Patrick Admin’s Misdiagnosis on ACA Transparency

This post was co-written by Michael Morisy.

During this year’s budget debate, Pioneer asked many questions about the reality behind optimistic health care cost predictions which, if flawed, could leave the state facing a $900 million budget hole next year alone. The passage of the Patient Protection and Affordable Care Act (PPACA) could make things even worse down the line – if it survives judicial challenges. But as much as we’d like to share the state’s optimism, we have had an incredibly hard time getting answers to some basic questions about the underlying assumptions that the state may have about future health care costs.

Back on April 9, we requested documents from the Massachusetts Health Connector that discuss the financial implications of the Affordable Care Act on Massachusetts, including estimates of the impact on those currently enrolled in an insurance plan offered through the Connector. Early Pioneer research on the impact of PPACA on Massachusetts, estimates that 95,000 individuals will be moved out of the Connector and into the Medicaid program. The Connector will lose almost 60% of its current operating revenue under this scenario, which will have a direct impact on the state budget.  Under PPACA, the state can transfer many of these people onto Medicaid any time before 2014, so it should impact state budget estimates and discussions.

We received an e-mail on March 18 stating that all responsive materials were posted on the Connector’s website.  While there is certainly some useful information there, nowhere to be found are the critical, underlying calculations and estimates we requested.

We re-sent the request to the MassHealth (Medicaid) Privacy Office on June 7, hoping for a more useful response, and while the request was confirmed the same day, to date we have received none of the requested materials.

We’ve found this sort of bureaucratic opacity nearly every direction we’ve turned when requesting materials related to Massachusetts’s health care planning. In late April, we filed a request for a list of participants in meetings analyzing the impact of federal health reform on Massachusetts, as well as the names of any committees or sub-committees they sit on. The latter part of the request was particularly important: Agency after agency passed the buck when we asked for materials, so by naming the members and sub-committees involved in the analysis, we could more specifically ask for materials.

A single hand-written attendance sheet was produced, as well as an explicit confirmation that this document was the only response material that the Executive Office of Health and Human Services of Massachusetts possessed. The agency later provided the agenda for the April 13, 2010 “Federal Health Reform Implementation Working Group Kick-Off Meeting.”

By that point, we were frustrated and confused as the exchange planning grant quarterly progress reports listed on the Connector website outlined a number of efforts that had been ongoing for months, and some of which were supposed to be complete at the time of our requests.

After being given very little information from the FOIA process, you can imagine our grievance when, in multiple public forums this summer Connector, Medicaid and HHS staff talked about the work of numerous committees that had been meeting roughly twice monthly for a year or longer.

The groups had: identified outstanding policy questions, identified potential options/approaches, solicited feedback on the policy options and evaluation components from leadership and Health Connector Board, and established an advisory council.

A recent Blue Cross Blue Shield Foundation report documented the five interagency committees: Insurance Reform, Long Term Care/Behavioral Health, Employer, Health Care Workforce, and Subsidized Insurance/Medicaid.

And the Connector’s quarterly exchange planning reports listed other subgroups: Policy and Legal, Product Assessment and Development, Subsidized Insurance/Medicaid, Small Business, Information Technology (IT) and Business Development, and Financial/Accounting.

The Executive Office of Health and Human Services (EOHHS) has done its best to appear transparent. They send roughly weekly “Affordable Care Act Massachusetts Implementation Updates,” set up a website, and hold occasional stakeholder meetings. Yet these outlets have lacked policy substance, and mostly have served to copy and paste basic information on federal regulations and grants. State officials have referenced a major report to be released in September, and Pioneer looks forward to that analysis as officials have stressed the importance of “a comprehensive assessment of each option” including federal and state finances. Yet Pioneer has received only the limited information mentioned above.

If trust is going to exist in the public sector, transparency is necessary. Pioneer has been frustrated and disappointed in the lack of compliance and engagement with the FOIA process that is intended to protect public access to information. In this case, there seems to be a clear disconnect between the reported activities of government and the FOIA documents returned to us.

If these committees are working so hard and for so long, why won’t they provide even the most basic information required by the open records law?