THE PIONEER BLOG

Joshua Archambault

Cart Before the Horse in Media Coverage of Massachusetts Payment Reform

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Before digging into the Senate bill this afternoon, I wanted to express my concern about early media coverage of the payment reform debate. The spotlight has become focused on 3 or 4 points, all contained in press releases. No one can knowledgably comment on the Senate bill since they have not seen the full language- as they are still finalizing parts of it this morning. It is easy to say the two bills look the same from the press release, but are they? The debate over somewhat arbitrary cost growth goals is pointless, unless there is a debate about the mechanisms to get there. Did we forget that DHCFP data tells us 53% of employers are self-insured in our state […]

Jim Stergios

Not grateful about “charter cap lift”

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The 2010 Achievement Gap bill that was passed by both the House and the Senate and signed into law by Governor Patrick lifted the limits on charter schools and the number of students in them in districts that were failing to see improvements in student achievement. Rather than limiting the number of students to 9% in these largely urban districts, the law allowed up to 18% of students to attend charter schools. The six-year period for the expansion up to 18 percent of students was not coincidental. It aligns with the six-year reimbursement schedule for districts, by which districts: • receive 100% of the per-pupil funding for in the first year after a student leaves for a public charter; • […]

Joshua Archambault

I Pledge My Faith in Bureaucracy- Mass Health Reform II

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The House version of payment reform creates a new mega agency, the Division of Health Care Cost and Quality. To be fair, the House collapses a few other state agencies into the new Division, but there is no question this entity is given far-reaching and broad regulatory power. The Division will be independent and “not subject to the supervision and control of any other” public entity. (Section 29, subsection 2(a)) The controversial federal Affordable Care Act drew negative attention for how many times the Secretary of HHS was instructed to act on major policy, roughly 700 times in 2,700 pages. The House’s bill outdoes the ACA by requiring the division to take action 163 times in 178 pages, or almost […]

Jim Stergios

How are the Rural Poor Doing at School?

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Massachusetts is a wealthy place. We are among the wealthiest states in the country, and the educational attainment of Massachusetts parents is well beyond that of parents in every other state. All this should point to high-powered students and schools in the Bay State. In fact, “big thinkers” in education policy often point to those factors to explain why Massachusetts does so well on national and international assessments. In part, that’s true. But what these big thinkers fail to see is that Massachusetts not only has risen from around 11th in the country on the national assessments to number one, but also that the performance of all Massachusetts student groups has gone up. In fact, Massachusetts’ improvement in performance among […]

Joshua Archambault

Many Unanswered Questions On Payment Reform

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The next act of the Massachusetts health care reform drama is about to play out on Beacon Hill. As the same familiar characters return to the stage, the character who should be the hero of this drama, the patient, is nowhere to be found. Instead we are sitting down to a repeat performance. The language of reform is promising, but the reality of implementation remains hazy. Over the next few days I will blog on why the House of Representatives’ bill left out the patient as part of the solution. However, for now, below are just a few questions to prime the pump for this discussion and for you to consider: How will western Massachusetts comply with the state mandate […]

Steve Poftak

UMASS Law School Revisited

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I won’t bury the lede — the UMASS law school has been recommended for provisional accreditation by the ABA’s Accreditation Committee. The next step will be a consideration of that recommendation by the ABA’s Council on Legal Education. A commenter on a related post claims that the Council has always accepted the recommendation of the Committee. After receiving provisional accreditation, the school undergoes at least three years of review to move from provisional to full accreditation. That will be an ongoing challenge for the school but from the perspective of students, provisional accreditation gets them the right to take the bar in any state they want, so provisional is good enough right now. As a longtime critic of the law […]

Jim Stergios

Romney and Obama tussle on education

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So let the games begin. Finally, the presidential candidates may get to education. For the greater part of a month, the presidential candidates have been sizing each other up, jabbing each other on jobs and the economy, who’s more in touch with the average voter, and all sorts of distractions like who is waging that war on women and whether the president should play politics with foreign policy (as if that’s anything new). Given that education is a key factor affecting the country’s ability to create jobs–and that it is one of the key sectors of public employment–you would have thought that education would have made the dance card a little earlier in the process. But no. Finally, we have […]

