Entries by Joshua Archambault

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

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

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

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?

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

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

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

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?

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

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

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?

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?

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?

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

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?

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 […]

Session 6 -CMS & Mass Marriage Counseling

Today marks the 6th extension granted to the Commonwealth for the Medicaid waiver that serves as the foundation for our 2006 reform. I have written about this before here and here. As a review, the Massachusetts MassHealth 1115 waiver from the federal government allowed the 2006 health reform to become a reality financially. The waiver was last negotiated by the Patrick Administration in 2008, and was extended until June 30, 2011. From SHNS this morning ($): HIGH-STAKES MEDICAID TALKS DRAG ON: Secretive negotiations between the Patrick administration and the Obama administration over the distribution of billions of dollars in Medicaid funding have failed to produce an agreement and will continue into December.  The outcome of the talks, which are occurring as Washington looks […]

Questions for the AG on Health Reform 2

Attorney General Coakley spoke this afternoon at MAHP’s annual conference. I wanted to offer a few thoughts and questions. Video can be found here. I like the AG’s focus on transparency and health literacy, but I am not sure these actions alone move us towards fully engaged consumers when they still have employer sponsored insurance that covers most costs. What is their motive? Other questions: 1)Why are providers responsible for giving pricing information when insurers have that data? 2)What is the value of bringing everyone around a benchmark average price for a service? That does not reward low-cost/high quality service, it does the opposite, and allows higher cost/ lower quality service to remain. 3) Will rejections of provider contracts be per procedure, […]

Obama Admin Rethinking Massachusetts Model? Part 2

My now monthly blog post wondering if there will be agreement soon between the Obama Administration and the Patrick Administration on a multi-year extension of the Massachusetts health care waiver. As a review, the Massachusetts MassHealth 1115 waiver from the federal government allowed the 2006 health reform to become a reality. The waiver was last negotiated by the Patrick Administration in 2008, and was extended until June 30, 2011 at that tome. Quietly this summer, the new deadline was pushed back three times, and is set to expire again tomorrow. The Boston Globe’s Liz Kowalczyk and Chelsea Conaboy were kind enough to ask CMS Administrator Dr. Don Berwick about it in a recent interview: Berwick would not comment on negotiations with Massachusetts over […]

Is Cake Health the Answer to Our Health Care Cost Problem?

I just stumbled upon a great app that is helping individuals become better consumers of health care AND understand the piles of health care related paper work sent to their homes. It is available at:  CakeHealth.com If we are to move in the direction of more consumer driven health care, we will need LOTS more where this came from. BCBS of MA has mentioned an app they are developing to help control costs by directing patients to nearby hospitals with lower rates. So lets hope other local insurers get on board and make this information available to their members in some form in the future.

Patrick Admin’s Misdiagnosis on ACA Transparency

This post was co-written by Michael Morisy. During this year’s budget debate, Pioneer asked many questions about the reality behind optimistic health care cost predictions which, if flawed, could leave the state facing a $900 million budget hole next year alone. The passage of the Patient Protection and Affordable Care Act (PPACA) could make things even worse down the line – if it survives judicial challenges. But as much as we’d like to share the state’s optimism, we have had an incredibly hard time getting answers to some basic questions about the underlying assumptions that the state may have about future health care costs. Back on April 9, we requested documents from the Massachusetts Health Connector that discuss the financial […]

Are ACOs designed to care for grandparents also good for their grandkids?

This op-ed ran in the Boston Business Journal Friday September 2, 2011. Boston’s Children’s Hospital was recently recognized as the nation’s top hospital for children by U.S. News and World Report. But what will Obamacare and Gov. Patrick’s “Phase II” state health reform, which move the health industry toward so-called accountable care organizations (ACOs) and alternative payment methods, have on world-class medical facilities like Children’s? An ACO is a network of doctors and hospitals that share responsibility for patient care. In theory, it’s like purchasing a car from a dealership; instead of buying each part yourself, an ACO brings together the different parts of patient care and ensures that the pieces work well together. Yet the reality isn’t so simple. […]

Does Your Doctor Know How Much That Costs?

A local group  (run by a former classmate of mine) is accepting entries for an annual contest that highlights stories of medical costs gone wild. The group Costs of Care’s mission is that:  All doctors should understand how the decisions they make impact what patients pay. The prompts for the contest stress the importance of all stakeholders being more aware of the impact of decisions that we make in receiving our health care. 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 […]

Obama Admin Rethinking Massachusetts Model?

