Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system. One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid. This paper aims to explain the possible benefits of DHCs, often using DPCs as an example, as they have built a successful record around the country and in Massachusetts.
About Joshua Archambault
Josh Archambault is Pioneer’s Director of the Center for Healthcare Solutions. He is editor and co-author of The Great Experiment: The States, The Feds, and Your Health Care. Prior to joining Pioneer, Archambault was selected as a Health Policy Fellow at the Heritage Foundation in Washington, D.C. He has served as legislative director in the Massachusetts State Senate Scott Brown and as senior legislative aide in the Governor’s Office of Legislative and Intergovernmental Affairs. He holds a master’s degree in public policy from Harvard University’s Kennedy School and BA degrees in political studies and economics from Gordon College.
Josh has been interviewed on radio and news outlets around the country. His work has been featured in a range of publications, from The Wall Street Journal, Chicago Tribune, The Boston Globe, Politico, The Cleveland Plain Dealer, Milwaukee Journal Sentinel, and The Anchorage Daily News. Josh regularly speaks on state and national health care issues, and urban redevelopment and performance management.
At a time when the coronavirus pandemic has caused massive shifts in state policies on telehealth and scope of practice in healthcare, a new Pioneer Institute study underscores that most of the 50 states continue to suffer from weak laws regarding price transparency. The study identified states that have laws that require carriers, providers or both to provide personalized cost information to consumers before obtaining healthcare services.
This op-ed appeared in Commonwealth magazine on March 25th, 2020. Coronavirus crisis is an opportunity to get it right GOV. CHARLIE BAKER and his team have been rolling out almost daily emergency orders and guidance to react to the spreading of COVID-19. Many of the health care orders have waived barriers in law that stand in the way of public or patient-focused care. There is a growing acknowledgement that telehealth is a vital tool to serve patients and protect medical providers, and Gov. Baker has taken some important steps to address current obstacles. But more steps are urgently needed to harness the full benefits of technology that allows for clinical “visits” with providers via a video connection or the transmitting of […]
This report finds that Massachusetts’ enhanced eligibility verification has allowed MassHealth, the Commonwealth’s Medicaid program, to save significant resources that could be redirected to the care of truly needy Medicaid recipients.
Regardless of what happens in the debate over repealing and replacing the ACA in D.C., Massachusetts has to tackle health care costs intelligently. We need to do more than provide insurance; we need to increase access to care. That means thinking seriously about the role of private market insurers, insurance regulations and the regulation of medical providers.
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 […]
In “Over a Decade, the ACA Fee on MassHealth Will Cost Hundreds of Millions of Dollars,” authors Lauren Corvese and Josh Archambault examine the potential budget impact of the Health Insurer Provider Fee (HIPF), a revenue-raising mechanism for the Patient Protection and Affordable Care Act (ACA).
State officials knew that development of a federal Affordable Care Act (ACA) website was off track for more than a year before the October 1, 2013 launch date. Instead of raising concerns about the project, they misled the public by minimizing the shortcomings of the contractor hired to build the website, asked state workers to approve shoddy work and appear to have covered up the project’s abysmal progress in a presentation to federal officials.
Healthcare must remain a top policy priority for the next administration. It consumes nearly half of the state budget, has been a “pac-man” eating up resources for every other public policy priority, and has been an important driver of legislative discussions around tax increase proposals. The current path is unsustainable.
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 […]
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 […]
The transition to the Affordable Care Act (ACA) in Massachusetts has been a bumpy one, to say the least. The state still lacks a functional website, and currently has almost 300,000 individuals on a newly created transitional Medicaid (MassHealth) program, with almost no program integrity provisions being observed, as little eligibility verification was run on the population upon enrollment.
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
This paper will discuss the importance of secure medical records in health information exchanges (HIEs), the general history of EHRs in the US and in Massachusetts particularly, the history of privacy rights in the medical field, and finally efforts being taken to ensure more protected and private EHRs.
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 […]
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, […]
A First Step Toward Retiree Healthcare Reform, But Much More is Needed was provided in October 2013.
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 […]
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 […]
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 […]
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 […]
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 […]
As convenient care clinics (also known as walk-in clinics or limited service clinics) grow in popularity across the nation, Boston remains empty of these clinics due to mayoral opposition. Convenient care clinics, a relatively new development in the world of health care, first emerged just 12 years ago.
This brief is part of an occasional series from Pioneer Institute examining the direct effects of the ACA on Massachusetts. Please see the end of the paper for more examples.
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 […]