Entries by Joshua Archambault

Beacon Hill’s Budget MassHealth Mirage

Today the Legislature will vote on the final state budget. I wanted to take one last opportunity to highlight the unrealistic assumptions that are being used for the MassHealth (Medicaid) program. If the state is unable to achieve these “savings” and instead follows historic spending trends, it could be looking at a $900 million gap, just for MassHealth. For years, Medicaid costs have advanced robustly, at roughly 7% per year which is a big number given that it’s building on a base of billions. See Pioneer’s work on this here. The Legislature is hoping for the state to drive down its per Medicaid enrollee costs by 3.5% next year. How have we done at that recently? On average, per enroll […]

HCFA & GBIO’s Misdiagnosis

Health Care for All and the Greater Boston Interfaith Organization held a rally today at the State House to call for a zero percent increases in premiums for health insurance. The intent may be worthy, but the mechanism is misplaced. Focusing on a cap of premium increases is like trying to prevent all car accidents by adding an extra bumper at the end of a production line. (The analogy only goes so far, I know) Until consumers understand the cost impact of their health care decisions, and small businesses are relieved from the burden of state mandates and over regulation in Massachusetts, this cap will be an unrealistic goal that will result in one more year of finger pointing without […]

Misinformation About Massachusetts Reform from the Left

Jonathan Cohn, Senior Editor of The New Republic tries to undercut the controversial McKinsey study on employer sponsored health insurance (esi) under Obamacare at Kaiser Health News. I wanted to take a moment to highlight one talking point that I have seen repeatedly in the media from the left to defend the federal law and bash the McKinsey study. …studies have consistently shown a very different result: that the majority of employers will continue to offer health insurance, even after health care reform… While these predictions could be wrong, obviously, their findings are consistent with what happened in Massachusetts, where a similar coverage scheme actually bolstered employer-sponsored insurance. (I added the link to DHCFP data here in MA) The problem with […]

Doc Gives Grim Diagnosis to “HCR II” in MA

WBUR’s CommonHealth blog posted an interview with Dr. Wayne Glazier on payment reform that hits so many of the important issues on this complex topic. I have written on the Governor’s proposal a few times before and testified in front of the Joint Committee on Health Care Financing outlining some of my concerns. However, Dr. Glazier provides a front line perspective that many on Beacon Hill try to simplify in an effort to pass health care reform “phase II” quickly. 1) Global payments don’t get the patient involved in containing costs. The consumer needs to get involved. The current situation puts us in a very bad spot. My patient says ‘I want to go to UMass for my surgery,’ and […]

Mass Takes a Pass on HSAs

America’s Health Insurance Plans (AHIP) released a report on the utilization of health savings accounts (HSAs) around the country. Massachusetts has lagged behind for years in the adoption of HSAs. One reason may be that only 43.1 percent of Massachusetts private-sector employers were enrolled in a plan with a deductible compared to 73.8 percent of employers nationally. Massachusetts residents enrolled in high deductible plans (often coupled with an HSA) account for only 2 percent of those with health insurance,  placing the Commonwealth with one of the lowest percentages of residents enrolled in these plans in the nation. The trade-off is two fold. One, these employees are receiving a pay cut as more money is spent on health insurance. Second, the […]

Beacon Hill’s Magical Mystery Medicaid Savings

As the Senate and House work to reconcile their respective versions of the 2012 budget, I wanted to take one last opportunity to highlight the unrealistic assumptions that are being used for the MassHealth (Medicaid) program. If the state is unable to achieve these “savings” and instead follows historic spending trends, it could be looking at a $900 million gap. See graph here. A recently released report from The National Governors Association and the National Association of State Budget Officers “The Fiscal Survey of States” contrasts Massachusetts’s projections to the 49 other states and Puerto Rico. Annual Percentage Medicaid Growth Rate (p52) The average percentage Medicaid growth rate is 18.6 across the nation, Massachusetts will be 0.5%? First introduced in […]

MA Public Opinion of RomneyCare

Kay Lazar had an interesting piece in The Boston Globe on a joint survey with Professor Bob Blendon of the Harvard School of Public Health on Massachusetts health care reform. I am sure it will be part of the narrative of the presidential race. Some general trends that they noted: Increasing support for repealing the mandate. Forty-four percent said they oppose the mandate in the Massachusetts law, compared with 35 percent who opposed it in a 2008 poll. Residents don’t see a connection between the law and increasing health care costs. Yet when asked about the law’s role in boosting health costs in Massachusetts, 72 percent said rising costs were mainly because of factors other than the law. Perhaps this […]

More Bad News for Governor’s Regulatory Regime for Payment Reform

A Washington Post article today is sure to influence the debate in the beltway on reforming our health delivery system towards accountable care organizations (ACOs), one can only hope it will reach the leaders of the Commonwealth before they pass the Governor’s “phase II” payment reform legislation. ACOs are the skeleton that Governor Patrick is attempting to fuse his alternative payment methods with. ACOs are the hot concept in health policy circles, as the Obama Administration is rolling out new regulations to form ACOs for the Medicare population. Many experts believe that as the Medicare delivery system goes, so does the rest of the health care market. So the article brings to light many concerning devolpments that should influence the […]

Is Medicaid (MassHealth) Preventing the Poor from Breaking out of Addiction?

