital. It will serve as the first post in an occasional, but ongoing, series documenting what the real impact of the ACA means in Massachusetts. For the last three years, our state leaders have been promising that the ACA will mean only improvements for the citizens of our state. Now reality is starting to set in… Do you have a personal story about the ACA you would like to share? E-mail me the details… josh [at] pioneerinst.wpengine.com I am happy to keep any story anonymous. Didn’t they promise lower costs? Ross Douthat writes in the New York Times that Americans will soon be able to get “a real look at what […]

More Americans In 3 States Have Had Their Insurance Canceled Under ObamaCare Than Have Filed An Exchange Account In All 50

This week the reality of the ObamaCare roll-out appeared in a set of news stories that serve as an ironic juxtaposition. Over 500,000 individuals have seen their insurance policies cancelled in just 3 states.  In all 50 states, only 476,000 applications have been “filed” in an exchange. (Even though we are still learning the true definition of “filed.”) First from Anna Gorman and Julie Appleby at Kaiser Health News: Thousands get insurance cancellation notices Florida Blue, for example, is terminating about 300,000 policies, about 80 percent of its individual policies in the state. Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state. Insurer Highmark in Pittsburgh is dropping about […]

Mass Health Connector 2.0: Limited Function and Unable to Provide Subsidy and Medicaid Information

The Health Connector has spent the last 3 years telling everyone how great the new “Health Connector 2.0” will be. The state has  received $180 million to change the tires on health reform in the state, yet during week one of open enrollment…There were messages like this on Twitter: According to The New York Times, “the exchange is currently unable to provide subsidy or Medicaid information.” And from personal experience last week, the website was returning error messages for none enrollment information. For example, I spent 30 minutes trying to pull up past Board meeting minutes on both the new and old versions of the site with no luck. Is there a return policy for our tax dollars? Or at […]

Healthcare.gov Crashes During First Day, Why Massachusetts Never Had This Problem

In the grand scheme of the ACA, the first day of open enrollment today is pure symbolism and nothing else, however the early signs are not good. Healthcare.gov has crashed, and users are receiving error messages as seen below. The Washington Post has just put up a story highlighting the crash of the Maryland exchange, which is full of irony given that often quoted consultant Bob Laszewski wrote in April that Maryland will be, “A Health Insurance Exchange That Won’t be a ‘Train Wreck‘” There have been reports on social media about the California exchange crashing as well, and Sarah Kliff has a sad story of a man that stayed up late in West Virginia, yet failed after two separate […]

Will ACA Cause Rate Shock in Massachusetts? It Appears So, Small Biz To See Premiums Rise Up to 97%

Conventional wisdom has held that the ACA impact on Massachusetts will be small. Some high profile academics have gone as far as to attack presidential candidates with colorful language if they suggest otherwise. Well, the conventional wisdom has had a nuclear bomb dropped on its head with the release of an independent analysis by the major insurance companies in Massachusetts. The implications are clear– the ACA will supply a rough ride for many small companies in the state. Unlike other states where the rate shock will be most pronounced in the individual marketplace and/or for younger adults, the ACA will cause the most turmoil in the much larger small business market in the Bay State. For some companies in Massachusetts, the shock will be […]

Do Insurer Rate Filings Tell Us About the ACA/Obamacare in Mass? Not really

This morning the state of Massachusetts released quarterly rate filings from insurers for Q4 2013, and Q1 2014. Some will interpret these as the first sign of the impact of the ACA on Massachusetts residents, but it is far from that. A few thoughts on the filing: 1. These are base rate increases (or decreases), so they will not reflect the rating factor changes that are coming under the ACA. This is well worth mentioning since the ACA rating factor changes will be responsible for roller-coasting premiums +/-50%. As I discussed in this Pioneer blog post there are many other factors to consider.  In other words these will not be the percent increases or decreases that residents will actually see next year.   2. […]

Promising State “Duals” Pilot (One Care), Late and Losing Carriers

Pioneer has long advocated for reforming the way that healthcare is delivered to those on both Medicaid and Medicare. In fact the idea won the 2012 Better Government Competition. Winners of the 2012 Better Government Competition from Mike Dean on Vimeo. This morning State House News Service reported that the state has finalized agreements with three carriers in the newly renamed “One Care” program. PLANS TO SERVE “ONE CARE” PROGRAM FOR THOSE WITH COMPLEX HEALTH NEEDS: Three health plans have signed contracts to participate in a new pilot aimed at serving adults with disabilities who receive both MassHealth and Medicare benefits.   The Patrick administration announced Tuesday that its integrated health care pilot, called One Care, will better coordinate care for those […]

