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.
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.
Entries by Joshua Archambault
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 […]
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. […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 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 […]
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 $225 million assessment that is part of Chapter 224. Putting aside the questions of whether taxing those in the medical field is a good policy to reduce medical spending, I think this move only foreshadows the increase in behind closed door lobbying that takes place when the legislature abdicates its role to a powerful public entity. Find me on twitter: @josharchambault
In a surprising editorial yesterday, the Boston Globe has flipped on its full support for the ACA in Massachusetts. Without realizing it, they have also made a strong argument for not supporting the law’s one-sized-fits all blunt approach to reform in other states as well. In a letter to federal regulators the day after Christmas 2012, Massachusetts officials floated the idea of a waiver from the new rating factors for small businesses. They warned that the changes will result in a significant number of citizens experiencing, “extreme premium increases.” Recently finalized federal ACA regulations shut the door on that flexibility. Instead the state will now replace current law which statutorily requires rating factors within a 2-to-1 rating band, and allows insurers to rate on factors such as– age, […]
It often goes unreported, but Beacon Hill does have a wide revolving door into lobbying firms and non-profit advocacy groups that are politically active. While the trend receives much more ink in D.C., it is important given the amount of money being spent on lobbying on laws like the massive healthcare “cost containment,” Chapter 224. The latest example appeared in SHNS ($) for the chief of staff of the committee that wrote the House version of Ch 224. His new employer represents some of the biggest players in healthcare in the state. Health Care Financing Committee Co-chair Rep. Steven Walsh’s chief of staff JOSH HARRELL is leaving the House of Representatives for a job at Nutter, McClennen & […]
Put retiree health care to bid AS I SEE IT http://www.telegram.com/article/20130226/ NEWS/102269882/1020/opinion By Josh Archambault and Casey Miles (published on Feb 26, 2013) Critics suggest changing insurers can be problematic, but at least two Massachusetts cities already competitively bid their health care insurance. The evidence shows that they have been able to decrease costs and improve the quality of benefits. Gov. Deval Patrick’s recently proposed $35 billion state budget includes $2 billion in tax increases that would raise the taxes of more than half of Massachusetts residents. While taxes are an inevitable part of life, the state has a responsibility to prune unnecessary spending before increasing taxes. One area to find significant savings is retiree health care. Competitive bidding is […]
Governors need to require greater flexibility in order to tailor reforms to their state. As the key months for implementing the Affordable Care Act begin, 30 governors are resisting key provisions of the law. But these leaders don’t need to act just as a phalanx of opposition; if they work with President Obama and Obama works with them, they can change the law’s future for the better. COLUMN: Affordable Care Act will work if we embrace it (http://www.usatoday.com/story/opinion/2013/02/15/affordable-care-act/1923671/) The law won’t work without state and local execution of the reform. Governors need to use that fact to exact a price, greater flexibility, for their cooperation. Obama would be wise to play ball. The more governors can tailor reforms to their […]
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 to illustrate some trends, and provide five takeaways. 1. Increasing Uninsured Rate — We have seen an uptick in the number of uninsured, 3.1% in 2011 when compared to 1.9% in 2010. Could this account for […]
The agency responsible for much of the publicly available data on healthcare in Massachusetts appears to be falling asleep at the wheel. The newly renamed Center for Health Information and Analysis (CHIA) has fallen woefully behind on releasing regular reports on their website. While Massachusetts embarks on a massive reconfiguration of our marketplace (Chapter 224) and so much national attention lingers on the state’s 2006 experiment, the agency that has helped to inform policymakers is missing in action. In some cases, regular reports have not been updated since before the current Commissioner took over 16 months ago. In my mind, this raises some serious questions about what CHIA is being asked to do under Chapter 224. How can the state guide a $18 […]
The Boston Globe reported on its website yesterday that the Massachusetts Connector was awarded a Level Two establishment grant worth $81 million. I have written before on the Pioneer blog about the fire hose of federal dollars coming to New England for exchanges, but Massachusetts was always seen as just needing to make “minor” tweaks to be in compliance. In fact, many supporters of the ACA contend that the Massachusetts health care law is the exact same as the federal version, some have even used colorful language to make this point. (The irony is that this individual sits on the Connector governing board and should know better.) NE Exchange Money MA Planning Grant $1,000,000 Level-1 Establishment Grant (a) $11,644,938 Level -1 Establishment Grant (b) $41,679,505 […]
In an effort to achieve greater transparency, I decided to pull the requirements listed in the new healthcare law in Massachusetts that promises to save the Commonwealth billions. I have blogged about my skepticism numerous times before. It is important to keep in mind that these are the explicit implementation requirements or permissions granted to existing or new agencies in 2013. Many other implementation actions were intentionally left vague or were not assigned a start date, but can commence in 2013 or in the years to come. Those statutory requirements are not included in this list. The list also does not include the significant requirements that will take place every year, such as reporting by the Health Policy Commission (HPC) or the Center for Health Information Analysis (CHIA). Let me […]
During the formation of the FY 13 budget the Governor and his staff made a point to highlight the fact that healthcare spending now composes 41% of the spending. They warned: Based on long term forecasts conducted by the Executive Office for Administration and Finance, were health care costs to continue to grow at these historic rates, they would consume approximately 50% of state spending by 2020. Health care spending has crowded out key public investments that, among other things, likewise significantly impact the health and welfare of the people in the Commonwealth. The historic trends are also unsustainable for local governments, businesses and families, forcing all of these groups to make difficult choices between paying for health care and other […]
The headline from the AP this morning Surprise: New Insurance Fee in Health Overhaul Law The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63.
I have written many times before on this blog about individual provisions in the ACA/ Obamacare and their impact on Massachusetts. Some examples include: Obamacare Means Big Changes for Romneycare How SCOTUS ACA/Obamacare Ruling Impacts Mass ACA Impact, Part 1: Low-income Residents will Pay More for Healthcare and Insurance ACA Impact, Part 2: $14B in Medicare Cuts for Massachusetts ACA Impact, Part 3: Cadillac Tax on Middle-Class and Up, $87K for Small Biz Employee Will the ACA Bankrupt the Mass Connector? Understanding ACA’s Essential Health Benefits for MA: Square Peg in a Round Hole? A Dive into the MA Health Reform Waiver & Why it Matters to the Future of the ACA Will Mass Set up a Basic Health Plan […]
More patients and companies are moving away from traditional healthcare; this video of the Oklahoma Surgery Center explains why.
For those keeping track at home, ACO is the acronym for an accountable care organizations. Under the new growth capping law Chapter 224 passed in July of 2012 here in Massachusetts, they are given strong contractual preference to deliver care for all state programs, and for those in the non and small group markets. They also were part of the ACA at the federal level. In fact, five provider systems in Massachusetts have been federally registered as an ACO. In the new Massachusetts Medicaid “duals” pilot program, for 110,000 individuals on both Medicare and Medicaid, the state recently selected six insurer-centric ICO ” integrated care organizations” to deliver the care. So one is prone to ask: Will these two parallel […]
Healthcare reporters have been in a frenzy to report this week that the ACA is a done deal and states should get on with it. The election certainly changes the dynamic in the repeal effort, as Speaker John Boehner indicated in a recent interview with ABC News, yet the implementation battle is far from over. The next interesting story line is developing out of an OK lawsuit pertaining to the legality of subsidies being made available in the federal exchange. To be more specific, it challenges an IRS rule that imposes ACA employer mandate where the statute does not appear to authorize it. If this case were to prevail, it would undermine the “fallback” federal exchange that is going to […]