Entries by Joshua Archambault

Mass House Pulls a “Charlie Brown” on Payment Reform Redraft

/by

The Massachusetts House rushed the release of their payment reform bill to beat the Senate the first time around. As a result, the next few weeks provided time for House lawmakers to receive feedback and improve the bill before it was to be voted on. Unfortunately, the bill’s authors missed the ball again, and made only small changes. Unfortunately, the House has decided to follow the Senate precedent of rushing passage of the final bill. 48 hours to file amendments, and only a couple more days before it is debated and voted on next week. [Changing 18 percent of our economy in two days, with many unanswered questions about added costs, lack of evidence of savings, and lots of new mandates, […]

Video: But Will The Cost-Cutting Bills Really Save Money?

/by

The debate on Beacon Hill is heating up on payment reform legislation, but the public discourse has revolved primarily around dueling press releases.  There has been little discussion exploring the real challenges of fundamentally changing 18 percent of the Massachusetts economy with new payment and delivery methodologies. With 20 percent of patients accounting for 80 percent of health care costs, is this the right approach? Will it save money and engage consumers? CommonWealth magazine hosted a recent web discussion to cover a few of these topics. WBUR’s CommonHealth blog recently shared the video as well.

Is Maine Leading the Way on Health Care?

/by

The Commonwealth is currently debating greater government intervention in our health care system with payment reform legislation. Maine is moving in the opposite direction. This press release was just put out by the think tank Maine Heritage Policy Center. Unprecedented: Rates for health insurance plans to drop as much as 60% PORTLAND – Rates for individual health care plans in Maine will drop as much as 60% in July as a result of health reform law PL 90, the free-market health insurance reform bill passed by the legislature last year. The Maine Heritage Policy Center was a key advocate of the bill. Information contained in Anthem’s most recent rate proposal indicates substantial positive results from the law’s passage. After years […]

Will Your Next Cancer Treatment Be In New Hampshire?

/by

New Hampshire lawmakers have a long history of jeering Massachusetts over taxes, but it looks like they have moved to a much bigger sacred cow, health care. The Boston Globe ($)recently reported that in New Hampshire there is a bill, “eliminating a state review process and exempting it [specialty destination hospitals] from a tax that New Hampshire’s nonprofit hospitals pay.” By contrast, the two recently proposed payment reform bills on Beacon Hill move in the opposite direction. The bills “reform” the determination of need process to make it more government-centered and will severely limit any future expansion of similar facilities in the Commonwealth. Massachusetts policymakers should be watching our borders closely as they aim to significantly alter our local payment […]

Red or Blue Pill for Payment Reform? Both Won’t Work

/by

Are the House and Senate giving us a false choice for how to control health care costs in Massachusetts? Aren’t there other options? A few major themes have emerged from the two payment reform proposals and highlight the fact that they fail to align incentives for patients to be more involved in the purchase of their health insurance and their health care. For example, even with full transparency of cost and quality (which is a huge lift on its own) for many patients, high-cost still correlates with higher quality in medicine. A recent report from Attorney General Coakley proved this theory wrong, but simply providing patients with cost data without placing the right incentives in their health plan to choose […]

Cart Before the Horse in Media Coverage of Massachusetts Payment Reform

/by

Before digging into the Senate bill this afternoon, I wanted to express my concern about early media coverage of the payment reform debate. The spotlight has become focused on 3 or 4 points, all contained in press releases. No one can knowledgably comment on the Senate bill since they have not seen the full language- as they are still finalizing parts of it this morning. It is easy to say the two bills look the same from the press release, but are they? The debate over somewhat arbitrary cost growth goals is pointless, unless there is a debate about the mechanisms to get there. Did we forget that DHCFP data tells us 53% of employers are self-insured in our state […]

