Entries by Joshua Archambault

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 […]

Governor Patrick’s Budget on Health Care: Playing Around the Edges

Medicaid (MassHealth) The Administration is feeling the heat with the increase in Medicaid (MassHealth) spending. Without a doubt something needs to be done—as spending now accounts for almost 40% of the overall budget. That’s less money for schools, for cops, and for roads. I, among others, think the Administration is being too optimistic on how much they can save by tweaking things on the edges. Will they really get almost $10 billion from rebidding Medicaid contracts? The budget grants the MA Secretary of HHS authority to change benefits and eligibility in MassHealth when possible— however her actions are restricted by the many constraints placed on the state by the federal government in the stimulus and Obamacare. 33 Governors sent a […]

Feds plug the Money Hole in Massachusetts Health Reform?

To close the loop from an earlier post on federal money being sent to safety-net hospitals in Massachusetts to balance their budget sheets, the State House News Service had this piece recently. FEDS OKAY $157 MILLION FOR MASS. HOSPITALS Massachusetts is due to receive $157 million in federal funds that will help trigger the release of $230 million in payments to hospitals that serve disproportionate shares of low-income and uninsured patients.  The funds are expected to provide state matches and free up the flow of funding to Boston Medical Center and hospitals in Brockton, Dorchester, Lawrence, Holyoke and Springfield.  Cambridge Health Alliance has already received about half of the $486 million in funds approved last October by federal government health […]

Troubling Cost Trends in Massachusetts Health Care

Two trends that might determine the long term success of health reform here in Massachusetts: 1) The Boston Globe ran an article about the immense upward cost pressure on the state’s Medicaid program. I blogged about the enrollment and cost increases in Medicaid about a week ago, here. In addition, under the federal law, at least 90,000 people will be moved from the current state subsidized privately run CommonCare plans into Medicaid. However, the double hit of enrollment increases are not the only issue: “The state is also being pushed by Washington, which is cutting back its support. The federal government, which had been paying 62 percent of the state’s Medicaid costs as part of the stimulus program, will pay […]

GLOBE OP-ED: Mass. cities need new deal with public employees

The Mayor of New Bedford– one of Pioneer’s Middle Cities– wrote an interesting op-ed that ran in the Boston Globe. He calls for a statewide task force to develop a new framework for public union contracts in the future. He outlines the fiscal mess that many local communities face, and advocates for immediate action to re-imagine how local governments are run. I wrote an op-ed giving some suggestions from the state level a few weeks ago. However, Mayor Lang’s strongest argument to support his call for action is that: “We cannot have a strong state unless we have strong municipalities. It is imperative that we find systemic and equitable solutions that will allow our cities to strengthen public safety, revitalize […]

VIDEO: Is Beacon Hill Rigged?

On a quiet Friday afternoon during the holidays, Beacon Hill gave members not returning next session a chance to give farewell speeches. The one that stood out was most was Rep. Matthew Patrick calling out the status quo for doing business in the Massachusetts State House. “If you play your cards right, vote the right way, keep your criticisms to yourself, you have a chance of becoming a chairperson of a committee,” he said, adding that eventually, “You find yourself not participating in debates, not even listening, because you and everyone else knows what the outcome will be. It’s preordained. You continue to play the game until one day you find out that some lobbyists have more influence than you, […]

Health $ Elbow Out Kids, Cops and Trees

Just wanted to share a dramatic graph from a recent Boston Foundation report. While the report focused on the money that is being sucked away from education, the graph above should raise big red flags on Beacon Hill about the stark increase in health care spending. The report was followed by an investigative look into the Medicaid expansion that has taken place during the economic downturn. It will be over 30% of the Massachusetts budget next year.  State House News Service Massachusetts taxpayers have delivered more revenue to the state Treasury nearly every month since October 2009, but the Patrick administration still faces a significant budget gap, largely because of soaring costs in the state Medicaid program. It may be […]

Payment Reform: No Government Mandate Needed

The move in the health sector towards payment reform took a big leap forward as 1,800 doctors at Beth Israel Deaconess Medical Center signed a global budget contract with Blue Cross for HMO patients. In other words, doctors are given a fixed budget for the care for each patient during that year. Supporters of global payments hope that the quality of care will be improved. WBUR’s CommonHealth Blog posted an interview with Dr. Stuart Rosenberg about the move. What I found especially interesting was Dr. Rosenberg’s statement at the end of the video. 4:40 My idea is let’s just get on with the solution, and not wait for the government to pass a law. During a radio story carried on NPR, the […]

Decrease Insurance Premiums or You’ll Be Sleeping with the Fishes

A study released this morning may lay out the possible future of state intervention in premium increases for health insurance. The Kaiser Family Foundation examined the different methods by which each state reviews proposed health insurance rates. They found: Many states use subjective standards to guide the review and approval of rates, such as that rates cannot be “excessive, inadequate, or unfairly discriminatory” or that “benefits are reasonable in relation to premiums charged.” Such standards give states more flexibility, but can make the process appear arbitrary and opaque to consumers and the public. Does this sound familiar in Massachusetts? The election year– small businesses health care bill– granted the executive branch the authority to reject premium rate increases if they […]

Massachusetts Health Care Transparency: Bright Enough Spotlight?

