Entries by Joshua Archambault

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 […]

Health Policy Commission Starts to Pick Winners and Losers

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  

Boston Globe’s Flip-Flop on ACA’s ‘Counterproductive’ Regulations

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, […]

Revolving Door on Beacon Hill, Healthcare Edition

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 & […]

Worcester Telegram & Gazette op-ed: Put retiree health care to bid

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 […]

USA Today op-ed: “How ObamaCare can improve for states”

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 […]

5 Takeaways from the Employer Healthcare Survey in Massachusetts

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 […]

Data Neglect at Massachusetts’s Data Agency (CHIA/DHCFP)

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 […]

Mass Connector Up to $180 Million to Change Tires on the Exchange

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 […]

What is ahead for Chapter 224 in 2013

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 […]

FY13 Healthcare Spending Tips 50% of State Budget ($16.5B)

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 […]

ACA Impact, Part 4: $3.89 Billion in New Insurance Taxes Over 10 Years

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 […]

Can Mass ACOs & ICOs Co-Exist? Wait…What is an ICO?

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 […]

9 States to Watch for ACA Implementation

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 […]

Responding to Cadillac Tax Report Concerns

Pioneer’s recent report on the Cadillac tax has garnered a good deal of media attention and some political push back. Political pushback comes in the form of objections that fail to engage on the issue of the Cadillac tax itself; rather they focus on two assumptions made in the Pioneer study: 1) Healthcare growth rates in the future will look similar to the recent past, and 2) Income growth rates in the future will look similar to the recent past. Of course, we have no more of a crystal ball than anyone else does, however… As is our practice, we made our assumptions very clear, right up front. And second, we based our assumptions on data. Pioneer is an empirical […]

Fall River Herald News: Beware ObamaCare’s “Cadillac Tax” That’s More Like a “Ford Tax”

President Barack Obama has consistently said that Massachusetts was the template for the Affordable Care Act, often referred to as ObamaCare. So the conventional wisdom has been that the new law won’t change much here. But a new Pioneer Institute study demonstrates just how wrong the conventional wisdom has been. Starting in 2018, the federal law includes an excise tax on your annual health insurance benefits that exceed $10,200 for an individual and $27,500 for a family plan. While stumping for the law, President Obama said the tax, which was reportedly Massachusetts Sen. John Kerry’s idea, was aimed at “super gold-plated Cadillac plans” or $40,000 Wall Street health insurance plans. The Obama administration has done its best to highlight some […]

MetroWest Daily News: State’s mixed record on health reforms

Massachusetts has chosen to incubate health care solutions rather than wait on the rest of the country. That impulse is correct, provided we take the task seriously. The past 90 days have given us two examples of big policy changes — one empirically based and understated; the other hasty and oversold. First the good news. For some time now, state healthcare officials have been working on a limited experiment to integrate care for those eligible for both Medicare and Medicaid. So called “dual-eligibles,” have for too long received uneven and uncoordinated care. Two different sets of rules often require duals to schedule multiple appointments as limits are set on billable procedures per visit. The state has a financial incentive to […]

Big ACA Middle-Class Tax Increase in Mass, $87K for Small Biz Employee

Pioneer is releasing a new brief estimating the impact of the so-called “Cadillac tax,” targeted at high cost insurance plans, contained in Obamacare. The report finds that given our high premiums, a majority of workers in Massachusetts will pay the tax in 2018. On a more micro level, the report examines the impact of the excise tax on a small business employee, a police officer, and a teacher. The future looks expensive! For the 10 years following the introduction of the tax: Business employee on a family plan will owe $86,905 in additional taxes. Police officer on a family plan will owe $53,907 in additional taxes. Teacher on an individual plan will owe $20,807 in additional taxes. Remember this is all on top of paying […]

Case Study-When Politics Influences Policy: Liberal Health Wonks from Mass

This afternoon FamiliesUSA released a report from a trifecta of liberal health policy wonks– Jon Gruber, Stuart Altman and John McDonough. I joined the press call to listen to the discussion. Just to say upfront, I know all of these authors and consider them friends or good acquaintances. However, as you will see below we don’t always see eye-to-eye. The goal of the new report was to compare RomneryCare vs ObamaCare vs RomneyCandidateCare. Not surprisingly, Obamacare comes out smelling like roses, and RomneyCandidateCare will push Americans into the deep uninsured abyss. Avik Roy over at Forbes.com rightfully takes issue with a number of assumptions being made in the modeling of Governor Romney’s plan for the nation. One in particular is […]

If Doctors Know the Price, Would It Change Behavior? Essay Contest

The great folks over at Costs of Care have opened their 2012 essay contest to collect stories (the good, the bad, and the ugly) from both patients and  medical professionals as they wrestle with healthcare costs.  The full details: Essay Question: Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to save money while still receiving high-value care? Judges Pauline Chen, surgeon, New York Times columnist Jeffrey Drazen, editor-in-chief, New England Journal of Medicine Donna Shalala, former United States Secretary of Health and Human Services Ezekiel Emanuel, ethicist and […]

NYT: Medicare Bills Rise as Records Turn Electronic

The theory of cost savings don’t always match what happens in reality: When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier… A future unintended consequence of […]

Does Health IT Guarantee Better Care & Save Money?