I Pledge My Faith in Bureaucracy- Mass Health Reform II

/by

The House version of payment reform creates a new mega agency, the Division of Health Care Cost and Quality. To be fair, the House collapses a few other state agencies into the new Division, but there is no question this entity is given far-reaching and broad regulatory power. The Division will be independent and “not subject to the supervision and control of any other” public entity. (Section 29, subsection 2(a)) The controversial federal Affordable Care Act drew negative attention for how many times the Secretary of HHS was instructed to act on major policy, roughly 700 times in 2,700 pages. The House’s bill outdoes the ACA by requiring the division to take action 163 times in 178 pages, or almost […]

Many Unanswered Questions On Payment Reform

/by

The next act of the Massachusetts health care reform drama is about to play out on Beacon Hill. As the same familiar characters return to the stage, the character who should be the hero of this drama, the patient, is nowhere to be found. Instead we are sitting down to a repeat performance. The language of reform is promising, but the reality of implementation remains hazy. Over the next few days I will blog on why the House of Representatives’ bill left out the patient as part of the solution. However, for now, below are just a few questions to prime the pump for this discussion and for you to consider: How will western Massachusetts comply with the state mandate […]

If Only Governor Patrick Knew What His Medicaid Office Was Up To

/by

While Governor Patrick has been pleading with the Legislature to act on his February 2011 payment reform bill that would move our health care system towards global payments and accountable care organizations, his MassHealth (Medicaid) office has moved in the opposite direction. (You can read my testimony on the Governor’s bill here) In March 2011, the MassHealth program changed their default enrollment policy for new enrollees that did not affirmatively select a managed care option–either one of the 5 Medicaid managed care organizations (MCO) or the Primary Care Clinician Plan (PCC). Before the switch, if an individual, after being determined eligible for Medicaid, did not affirmatively select a managed care option, the MassHealth office would auto-enroll them into either one […]

Is Romneycare A Budget Buster?

/by

The Massachusetts Taxpayers Foundation (MTF) put out a report late last week on the cost of Massachusetts health reform. The number from the report that has gotten the most media attention has been– $91 million. Over the five full fiscal years since the law was implemented, the incremental additional state cost per year has averaged $91 million… This is a very strange way to interpret the cost data. Here is the breakdown from the report: The better number to highlight would be the incremental increase each year over the 2006 baseline. 2006 2007 2008 2009 2010 2011 Over 2006 baseline (millions) – $268 $645 $1,037 $834 $906 If you add this up and divide by 5, you come up with […]

News Flash: Gruber and McDonough are Political

/by

Jonathan Gruber and John McDonough are widely quoted in the media on both Romneycare and Obamacare. Without question they are both extremely intelligent, I have a deep respect for their commitment to health policy and enjoy the frequent interactions I have with them. However, I have wondered for months when the media will finally acknowledge that they both have a political angle.  This week President Obama’s campaign made it official by putting them into a video: Will this put an end to the neutral observer status afford them in most media stories?

How Much Do Same-Sex Marriage & Health Care Overlap Constitutionally?

/by

Socially liberal commentators opine against some conservative’s preference to nationalize the issue of marriage when they argue so strongly for a federalist impulse in many other areas of policy including health care. On display this past month has been the exact opposite positioning by Massachusetts’ Attorney General Martha Coakley. It is interesting to juxtapose her two recent high profile affairs in the federal court system. First up was her amicus brief in support of the President’s Affordable Care Act (Obamacare) which argued that the federal government has the right to regulate health insurance because it is an example of interstate commerce. Weeks later she entered a federal appeals court leading the charge to uphold her earlier victory in court to overturn the federally passed Defense of […]

Applying Finance to Health Care: ROI of Wellness Programs

/by

A new report from Health Fairs Direct, a corporate health and wellness events provider, asks the very important question: What is the most effective way to control rising healthcare costs? While they might be somewhat self-interested given their line of work running health and wellness events, the return on investment analysis should inform any company tackling this issue. The Connector has launched a wellness program recently and should examine this study for any best practices. The report analyzed 50 studies of the wellness programs offered at different organizations including Johnson and Johnson, Citibank, DuPont, Duke University and The California Public Retirees System. Here are the six best wellness initiatives Health Fairs Direct identified as producing the the greatest ROI: Health […]