Massachusetts officials published online this week a database containing “payments drug companies and medical device makers made to hospitals, doctors, nurses, pharmacists, and other health care providers in the state.” This is a move in the right direction for transparency, but I have to wonder why these two industries were the sole targets. I know the Legislature has focused on gift restrictions in past legislation, but why the narrow focus. While it is nice to be able to download the data in a spreadsheet and manipulate it yourself, the site is not the most user-friendly. For example, it took me 10 clicks deep to get to an individual report. There is much more work ahead before an average consumer would […]

Pioneer Senior Fellow on PBS's NewsHour

Pioneer’s Senior Fellow on Health Care, Amy Lischko, was interviewed on PBS’s NewsHour for a series on the reform law here in Massachusetts. I personally think the report glosses over the connection between increased costs for small businesses and policy decisions by the Legislature and the Connector.  You can read more about this in a Boston Globe op-ed by Jim and Amy. For more history you can read my report from the Heritage Foundation “The Impact on Small Business of Health Care Reform in Massachusetts“. Please check out the video below, or click the link NewsHour Amy appears at 7:44.

Health Care Costs Crushing States– Is the Solution to Drop out of Medicaid?

The headline says it all. “States’ Woes Spur Medicaid Drop-Out Talk” An article in The New York Times today highlights the serious consideration by at least a dozen states to withdraw from the Medicaid program. Supporters are arguing for either a state financed Medicaid program to allow for maximum “flexibility in benefit and cost design” or a federal waiver for states to make some changes on their own. At first glance, leaving the Medicaid program would seem illogical given the federal match that would be left on the table. However estimates that have been conducted– both by think tanks and independent sources– highlight a budget busting tidal wave on its way if the status quo is followed. Lanhee Chen has […]

Raining Cats and Dogs: Massachusetts Local Budgets

A Boston Globe headline today seems to imply cities and towns are being irresponsible by saving, yet many local officials appear to be anticipating dark clouds ahead. As Jim Stergios, executive director of Pioneer is quoted in the article, “They [Massachusetts communities] know the stimulus money is gone, and that in 2011 and 2012, they’re going to get hammered.’’ As the town administrator of East Bridgewater expounds, “Since the state is out of control in the way they dole out their money, you have to solidify your own finances.” When will the state get it? Since 2008, Pioneer has been working with 14 Middle Cities to address some of these pressing fiscal issues in post-industrial cities.  Without measuring performance, improvement […]

Health Care in the Mid-terms: What the Polls really tell us

Trying to read the tea leaves of poll numbers on the general public’s opinion of Obamacare has been especially confusing this election cycle.  Either 70% still want a public option or 70% deride Obamacare. Pundits gladly spin these numbers in support of their viewpoint, but could there be truth hidden in the seemingly contradictory numbers. An interesting article written by Robert Blendon and John Benson in The New England Journal of Medicine last week tried to uncover some of the nuance. Some of the more interesting numbers presented: “18% of registered voters believed that Congress should implement the bill as it currently stands, 31% thought Congress should make additional changes to increase the government’s involvement… and 41% believed that Congress […]

American as baseball, apple pie and primary care doctors?

Harvard Medical School recently announced an anonymous gift of $30 million to create a center to “transform primary care medicine.” What I was hoping to read next was a vision for a metamorphosis of the role of primary care doctors. Instead the Boston Globe article went on to say the school hoped to “fix the nation’s shortage of primary care doctors by raising their status.” The news story reignited a discussion– that I have been having with myself– over the reasons such a high importance has been placed on primary care doctors in the American health care system. In policy discussion after policy discussion, primary doctors might as well be lumped into the same camp as baseball and American pie, […]

ObamaCare blowback

Great piece in the Boston Globe titled “ObamaCare blowback” by Jeff Jacoby outlining the litany of actions that opponents of the national health care law have highlighted to express concerns about new regulations. It certainly has been interesting to watch how the bill has played out on the campaign trail. Predictably most Republican candidates have attacked the new law mercilessly, and if they flip the House come November, they better have a good plan B to explain to the American people why they are unable to repeal the law. Even with huge GOP gains, the White House health care team will breathe a sigh of relief when they know the House Republicans stay below 290 and/or the Senate Republicans stay below 67. Both […]

Unresolved Safety Net Hospital Issues

Mr. Keefe, First, thank you for taking the time to read my post and comment. There is no question that you have played a significant leadership role in health care reform both as a CEO of a major integrated healthcare delivery system, and now as the chair of the board for the Massachusetts Hospital Association. It is clear that your intent is to advocate for the best interest of your organization. However, I did want to offer a few comments in response: Recent Actions: Credit is due for moving forward more aggressively to reduce costs than other organizations in similar situations. I understand CHA attempted to strike a balance and find cuts in different ways, which have not always resolved […]

Next Step in Reform: Cost Control

The President & CEO of Associated Industries of Massachusetts (AIM), an employer association of 6,000 Bay State businesses and institutions, has an interesting piece in the Worcester Telegram & Gazette today that sets the goal line for reform. “We will know the reform works when the same employers who supported a 2006 reform that expanded coverage but did not control costs no longer suffer a sick feeling in the stomach every time they sit down to review premium increases with their health plans. We will know the reform works when employees no longer wonder whether they can afford rising deductibles. And we will know the reform works when the cost of health insurance ceases to be a structural impediment to […]

Feds giving a safety net to Massachusetts’s safety net hospitals?

Two of the most prominent “safety net” hospitals in Massachusetts are facing sizable budget gaps again this year, and are turning to the feds to bail them out. Boston Medical Center (BMC) and Cambridge Health Alliance (CHA) have long received, in part because of their emphasis on the under- and uninsured, greater political assistance in propping up their balance sheets. The desired Medicaid waiver amendment would be worth $86 million this year for CHA and $90 million for BMC. These institutions play an important role in Massachusetts, but the new slug of federal dollars undermines the viability of Massachusetts health reform by introducing new annual bailouts. A key accomplishment of the Massachusetts experiment was a deal to leverage public money […]