Lawrence Harmon of The Boston Globe had a very interesting article that highlights the intersection of medicine and public policy. The issue was the debate whether MassHealth, our state’s Medicaid program, should move to pay for Suboxone versus methodone for opioid-addicted patients (for example heroin addicts). The article examines the growing medical evidence of the clinical effectiveness of Suboxone and the benefits versus commonly utilized methadone. I suggest you read the whole article for yourself to get the full medical discussion of the upsides of Suboxone versus methodone, but here are the sections I found most interesting on the public policy front: In 2007, MassHealth paid $325 million to treat 18,000 low-income addicts with either methadone or Suboxone, according to […]

Gov. Patrick’s Regulatory Regime for Payment Reform

This was the testimony I submitted today to the Joint Committee on Health Care Financing for the hearing on the Governor’s proposal to reform the payment methods we use in health care and to change the delivery system. Thank you to Chairman Moore and Chairman Walsh and to the Committee members for the opportunity to speak with you today. My name is Josh Archambault, Director of Health Care Policy at Pioneer Institute. The issue before the Committee today—the Governor’s proposal to change the payment methodologies for the delivery of health care—would as currently written set up a framework for momentous regulatory intervention in the health care marketplace, and possible significant adverse impacts on health care access and spending in the […]

Maine Moving on Health Care

An interesting experiment is about to be unleashed in one of our neighbors to the north–Maine. The newly Republican controlled House and Senate are moving quickly (too quickly for some) to strip away state regulations and mandates that were put in place over the past two decades and open up the individual and small group insurance market to more competition. The bill, among many things, will allow individuals to purchase insurance from companies licensed in other states (including Massachusetts.) And it will permit the price differential that insurers can charge sicker residents when compared to healthier residents to grow. Maine currently only allows a very narrow ratio of 1.5 to 1. The current law translates into healthier (mostly younger) folks […]

Massachusetts Medicaid “Savings” in Trouble?

The New York Times reports In a new effort to increase access to health care for poor people, the Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. I wonder if this will impact Governor Patrick and the Legislature’s reduction in reimbursement levels included in the FY 12 budget? If yes, there goes another chunk of the $1 billion in projected “savings”–making the near-impossible prediction of reducing per enrollee spending by 3.5% this year all that more improbable. See Poftak’s Do You Believe in Medicaid Miracles? This is also an interesting move from the Obama Administration as the Secretary of HHS recently advised states to use […]

Connector Saving Taxpayer Money

On this blog– and in the press– I have often been critical of the policy choices of the Connector and its governing Board. However, credit is due to the staff at the Connector for the latest round of negotiations with CommCare’s managed care organizations, in which $80 million of taxpayer money was saved.  With a projected 11% membership growth this coming year, any savings is welcome in a program with subsidies of roughly $840 million. As Executive Director Glen Shor said in his monthly update e-mail, this will mean that CommCare “members will not have to face the prospect of benefit reductions…”– good news in a tight budget year.

Harvard’s Effort to Make Cities Matter

Harvard’s Advanced Leadership Initiative has recently launched an interesting academic exercise of a virtual think tank at the Harvard Business Review website HBR.org on the topic of revitalizing cities. The series of thought pieces serve as the appetizers for an upcoming multi-day conference feast at Harvard Law School on the same topic. Thursday, April 28-Saturday, April 30. Globally, 2008 marked the first time that a majority of citizens would reside in cities. Locally, the most recent census data showed significant growth in many smaller cities in Massachusetts. While large cities like Boston garner significant attention and resources as they adapt to population growth, the new growth in these smaller cities is more significant since they often have fewer resources to […]

Pioneer Goes Local! “MuniShare” Municipal Report Contest

As part of Pioneer Institute’s annual Better Government Competition, Pioneer is offering two $3,000 awards for the best municipal reports. No daunting application and little effort!  Entering is as simple as submitting a report by e-mail, with a brief (150-word) summary. What Kind of Reports? We are interested in public opinion surveys, departmental studies, environmental audits, and really, any type of report. The only requirement is that the report tackle an issue that fellow municipal governments might face as well. The reports can focus on department-specific or municipality-wide issues, and can be up to ten years old. There is no minimum or maximum length and no limit to the number of entries from a municipality. The more, the better! Selection Process: A panel of judges with vast experience […]

Lessons from Massachusetts Health Care Reform (Romneycare)