WSJ on “The Great Experiment” in Health Care

/by

Kim Strassel of the Wall Street Journal($) wrote on Pioneer’s health care book today, and  she highlights a very important historical point. Major entitlement reform is only possible when some level of national consensus has been achieved around end goals. In The Great Experiment: The States, The Feds and Your Healthcare we examine welfare reform in the mid-1990’s as a perfect example of this paradigm. Excerpt from The Wall Street Journal column: The more conservatives have been forced to think about health care, the more they’ve understood the merits of state experimentation. Jim Stergios, executive director of the Pioneer Institute—a free-market think tank in Boston that has published a book on ObamaCare and RomneyCare titled “The Great Experiment: The States, the Feds, […]

Understanding Obamacare’s Essential Health Benefits for MA: Square Peg in a Round Hole?

/by

The Affordable Care Act (ACA) requires insurers to provide an essential health benefits package (EHB). ACA legislation identifies ten general categories of mandated coverage (see right hand side below). A recent HHS informational bulletin outlined the scope of EHB in any given state must be equal to: One of the three largest small group plans in the state by enrollment; One of the three largest state employee health plans by enrollment; One of the three largest federal employee health plan options by enrollment; The largest HMO plan offered in the state’s commercial market by enrollment. States will need to spend a significant amount of time deciding what “benchmark typical employer plan” they would like to use, or HHS will select […]

Hold the Cork for The Connector

/by

The Connector made a “big” announcement about the Business Express program today– that all carriers are now selling in the exchange. But a little context is needed before we throw a party. In a September 2010 paper, I addressed the limited benefit of the Business Express program in the Connector. …Business Express (BE) also suffers from design limitations and does little to address the underlying reasons behind premium increases. It does reduce the monthly fee that small employers typically pay to third-party administrators from $35 per subscriber to $10 per subscriber, saving employers roughly $300 per employee per year. However, this reduced fee is not unique to the Con­nector. The Massachusetts Business Association contends that it offers a similarly low-priced plan. […]

Case of the Missing State Reports

/by

The Division of Health Care Finance and Policy (DHCFP) plays an important role in the Bay State with their regular data reports. This data helps policymakers and those outside government plan and adjust to changes in the market. So, I have been wondering for months why DHCFP has fallen way behind releasing a number of regular reports. For example, a Key Indicators report was due in December 2011. This is a quarterly report that the Division has released religiously for years. The last report on-line is from May. What gives?

BCBSF of MA and Health Affairs Spinning the MA Reform

/by

The Blue Cross Blue Shield Foundation of Massachusetts (BCBSF) put out an annual survey this week on the Massachusetts health reform law, along with a Health Affairs piece that has left me shaking my head. The presentation of the results seems to overstate the findings and draws unlikely conclusions about the federal law. In my humble opinion, Health Affairs has lost some credibility with the pieces they publish on Massachusetts. Editor-in-chief Susan Dentzer admitted the publication’s bias in a recent speech to the Massachusetts Association of Health Plans. A New Era in American Health Care: What it Means for Health Plans, Providers, Employers & Consumers from Eric Linzer on Vimeo. On the actual BCBSF report, just a couple of comments: […]

Are We Fighting Health Care Costs or Health Care Spending?

/by

Liberal blogger Matt Yglesias over at Slate recently made a great point about the difference between health care costs and spending. It is one that I hope local pols on Beacon Hill will keep in mind as they consider payment reform legislation that will regulate by price controls. The health care system in the United States has a lot of problems, but I think people are sometimes too pessimistic about it. This happens largely through slippage between the phrases “health care spending” and “health care costs.” Everyone knows, for example, that economy-wide spending on tablet computers has surged over the past three years. But nobody says “tablet costs are skyrocketing.” What happened is that iPads came on the market, followed by […]

A Deeper Dive into the Mass Health Reform Waiver & Why it Matters to the Future of the ACA

