THE PIONEER BLOG

Joshua Archambault

Responding to Cadillac Tax Report Concerns

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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 […]

Joshua Archambault

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

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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 […]

Joshua Archambault

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

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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 […]

Joshua Archambault

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

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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 […]

Joshua Archambault

NYT: Medicare Bills Rise as Records Turn Electronic

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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 […]

Joshua Archambault

Does Health IT Guarantee Better Care & Save Money?

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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 […]

Jim Stergios

Huck, Jim and our interest in education

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Twain famously noted that the difference between the right word and the almost-right word is the difference between the lightning and the lightning-bug. Getting words right is arguable the key task in educating an individual, for precise use of language is critical to developing the ability to observe and to think. Then there is the sinister twisting of language for reasons of power (most often political power). This was a topic of intense focus by George Orwell, who in his staple of 9th grade reading courses, Animal Farm, described how the vision of Old Major was transformed to the darker purpose of other animals after his death. In the novella, the animals rebel against the drunken farmer Mr. Jones for […]

Jim Stergios

The Democrats’ Platform on K-12 Education

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Here is the Democratic National Platform on K-12 education, taken from the national Democrats.org site: An Economy that Out-Educates the World and Offers Greater Access to Higher Education and Technical Training. Democrats believe that getting an education is the surest path to the middle class, giving all students the opportunity to fulfill their dreams and contribute to our economy and democracy. Public education is one of our critical democratic institutions. We are committed to ensuring that every child in America has access to a world-class public education so we can out-educate the world and make sure America has the world’s highest proportion of college graduates by 2020. This requires excellence at every level of our education system, from early learning […]

Jim Stergios

The GOP Platform on K-12 Education

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Here is the Republican platform on K-12 education, taken from the National GOP web portal: Education: A Chance for Every Child Parents are responsible for the education of their children. We do not believe in a one size fits all approach to education and support providing broad education choices to parents and children at the State and local level. Maintaining American preeminence requires a world-class system of education, with high standards, in which all students can reach their potential. Today’s education reform movement calls for accountability at every stage of schooling. It affirms higher expectations for all students and rejects the crippling bigotry of low expectations. It recognizes the wisdom of State and local control of our schools, and it […]

Joshua Archambault

$14B in Medicare Cuts under ACA for Massachusetts

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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 […]

Joshua Archambault

Do Patient-Centered Medical Homes Save Money?

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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 […]

Jim Stergios

Schools and the conventional wisdoms

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Facts are, as John Adams famously noted, “stubborn things.” But facts are also what makes politicians of good will less stubborn; that is, it is empirical evidence that allows both major parties to to coalesce around reforms that will work. Compromise for compromise’s sake, or hewing to conventional wisdom, is most often pandering with an eye toward one’s own ambitions. But, armed with facts, people of even the most strongly held principles can come to very surprising positions. We’ve been hearing a lot about how education may be the area for compromise between the two major parties. What’s driving this coalescence? Hard choices by the Obama administration? Empirical evidence? Or it is conventional wisdom? With Labor Day now behind us […]

Joshua Archambault

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

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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 […]

Jim Stergios

An expert’s view of national standards’ focus on non-fiction texts

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(Gretchen Ertl for The New York Times) The Common Core national standards are increasingly controversial, with Utah, Indiana and a number of states that had adopted them now reconsidering. A recent New York Times education blog notes the following: Forty-four states and United States territories have adopted the Common Core Standards and, according to this recent Times article, one major change teachers can expect to see is more emphasis on reading “informational,” or nonfiction, texts across subject areas: While English classes will still include healthy amounts of fiction, the standards say that students should be reading more nonfiction texts as they get older, to prepare them for the kinds of material they will read in college and careers. In the […]

Joshua Archambault

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

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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, […]