Last month marked the first anniversary of the federal healthcare law; this week the fifth anniversary of Massachusetts’ own health reform. President Obama likes to tout the federal effort as paralleling the Massachusetts’ reform, but the fact is that Obamacare has created a lot of uncertainty for states across the country, including Massachusetts. For example, will Massachusetts now have two individual mandate penalties? Will we shift close to 100,000 individuals from the new healthcare exchange to Medicaid? What are the implications of the federal law for the cost picture in already expensive Massachusetts? Obamacare is of little benefit to Massachusetts beyond pouring billions more dollars into the Massachusetts healthcare industry, which is likely to push the cost of care even […]

Gov Patrick Confused on Economics on “Daily Show”

Governor Patrick was on Comedy Central’s “Daily Show” Tuesday night to promote his new memoir.  But the joke may be on us, if his flawed understanding of healthcare economics on the show translate into policy. The Daily Show – Deval Patrick Tags: Daily Show Full Episodes,Political Humor & Satire Blog,The Daily Show on Facebook Stewart began an exchange on the Massachusetts reform by pushing back on the notion that markets can work in health insurance (with the clear implication that health insurers are currently operating in a free market system). Governor Patrick responded that double digit [health insurance] premium increases are the result of markets “without parameters.” Hmmm.  Would benefit mandates, guarantee issue policies, thousands of pages of state regulation […]

Romney Gets ALL the Credit for RomneyCare?

Today is the 5th anniversary of the signing of Chapter 58 (health care reform) here in Massachusetts. The anniversary has sparked a round of opportunistic political posturing from Democrats (and friends) thanking Mitt Romney profusely for his contribution. In return, Romney announced he is thinking about running for President. The one question I have is—Where is the love for former speaker Sal DiMasi? According to Governing magazine, he was the real power broker of the deal. I guess federal indictments hurt the number of times you are publically given credit. On a slightly more serious note, I will have an op-ed in the Boston Herald tomorrow describing the failure of the Connector to attract small company business.  Also see Pioneer’s […]

Governor’s Pep Rally on Health Care Cost Containment

Governor Patrick held an informational briefing on cost containment. The problem is that all things are not equal — insurance premiums are rising at an unsustainable rate…I am a private marketeer, not a market fundamentalist. I don’t think the market always gets it right and I don’t think the market has gotten it right in this case. I heard nothing new from the Administration, only the same unwavering faith in their ability to manage and regulate the marketplace.  I am not sure what the next step is, as the Governor’s bill calls for the details for payment reform and cost containment to form in the regulatory arena, and I don’t believe the Legislature will give that sort of power to […]

Health Care Econ-101 For Governor

During an appearance on WTKK-FM today, Governor Patrick dipped his toe into the uncompensated care pool controversy that has been splashed over the pages of The Boston Herald. Here and here. Some highlights (lowlights) from the Inspector General’s report that sparked the stories have been: $7 million on care for non-Massachusetts residents. Claims were paid out for patients with home addresses in 48 other states, and a handful of foreign countries. $17.8 million for more than 60,000 “medically unlikely” or “medically unnecessary” claims, such as foot X-ray charges for patients suffering from headaches. Suspicious claims for gender-specific procedures for members of the opposite gender. (Such as gynecological bills for men) $6 million for 13,000 duplicate claims. 45% of those seeking […]

CMS Ignites ACO (Accountable Care Organizations) Debate

Today the Centers for Medicare and Medicaid Services (CMS) released long awaited proposed regulations for accountable care organizations (ACOs). Under the federal Affordable Care Act (Obamacare), ACOs– which are associations made up of groups of health care providers—can share Medicare savings derived from improvements in care. In CMS administrator Don Berwick’s own words: The creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the ACA [the national Affordable Care Act]. Its purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care. Under the law, an ACO will assume responsibility for […]

Medicaid’s Drug Problem: $329 million a year

I have blogged before about the problems that we have here in Massachusetts with our exploding Medicaid costs (here, here, here)– roughly 40% of the budget this year. Alex Brill at American Enterprise Institute (AEI) updated a working paper titled Overspending on Multi-Source Drugs in Medicaid that brings attention to one of those cost drivers –the elevated use of multi-source drugs in Medicaid. Multi-source drugs are prescription drugs that are available in both brand and generic form. While the title may not draw in many readers outside of the health policy community, it highlights a very important issue that does (and will continue) to impact state budgets for years to come. The recently enacted Affordable Care Act (ACA or Obamacare) […]