The summer has led to little news from the Legislature and Governor Patrick on the health policy front. Which, on the first day of September, left me to wonder whatever happened to the temporarily extended Massachusetts MassHealth 1115 waiver? Simply put, this waiver from the federal government allowed the 2006 health reform to become a reality. The waiver was last renegotiated by the Patrick Administration in 2008, and was extended until June 30, 2011. Quietly this summer, that deadline was pushed back twice, and was set to expire yesterday. I have just learned that the waiver was extended for another 30 days. So I am left to ask–what is the issue(s) holding up a longer term renewal? In a summer […]

Governor, When is Excessiveness Excessive?

The state senate is trying to decide whether to override the governor’s veto of provisions that were included in the state budget that …narrow the amount of time the insurance commissioner has to review [health insurance] rate-hike proposals to 30 days from 45 days. In addition, if the commissioner fails to make a judgment within 30 days, the proposed rate hikes would automatically take effect. These provisions were included in the budget in response to the Division of Insurance’s denial of 235 of 274 increases proposed by insurers for plans covering individuals and small businesses, last April. However, the madness of this debate from the Administration comes in the next paragraph of the State House News Services ($) story: Under […]

Wishful Thinking On Romneycare & Obamacare for Employers

Over at the left-of-center blog The Incidental Economist, Austin Frakt has picked up the misplaced logic of those on the left to compare the experience of Massachusetts and extrapolate it to the national level, especially for employer behavior. Perhaps some wishful thinking. By pointing to recent state data on employer offer rates for insurance, it seems to prove that employers under a mandate system at least still offer insurance. But I am not sure offer rates are a good indicator of much, especially in a down economy. Weaker companies go under and push up the rate. Plus if you look at historical data, offer rates have always been higher in Massachusetts compared to most of the rest of the nation. […]

Massachusetts is 1st in the Nation on Health Care Cost!

However, this gold medal is one we wish we could return. Kaiser Family Foundation released a report this week that documents the wide ranging differences in health insurance premiums across the country. Massachusetts led the pack with an average individual insurance premium topping $437 per person per month. This is almost double the national average. It should be noted that this report does acknowledge the many factors that lead to high insurance costs, such as  cost of living, patient cost-sharing, generosity of benefits, the base cost of care, age-based demographics, and cost control efforts. As a result, most of the Northeast is considered expensive. From a long term health policy perspective, the report will provide a baseline to measure changes […]

Do you feel safer in a hospital or on an airplane?

The World Health Organization released a report recently that led with the headline that you are more likely to die from a medical error than from flying in an airplane. Reuters take on the report: While being treated at a hospital, there is a one in 10 chance a patient will experience a medical error and a one in 300 chance that a patient will die because of the error. Meanwhile, the risk of dying in an airplane crash is about one in 10 million… Each year in the United States, 1.7 million infections are acquired in hospital, leading to 100,000 deaths, a far higher rate than in Europe where 4.5 million infections cause 37,000 deaths, according to WHO. More […]

Feds Crapping Away Health $ and Increasing Deficit

GAO (Government Accountability Office) will release a report today on the failings of the fraud and abuse system for Medicaid or Medicare. The study was requested by Massachusetts Senator Scott Brown (R) and Delaware Senator Thomas Carper (D). From the AP story this morning: The federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underused, making it more difficult to detect the billions of dollars in fraudulent claims paid out each year, according to a report released Tuesday. The Government Accountability Office report said the systems don’t even include Medicaid data. Furthermore, 639 analysts were supposed to have been trained to use the system — yet only 41 have been so far, it said. […]

Vermont Single-Payer Plan Full of Holes

The Blue Cross Blue Shield Foundation of Massachusetts held a forum in Boston recently on Vermont’s efforts to move towards single payer. A few takeaways. 1) Using the data and criteria cited at the forum,  every state should be moving towards a single payer system. Of course some on the left nod their head in agreement, to the rest of us, the logic seems flawed at best. For example, how does 7% uninsured in Vermont justify single payer? The national average is close to 17%. In addition, the architect of the plan Dr. Hsiao wrote recently in the New England Journal of Medicine. … Vermonters are also largely unwilling to reduce their level of benefits. Our analysis found that, on […]