10 Questions About ACA/Obamacare Implementation in Massachusetts That Need to be Answered

1.      Why is Massachusetts giving the federal government a free pass to overtake the states right to regulate our insurance marketplace? For an example, see the ongoing saga over rating factors changes, under which 60% of small companies will experience premium increases. Bob Dylan singing  The Times They Are a-Changin’ 2.      Why is Massachusetts letting the federal government push 100,000 low-income individuals out of the Connector and onto the flawed MassHealth (Medicaid) program? Arkansas has obtained approval from the federal government for a different approach that Massachusetts should learn from. When the ACA is fully implemented roughly 25 percent of our total state population will be on Medicaid. The MassHealth budget is scheduled to balloon well over 10 percent next […]

ACA Premium Roller Coaster for Small Business Coming to Massachusetts

A handful of owners of small companies in the Commonwealth have recently shared with me their deep sense of uncertainty and apprehension about what the ACA will mean for their health insurance premiums. They finally realized that local politicians were not telling the whole story when delivering speeches highlighting some of the similarities between RomneyCare and ObamaCare. In fact, implementation by federal HHS has only served to confuse them further and repeatedly moved the goal posts. The latest example is the ongoing saga of the ACA’s rating factors mandate on the Commonwealth. Beacon Hill is set to take up a bill on Wednesday that would place Massachusetts on track to be compliant with the federal health care law. A recently released Division […]

60% of MA Docs Will Not Meet Ch224 Electronic Medical Record Mandate

Putting aside a lengthy discussion about the merits of and cost saving of EMRs for a minute, comes this gem from the land of not so well thought out policy making… In 2010, the Massachusetts Legislature passed a law requiring that, as a condition of licensure starting in 2015, Massachusetts physicians must demonstrate proficiency in the use of electronic health records, computerized order entry, e-prescribing, and other forms of health information technology. Last year [ in chapter 224], the Legislature amended that statute to state that physicians must “demonstrate the skills to comply with the ‘meaningful use’ requirements.” There was no further language to explain the intent or scope of that amendment. Given that even the most optimistic forecast holds that […]

Update and Public Statement on Continued Lack of Transparency on the Impact of the Affordable Care Act on Massachusetts

The following is a statement from Pioneer Institute executive director Jim Stergios: “Massachusetts business owners need to be able to plan, and that means they need to have some idea about the future cost of their healthcare premiums. The fact is, state officials have information about the potential economic impact of the Affordable Care Act (ACA), and they have thus far refused to disclose what they know to the public. “While ACA will have the effect of reducing insurance premiums for some in the state, it will also cause premiums to spike for a number of individuals and businesses. In just seven months, major changes in our marketplace will take place due to the new federal law, and it is […]

Boston Herald: Gov owes Obamacare diagnosi$

Op-Ed by Mary Connaughton & Josh Archambault Wednesday, May 15, 2013 Think because you live in Massachusetts you’re protected from the Obamacare insurance premium spikes that you have seen in the national news? Think again, especially if you work at a small company. Ineffective cash-flow management is the No. 1 cause of business failure and layoffs. Regrettably, Massachusetts government leaders are making it even harder for companies to forecast cash flow because of the commonwealth’s opaqueness in implementing President Obama’s Affordable Care Act. And our leaders know it. According to a study commissioned by the state, massive ACA-related health insurance increases loom over small businesses because the federal government is forcing our insurers to use only four “rating” factors instead of […]

New “Grace Period” For ACA Implementation in Mass

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 just spreads it over three years instead of one. Making matters worse, the Patrick Administration has also refused to release an updated version of reports that estimate the true impact on small business. In […]

Oregon Medicaid Results: Half Full or Missing the Point?

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 dollars in order to assist low-income families and the disabled. From my perspective, it is not a matter solely of the amount of money being spent, I (along with Avik) would be happy to continue spending if we knew we […]

ACA’s Alice in Wonderland Twist: HHS Unilateral Delay of Regulations

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 is now left to wonder if there is a legal rationale for such a decision, and begs the question if other states should be making similar appeals to HHS to forestall regulations that will spike premiums for many younger individuals 30-100 […]

Untold Story of Small Biz Delay under ACA, Just Déjà Vu from Massachusetts

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 the experience served as a warning to other states. I suppose I should have targeted  it toward the federal government instead. Small companies should be even more uncertain of the law now that the cost–saving mechanism they were […]

Will Mass Unmerge Insurance Marketplace Because of ACA?

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 individual insurance markets, with state sources and policy experts indicating that the vast majority of states will keep the markets separate, at least in the first year. Merging the two markets would create more complexities and potential market destabilization during an already difficult implementation process, sources suggest. A source in […]

As Federal Health Law Turns Three, We Should Leverage The Power of Federalism

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 implementing reform by several years. The imposition of an unknown, nationalized program on the entire country has led to broad popular opposition. The Obama administration’s misinterpretation of Massachusetts’ health law, crafted to address the unique needs of a small, high-income state constituting 2 percent of […]