FactCheck.org: ‘RomneyCare’ Facts and Falsehoods

A reporter from FactCheck.org visited Pioneer’s office a couple of weeks ago to learn more about the Massachusetts health reform law. Without a doubt this will be a big issue in the 2012 presidential campaign. I give the Annenberg Public Policy Center at UPenn and their FactCheck.org project credit for attempting to get ahead of the curve here. A few thoughts on the article: More Research Needed: There are still a lot of unknowns in Massachusetts. The data in the state is improving but much is still unclear. Pioneer has attempted to capture key metric in its Report Card Series. Interim Report Cards on Massachusetts Health Care Reform A) Increasing Access B) Equitable and Sustainable Financing C) Administrative Efficiency D) […]

VIDEO DEBATE: Obamacare One Year Out

With the one year anniversary of the passage and signing of the Affordable Care Act or “Obamacare” next week, there will be many op-eds and articles trying to capture how things have changed over the last 12 months. Pioneer Institute decided the best way to do a “check-up” was to put two of the nation’s preeminent minds on health policy: Dr. Douglas Holtz-Eakin, former adviser to McCain for President, and Dr. Jonathan Gruber, former adviser to President Obama– in one room for a debate. The event naturally built on last year’s Hewitt Lecture delivered by the Dean of Harvard Medical School, Dr. Jeffrey Flier, in which he gave his pessimistic assessment of the newly passed law days after it passed […]

WSJ: “The Massachusetts Health-Reform Mess” Swing and Miss

The late John Calfee, has an opinion piece in the WSJ this morning on Massachusetts health reform. The piece is right on with a few fundamental points. One, that it was hubris to take the state experiment of 2% of the population—in a high income, high insured, and high medical infrastructure state– and mandate it on all other states, as if they are all the same. I also think Governor Patrick’s most recent bill is ill-defined and misguided in its potential anti-market elements. However, there were a few statements that are on very shaky grounds in the piece or are just wrong. (Gov. Deval Patrick wants a new law to force the unions into the Connector.) This is not true, […]

Governor Patrick Found the Silver Bullet for Cost Containment?

Thoughts on Governor Deval Patrick’s speech this morning about phase II of health reform in Massachusetts: cost containment. Without seeing the bill language these are my thoughts—however, it sounds like much “fussing over the details” will remain even after he files the bill. Broad themes He deserves credit for putting the first bill on the table. As has been the case for almost a year, the devil is still in the details.  The speech did not do much to illuminate, but it did serve to take a few things off the table. Much of the implementation of this bill will play out in the regulatory space anyway. This is a longer term play. There are real problems happening now, especially […]

Blame Game in Massachusetts Health Care

An interesting piece from Paul Levy over at Not Running a Hospital.  He beat me to putting words on paper, but I had some of the same thoughts and feelings he did while reading a recent Globe article about the average premium increases from insurers this coming year. I will quote at length so you can get a full picture of his reasoning. Catharsis is not policy-making If you ever needed an indication of why the public remains confused about the issue of health care costs and insurance premiums, look no further than a story in today’s Boston Globe entitled, “Insurers seeking smaller rate hikes.” It is not that the reporter has done a poor job. Quite the contrary. The […]

“For small businesses, a hesitancy to hire”

An illustrative piece in the Boston Globe today by Megan Woolhouse about the high cost of running a small business in Massachusetts. This is an issue that Pioneer has been researching for years. Pioneer has released numerous papers discussing possible reforms to the programs that are most burdensome. The most recent was “Creating Jobs: Reforming Unemployment Insurance in Massachusetts.” From my perspective, one of the most expensive costs was only mentioned in passing in the article. Struggling to survive in 2008 and faced with rising health care costs, the Olsons eliminated health care coverage, offering employees a one-time payment of up to $5,000. The reform passed in 2006 promised to help small companies afford health insurance. During implementation, policy decisions […]

Real Competition at the Health Connector?

The Connector Board yesterday moved forward with plans to introduce “competition” into the bidding process for insurers selling to those buying coverage within Commonwealth Care (CommCare). CommCare: more than 160,000 residents – individuals who earn less than $31,000 a year or families of four that earn less than $66,000 and have no access to insurance through an employer or through Medicaid – obtain fully or partially subsidized health care at a projected cost of $822 million to taxpayers this fiscal year. (adapted from SHNS, 2/10/11) For some, myself included, a chuckle escapes whenever the word competition is raised as a novel cost saving method, and we shrug our shoulders wondering why this is new concept to the Connector. Simultaneously, we […]

Governor’s Budget & Plan for Cities

When it comes to the aspects of the Governor’s agenda that impact cities, the press has focused on two elements: 1) Cuts in local aid in the budget and, 2) The push to lower the union threshold in order to allow, or perhaps force, municipalities into the state’s Group Insurance Commission. While those certainly are newsworthy, there are two smaller intiatives that move the Commonwealth in the right direction on two fronts: A) local performance management and B) regionalization. Pioneer has been a vocal advocate for the state to be more aggressive in promoting these policy goals. Our Middle Cities Initiative has worked with 14 municipalities to improve data collection, to drive accountability and transparency– in order that local officials […]