/by

On December 20th, Governor Deval Patrick, and the entire Massachusetts Congressional delegation, congratulated themselves on the resolution of a six month delayed renewal of the Massachusetts Medicaid waiver. The waiver will run for the next 3 years. I blogged on Pioneer Institute’s website about the recent waiver delay here, here, here, and here. But for those that may not be as familiar, in essence the waiver serves as the foundation for the Massachusetts health care reform. At first glance at the new waiver, it does appear that the state squeezed substantial sums out of the federal government, but where that money ends up is the critical question. The media largely reprinted the press release, and completely ignored the historical context […]

Mass and Feds Cut a Deal on Medicaid Waiver

/by

This afternoon the Patrick Administration announced a new deal with Federal HHS on the Medicaid waiver that serves as the backbone of our reform law. The last waiver expired in June of 2011. It is a 3-yr $26.75 billion deal. I need some more details before I can figured out how exactly this waiver will mesh with the Governor’s payment reform bill. But until then, some early thoughts: The Patrick administration looks like they withdrew a number of requests to get this deal done. The Massachusetts waiver deal raises some interesting questions for the future of the national health reform law. [Even if I think the lessons to be learned from Massachusetts are somewhat limited to the national plan.] A […]

What will 2012 Look Like for Health Care?

/by

I was recently asked by a reporter for some trends that I expect to see in 2012. I thought I would share my bullet points on the Pioneer blog: In no particular order. Continued provider consolidation, both locally and nationally. Greater cost-shifting from Medicare and Medicaid, as both federal and state government continue to cut reimbursement levels. On a related side note, I think over the next few years you will see cash-based pre-paid practices opening in Boston. Gains in the use of high-deductible and health savings account plans nationally. The question for 2012 is whether Massachusetts will break out of its status quo and catch up. The story I will be watching for in 2012: The interaction between cost saving […]

Will Mass Set up a Basic Health Plan under ACA?

/by

The Connector held its annual retreat this past weekend, and since the omnipresent Health Care for All (HCFA) representatives were not in attendance to write up a summary, I thought I would provide an overview of what was discussed at the meeting, and outline some of the future challenges for the Connector. The agenda can be found here. Basic Health Plan The Connector is seriously thinking about offering a basic health plan, an option in the ACA, and is one of the few states in the nation to be doing so. (When the Connector posts the slides from Saturday, I will link to them for more detail on the different circumstances being modeled.) With a BHP the federal government would […]

Will the ACA Bankrupt the Mass Connector?

/by

The Connector held its annual retreat this past weekend, and since the omnipresent Health Care for All (HCFA) representatives were not in attendance to write up a summary, I thought I would provide an overview of what was discussed at the meeting, and outline some of the future challenges for the Connector. The agenda can be found here. State Budget Considerations The Commonwealth will have to finance state mandates that are over and above the federally set essential health benefits (EHB). The Connector has identified at least 7 current mandates that are unlikely to be in EHB. The Legislature will need to reopen the discussion over mandates. 40,000 legal immigrants will be enrolled back into Commonwealth Care due to a […]

Obamacare Means Big Changes for Romneycare

/by

The Connector held its annual retreat this past weekend, and since the omnipresent Health Care for All (HCFA) representatives were not in attendance to write up a summary, I thought I would provide an overview of what was discussed at the meeting, and outline some of the future challenges for the Connector. The agenda can be found here. The main theme of the retreat was the Affordable Care Act’s (ACA) impact on the Massachusetts reform. Connector staff, confirmed what Pioneer’s research has shown, that the Connector we know today will look very different by 2014. Here are a few of the examples of the policy discussions ahead: The Connector will need to figure out changes to the individual mandate (MEC […]

The Connector Supports President Obama’s Reelection?

/by

The Connector held its annual retreat this past weekend, and since the omnipresent Health Care for All (HCFA) representatives were not in attendance to write up a summary, I thought I would provide an overview of what was discussed at the meeting, and outline some of the future challenges for the Connector. The agenda can be found here. I must mention a moment that I found especially troubling. Politics at the Connector. Secretary Gonzalez made a statement during a conversation about protecting the reputation of the Connector and media coverage that struck me as odd. He said that the Connector needs to be seen positively as it means a great deal to the political future of the Governor and the […]