Will the ACA Bankrupt the Mass Connector?

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The Connector held its annual retreat this past weekend, and since the omnipresent Health Care for All (HCFA) representatives were not in attendance to write up a summary, I thought I would provide an overview of what was discussed at the meeting, and outline some of the future challenges for the Connector. The agenda can be found here.

State Budget Considerations

The Commonwealth will have to finance state mandates that are over and above the federally set essential health benefits (EHB). The Connector has identified at least 7 current mandates that are unlikely to be in EHB. The Legislature will need to reopen the discussion over mandates.

40,000 legal immigrants will be enrolled back into Commonwealth Care due to a lawsuit. The current Bridge program only has 15,000 legal immigrants, so the Connector will have to welcome back the Bridge enrollees and 25,000 additional immigrants picking up the additional cost in the process, till at least 2014.

One of the biggest changes will be enrollment in the subsidized CommCare program. The ACA, transfers a significant number of enrollees into Medicaid or a Basic Health Plan(BHP) (more on this in the 4th blog post) out of CommCare. This would leave the Connector with just over 60,000 enrollees, a huge drop in revenues, and a floundering unsubsidized CommChoice program. What became clear from Board members was that the Connector should be scared about future power and market share. Numerous board members wanted to discuss how the Connector could best position itself to keep the reins of power in the health care market.

A few other observations.

The small business and broker representatives were silent on Saturday. Not a single question or comment. They are some of the newer appointed officials, but this leaves the conversation to be dominated by government and union officials.

Is the tension escalating on the left? There was a lengthy conversation about the role of liberal advocacy groups going forward in Connector policy decision making. Some Board members expressed frustration with these groups and advocated for “education about the reality of the situation,” while others wanted to protect the access and input these groups have had since the Patrick Administration has been in office.

State officials are concerned about future cuts in federal funding. Given that the federal government finances a considerable portion of the Massachusetts reform, and is being debated in secret waiver negotiations, this issue could mean big changes in program design.

To the credit of the Connector staff, they presented ACA implementation as a chance to design Connector 2.0. I hope they mean that. But the sympathy shown by staff to Board concerns about the evils of– the private sector, competition, and greater choice for consumers—I have little confidence of real reform.

Shouldn’t the opposite question be asked– what reforms would be best for taxpayers and for possible consumers of Connector products?

This blog post is part 3 of 4 from the Connector meeting.

Twitter @josharchambault