THE PIONEER BLOG

Jim Stergios

Sunset the Lawrence district school monopoly

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One of two kids in the Lawrence Public School system do not cross the 12th grade finish line. Even that is beyond what the “soft bigotry of low expectations” crowd can explain away on the basis of factors like poverty and family situation. Sadly, that dropout reality holds true in a couple of other urban districts around the state. But no other district is in school receivership… in a city that is in state fiscal receivership. And no other district can boast of the on-the-record, court-documented corruption within the school district office that we’ve seen in Lawrence. As noted in several previous blogs (such as this one), in Lawrence, just over 1,000 students of the 13,000 in the district will […]

Jim Stergios

Grossman wants to look squarely at reality

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The treasurer’s call for a cut in the pension’s rate of return on its investment portfolio reflects his desire to look reality squarely in the face. While investment history from the mid-80s is higher than 8 percent, investments over the last decade have been well below that target, and the market continues to be plagued with uncertainty and real structural questions. The treasurer’s call to reduce the expected rate of return is also prudent planning, because the years in which the state doesn’t meet the benchmark are usually the years in which we can least afford to kick additional money into the fund. Rhode Island’s general treasurer Gina Raimondo, a Democrat, started out similarly, seeking a reduction from 8.25 to […]

Joshua Archambault

Rent Seeking in Mass Price Capping Law

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After Moody’s issued a credit negative analysis for hospitals in the Commonwealth under the new health care law signed this week, I started to wonder how hospitals will react to the incentives in this new proposal. One line from the Moody’s report is of particular interest: Another negative credit effect of the bill is that the state will use an excise tax on insurers to support smaller and less profitable hospitals, potentially allowing them to remain in business longer than would otherwise be possible… I contacted the author from Moody’s (Dan Steingart) to ask if they had additional information on the $135 million Distress Hospital Fund and the hospitals that would receive this money. Part of his response is below. The bill is vague […]

Joshua Archambault

Medicaid Patient Access in Mass

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Yesterday the Massachusetts Medical Society released its annual MMS Patient Access to Care Studies. While the media coverage has focused on the lack of change in wait times across the Commonwealth from last year and the regional issues that remain in the state, there is one subgroup that deserves special mention– those on Medicaid. Massachusetts has roughly 1.3 million people on MassHealth (Medicaid), and they are having problems seeing a doctor. Only 62% of family doctors are taking new MassHealth patients and only 53% of Internal Medicine doctors. We are putting more folks on this program under the ACA, and the regional issues are quite pronounced. Pages 23 and 19 in the report show this. Only 14% of Barnstable family […]

Joshua Archambault

Moody’s Report: New Mass Price Capping Law “Credit Negative” for Hospitals

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In the soon to be long list of unintended consequences as a result of the brand new price capping law signed yesterday by Governor Patrick, Moody’s released a report warning of the future impact of the law on hospitals in the Commonwealth. While not a formal downgrade, it could raise the cost of capital borrowing for these hospitals and increase the cost of providing health care going forward. These extra costs will be passed onto consumers in the form of higher care costs and insurance premiums. More from SHNS($): The health care cost control law signed by Gov. Deval Patrick Monday will hurt the bottom lines of Massachusetts hospitals and limit their flexibility to grow, a major credit rating agency warned Monday. “The […]

Joshua Archambault

Funny Business Ahead in Massachusetts?

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Over at the Manhattan Institute, Paul Howard recently blogged on Massachusetts’ move towards a price cap on health care growth.  The whole piece is worth reading, but he makes one great point that has not be explored enough in Massachusetts: Bay State legislators are betting that you can reform 20% of the economy from the supply side, with very little involvement from the demand side (the patients). (For more detail, see this post.) It also assumes that commissions and technocrats recruited from industry, hospitals, and academia won’t play favorites, or be pressured by interest groups into supporting pet projects and institutions. Good luck with that. Find me on twitter: @josharchambault

Jim Stergios

The right reform path in Lawrence?

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There are two issues that matter in K-12 education – what you might call the twin achievement gaps, those between the inner city poor (often including English language learners) and the rest of the state, and the international achievement gap whereby the percentage of students who are advanced in core subjects in the top-performing countries far outstrips the percentage among Massachusetts students. The second achievement gap is urgent; the first is an emergency and has to be treated as such. Ground zero for the emergency achievement gap is the city of Lawrence, where the public schools have been in free fall, where the previous superintendent has been convicted, where dropout rates are approaching 50 percent (not a typo), and where […]

Joshua Archambault

Will Government-Directed Healthcare in Mass. Really Contain Costs?