Steve Poftak

Here We Go Again… Now It’s Medford

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Several months back, the egregious abuses at the Chelsea Housing Authority showed the weaknesses in oversight of municipal housing authorities. The fact that it got away with that abuse for so long, even after federal and state audits, should give one pause. Now, the Medford Housing Authority is under scrutiny. This time, its not the Executive Director’s salary that’s in question. Rather, its his habit of hiring underqualified political favorites and widespread ‘irregularities’ in contracting. In addition, there are allegations of improper usage of funds by other employees. And, once again, we have the troubling spectre of the entity which is supposed to provide oversight — the Board of Directors — unable or unwilling to do its job properly. This […]

Jim Stergios

Self-dealing among education officials

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I’m conflicted about how to say this. Getting stuff done is about building relationships and trying to find ways to get along and in fact pulling the right people together toward a goal. But it is also about saying things straight and pulling no punches when what’s being debated matters a lot. I often write about education standards because, unlike some other ed policy choices, standards impact the entire landscape of education. If used effectively to drive reform, they set the contours of classroom content, they constitute the basis for student tests, and they define the basis for teacher tests that ultimately play a bigger role on the quality of teaching in the Commonwealth than any professional development program afterward. […]

Joshua Archambault

If Only Governor Patrick Knew What His Medicaid Office Was Up To

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While Governor Patrick has been pleading with the Legislature to act on his February 2011 payment reform bill that would move our health care system towards global payments and accountable care organizations, his MassHealth (Medicaid) office has moved in the opposite direction. (You can read my testimony on the Governor’s bill here) In March 2011, the MassHealth program changed their default enrollment policy for new enrollees that did not affirmatively select a managed care option–either one of the 5 Medicaid managed care organizations (MCO) or the Primary Care Clinician Plan (PCC). Before the switch, if an individual, after being determined eligible for Medicaid, did not affirmatively select a managed care option, the MassHealth office would auto-enroll them into either one […]

Jim Stergios

Conflicts of Interest in MA’s adoption of national standards

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“No man is allowed to be a judge in his own cause, because his interest would certainly bias his judgment, and, not improbably, corrupt his integrity.” – James Madison, Federalist #10 In this season of US Supreme Court decisions we’re reminded that independent and objective judgment on key legal and public policy matters has been an aspiration in Anglo-America law and justice (not to mention scientific inquiry) for centuries. In America, it was John Adams in Massachusetts and James Madison of Virginia who were best at articulating the importance of independent judgment. The push for national education standards has brought to light a variety of troubling questions about the legality, cost, and academic quality that has been discussed here and […]

Joshua Archambault

Is Romneycare A Budget Buster?

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The Massachusetts Taxpayers Foundation (MTF) put out a report late last week on the cost of Massachusetts health reform. The number from the report that has gotten the most media attention has been– $91 million. Over the five full fiscal years since the law was implemented, the incremental additional state cost per year has averaged $91 million… This is a very strange way to interpret the cost data. Here is the breakdown from the report: The better number to highlight would be the incremental increase each year over the 2006 baseline. 2006 2007 2008 2009 2010 2011 Over 2006 baseline (millions) – $268 $645 $1,037 $834 $906 If you add this up and divide by 5, you come up with […]

Steve Poftak

HOT(High Occupancy Toll) Lanes in Massachusetts?

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Toll hikes are a tough sell in this area, but what if tolls were optional? And what if you were getting a premium level of service in return for your money? That’s the basic idea behind HOT (High Occupancy Toll) Lanes. These are segregated lanes that are tolled (usually at variable rates to keep traffic flowing) and run alongside ‘free’, untolled lanes. Think the HOV lanes on I-93 except they charge an open-road toll for vehicles that aren’t carpools. The toll would vary according to the time of day in order to keep traffic flowing (e.g. the price would be high during rush hour and decline during times of lighter traffic). Lots of other places are trying this concept out […]

Joshua Archambault

News Flash: Gruber and McDonough are Political

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Jonathan Gruber and John McDonough are widely quoted in the media on both Romneycare and Obamacare. Without question they are both extremely intelligent, I have a deep respect for their commitment to health policy and enjoy the frequent interactions I have with them. However, I have wondered for months when the media will finally acknowledge that they both have a political angle.  This week President Obama’s campaign made it official by putting them into a video: Will this put an end to the neutral observer status afford them in most media stories?

Joshua Archambault

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

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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 […]