Given the near universal HIT mandate in Chapter 224 of the Acts of 2012 in Massachusetts, research on the effectiveness of the policy mechanisms in the bill should draw close interest. A WSJ op-ed this morning tackles the HIT question. SEPTEMBER 17, 2012 A MAJOR GLITCH FOR DIGITIZED HEALTH-CARE RECORDS Savings promised by the government and vendors of information technology are little more than hype. By Stephen Soumerai and Ross Koppel In two years, hundreds of thousands of American physicians and thousands of hospitals that fail to buy and install costly health-care information technologies—such as digital records for prescriptions and patient histories—will face penalties through reduced Medicare and Medicaid payments. At the same time, the government expects to pay out tens of billions of […]

$14B in Medicare Cuts under ACA for Massachusetts

During the Presidential race, we have heard a lot about the $716 billion that will be cut from Medicare under the ACA and the savings included in Congressman Ryan’s budget. (See my thoughts on the difference in the proposals at Boston.com) Locally, the important question is, how will the ACA cuts impact Massachusetts? An updated working paper, released this morning, from the University Of Minnesota puts some numbers to this question. So how much will future reductions be for Medicare Fee-For-Service and Medicare Advantage Payments in Massachusetts? Roughly $14 billion in reductions from 2013-2022. Just for review, the ACA cuts $716 billion in the following ways: The ACA reduces annual updates to Medicare’s payment rates for most provider services in the […]

Do Patient-Centered Medical Homes Save Money?

Locally, much has been made about the Massachusetts Patient-Centered Medical Home Initiative, with supporters claiming it will revolutionize medicine. It is too early to tell for sure, but will it save money? Picture: University of Pittsburgh Medical Center North Carolina started down this road before Massachusetts, and while early reports claimed historic savings, recent evaluations have called that conclusion into question. Al Lewis over at The Health Care Blog as some takeaway lessons. The ongoing saga of savings estimates for the Community Care of North Carolina (CCNC) patient-centered medical home (PCMH) is finally over.  The verdict: no savings. Because the scale and visibility of the CCNC experiment are unparalleled in the Medicaid sector today, it is important that the right policy and delivery system lessons be learned from this dispositive […]

New England Raking in $$$ for ACA Exchanges, $351 million and counting

Josh Archambault, Director of Healthcare Policy at Pioneer Institute in Boston 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.) A proxy for how big the changes will be is the level of funding coming from the Federal government to bring the Massachusetts Connector into compliance with the ACA. Answer: $48,236,271 and counting. Or is that $57,131,300, with an award supplement to “accelerate changes in its current Exchange IT infrastructure.” MA HHS grants so far. To be fair $36 million of this money is for a New England regional exchange for Connecticut, Maine, Massachusetts, Rhode Island, and Vermont. However […]

Change Coming for FSAs? Drop the “Use-it-or-Lose-It” Rule

HT to Meghan McCarthy at National Journal for the report and John Goodman for highlighting it on his blog, but there could be big changes ahead for flexible spending accounts. FSAs are a tool along with health savings accounts (HSAs) and health reimbursement accounts (HRAs) that can help to engage consumers to be value-seekers in healthcare. A little-noticed bulletin from the Treasury Department could have a big impact on the roughly 155 million Americans who use flexible spending accounts to cover out-of-pocket health care expenses. The government’s notice, sent out in May, included a surprise in what otherwise might have been a dry announcement on the implementation of President Obama’s health care reform law. In addition to detailing a new spending cap, […]

Rent Seeking in Mass Price Capping Law

After Moody’s issued a credit negative analysis for hospitals in the Commonwealth under the new health care law signed this week, I started to wonder how hospitals will react to the incentives in this new proposal. One line from the Moody’s report is of particular interest: Another negative credit effect of the bill is that the state will use an excise tax on insurers to support smaller and less profitable hospitals, potentially allowing them to remain in business longer than would otherwise be possible… I contacted the author from Moody’s (Dan Steingart) to ask if they had additional information on the $135 million Distress Hospital Fund and the hospitals that would receive this money. Part of his response is below. The bill is vague […]

Medicaid Patient Access in Mass

Yesterday the Massachusetts Medical Society released its annual MMS Patient Access to Care Studies. While the media coverage has focused on the lack of change in wait times across the Commonwealth from last year and the regional issues that remain in the state, there is one subgroup that deserves special mention– those on Medicaid. Massachusetts has roughly 1.3 million people on MassHealth (Medicaid), and they are having problems seeing a doctor. Only 62% of family doctors are taking new MassHealth patients and only 53% of Internal Medicine doctors. We are putting more folks on this program under the ACA, and the regional issues are quite pronounced. Pages 23 and 19 in the report show this. Only 14% of Barnstable family […]