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Governor Patrick signed a new healthcare law today aimed at cost containment, and the rhetoric soared assuring all that Massachusetts has “cracked the code on healthcare costs.” Unfortunately, with no debate on the underlying bill in the House of Representatives and only little debate in the State Senate, the 349-page statute, which was released just 14 hours before the legislative final vote, is little understood and brimming with unintended consequences. To mark the occasion, Pioneer released the follow infographic: Real cost-containment is only possible when we encourage patients to reward low-cost, high-quality providers with their business.  We’ve said it over and over again throughout this process. Instead, the law being signed today re-imagines and repackages so many failed top-down approaches […]

Joshua Archambault

Pioneer’s Statement on “Cost Containment” and Payment Reform Bill

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Another Lost Opportunity to Give Individuals and Businesses Relief on Health Care Costs Final Version of Conference Committee Bill Adds Hundreds of Millions to System BOSTON – After years of debate over how to contain health care costs, the Massachusetts Legislature is poised to approve a bill that burdens the entire health care system with more bureaucracy and hundreds of millions in increased expenses. “Real cost-containment is only possible when we encourage patients to reward low-cost, high-quality providers with their business,” says Josh Archambault, Pioneer’s director of health care policy. “Instead of providing financial incentives for individual patients to take charge of their own medical care, this legislation rearranges the system based on accountable care organizations (ACOs) and changes in […]

Jim Stergios

MA Goes For Top-down Health Care Policies

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Even as “Massachusetts Health Care 2.0” legislation moves to the Governor’s desk for signing, and with it the heavy hand of top-down policies, individuals and companies in many other states are adopting market-based solutions.

Jim Stergios

Happy 100th Birthday to Milton Friedman!

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Happy Birthday to Milton Friedman, who would have been 100 today. A great way to understand Friedman’s contribution to the field of education can be summed up in the following series of videos associated with his renowned Free to Choose series on PBS. This series of six YouTube segments covers (in the first three) the actual documentary/commentary of the Free to Choose on the idea of scholarship vouchers for students to attend K-12 schools, as well as a fantastic roundtable debate on the then controversial idea. The FTC special on education opens up with a look at a Hyde Park school that was in the 1980s already plagued by the need for uniformed police, metal detectors, and other safety features. […]

Joshua Archambault

ACA Impact on Mass, Part 1: Low-income Residents will Pay More for Healthcare and Insurance

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Affordability/ Subsidy levels for Low-income: How much will individuals pay for health insurance and health care under the federal law? Under the ACA, low-income individuals will pay more. Urban report I don’t recall supporters of the federal law in the Commonwealth highlighting this difference before it passed Congress or leading up to the SCOTUS ruling. Drilling down to look at cost-sharing as well along with the range of premium payment ranges: Mass vs Fed Diff in costs State Law – CommCare Federal Law – QHP Premium Cost-sharing Premium Cost-sharing 138-150% FPL $0 $29 $36-$54 $24 150-200% FPL $40 $29 $55-$114 $54 200-250% FPL $78 $43 $115-$183 $115 250-300% FPL $118 $43 $184-$259 $128 Source: Connector The State may have two […]

Joshua Archambault

How SCOTUS ACA/Obamacare Ruling Impacts Mass

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Most of the press coverage has focused on the political angle of the SCOTUS ruling, but the more interesting and complex questions lay at the policy level. Pioneer recently released a book to propose a new relationship between states and the federal government, and it has received considerable national attention. Even if Democrats or Republicans don’t talk about the law this way, the new healthcare law is a new entitlement program and will likely be reformed in some manner to address the federal deficit. [Learn more, and download a couple free chapters or buy a copy at Greatexperiment.org] But for now, and since the ACA was upheld, the policy questions refocus on individual state implementation. Locally, conventional wisdom would tell […]

Jim Stergios

Will New York Make Boston The Old Tech City?

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Neil Swidey had a wonderful article (N.Y. vs. Boston: The endgame) in the Boston Globe Magazine on the fabled Boston-NY (or is that NY-Boston) rivalry delving into the ever-timely question: “Where did all this nonsense begin?” What most intrigued me was his reference to New York’s plan to take “Roosevelt Island and a decrepit hospital that offers priceless views of the United Nations and the Chrysler Building” and turn it into “a new tech-focused graduate school that, in many ways, will be built in the image of MIT.” Swidey’s set-up is pitch-perfect in noting the pride Greater Boston takes “in our identity as College Town, USA, the egghead capital of the nation, anchored by Harvard and MIT and fortified with […]

Joshua Archambault

Pulling Back the Curtain on Beacon Hill’s “Healthcare Reform 2.0”

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T-minus 13 days until the end of the legislative session and one of the largest and most controversial pieces of legislation has moved with almost no media attention. The promises for the new cost containment/ payment reform bills (or health reform 2.0, as some are calling it) — now being considered by a joint House-Senate conference committee — are historic, according to the rhetoric of the elected officials who authored it. It “completely alters the landscape of our delivery system,” and “will result in an estimated $150 billion in savings over the next 15 years.” “It is going to work because it is well thought out?… It is not going to hurt our best hospitals… We will be the first […]