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MA vs. US: Round 1: Individual Mandate

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A mandate made sense in MA for a few reasons.  First, it was clear that our non-group market was failing due to adverse risk.   It was sort-of like a high-risk pool but there were no options for healthy people.  Because of changes that were made to the insurance laws in the mid-1990’s including guarantee issue, adjusted community rating (no underwriting allowed), and very limited product choice in the non-group market, the market was unaffordable.  The only people purchasing in this market were people who really “needed” insurance.  We saw large drops in enrollment each year  (insurance jargon calls this a death spiral) leading up to the reforms in 2006. Second, we had VERY EXPENSIVE safety net, the Uncompensated Care Pool, […]

A Low Cost Counterweight to Partners?

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I’m fascinated by the thinking behind the Caritas-Cerberus tie-up and today’s Globe speculates that the plan is to create a low cost provider of health care. I suspect that the Globe is right and I’d throw a few more ingredients into the pot: First, if Cerberus wants to play nationally in this market, they need to establish a reputation as an operator and not just short-term financial engineers. Building out the Caritas group gives them a chance to do this and get some rub from Caritas’ brand equity. Having Ralph de la Torre on your team doesn’t hurt either. Second, Caritas has tried to extend their value chain into insurance once before and almost succeeded. Depending on the structure of […]

How to Kill Off Manufacturing in Massachusetts

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Manufacturing in Massachusetts is dead, right? Rusted out and superseded by other, sexier industries. Wrong, its still the fourth largest employer in the state (behind healthcare, retail and education). And its disproportionately important in places like the South Coast and the Merrimack Valley. Plus manufacturing wages are above the state median wage. Check out this 2008 manufacturing chartbook put out by the state. What’s one of the key challenges facing the manufacturing industry? Its heavily reliant on energy as one of its major inputs (as opposed to other industries like financial services) and Massachusetts has one of the highest energy cost rates in the country. So, a new solar power mandate that may add up to $250m per year to […]

Race to the Top out of reach

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Holy s^&*! Jamie Vaznis of the Boston Globe is reporting that Massachusetts is not among the winners of the first round of the Race to the Top competition. Kudos to Delaware and Tennessee for wining the first round. A lot of hard work (900 pages of it in the application, plus a legislative process, lots of print, lots of arguments, and a few fried political relationships) in Massachusetts did not get us there. Time for a deep breath. How is it that the top performer on the Nation’s Report Card did not make it? Vaznis reports on Ed Secretary Paul Reville’s view: “We are committed to reworking the application and filing it again,” said Reville, who added that he is […]

Auto insurance does not equal health insurance

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What’s wrong with a government mandate for health insurance? After all, government mandates auto insurance, right? In any basic conversation about health care — especially in MA where the idea of a mandate started — that is a basic line of argument from pro-mandate folks. My problems with that line of argument are three: 1. The federal government does not mandate auto insurance, and it should not mandate health insurance. (In fact, three states do not have auto insurance mandates.) The point is, states can choose to or not to. I have no problem with the health mandate in Massachusetts – if the system that is scaffolded on top of it works. States constitutionally have the power to mandate such […]