Jon Kingsdale, former executive director of the Commonwealth Connector, has a piece in tomorrow’s (it’s 11:05 pm Sunday) Globe, which is worthy of the Obama teleprompter. The basic point he wants to make is that “Americans are confused” about the federal law, and that MA’s health reform experience has been a rousing success.
Uh, no. It’s neither been a flat-out success nor a failure. It’s a mixed bag, and some of the threads at the bottom of the bag are getting bare. Pioneer’s never come out for or against the MA reform. We first believe in state experimentation, and second that empirical data can sometimes surprise you. Given the mandates, credible coverage requirements, the uncompensated care pool, and the fact that we were at around 8% uninsured, for Massachusetts it seemed like an experiment worth trying.
And our series of report cards has shown that in some areas it has worked (1, 2, 3, and 4). Access to insurance products is better but not at all great for the folks who buy cost-sharing insurance products. The costs are unsustainable – at $88M extra per year (after 4 years that makes the cumulative impact around $350M). The take-up for small business is dismally low (again, the Connector’s been good at marketing near-free products). The administrative costs are way too high (cf. Utah’s exchange, etc.), But Jon is auditioning for the national health care gig and so he is in marketing mode, selling the MA’s success hard:
Four years after enactment, Massachusetts has learned about the challenges of implementing near-universal coverage. Here are a few lessons:
1. It’s a campaign: …. We launched this effort with the Red Sox, and held more than 300 educational forums across the state, the equivalent on a national scale of 15,000 outreach meetings. As a result, voter support for reform has remained high, ranging from 59 percent to 75 percent.
Jon & Co did work hard. And they marketed well. Kudos.
2. Adequate resources: The Massachusetts Legislature appropriately funded implementation with $35 million in the first year; the equivalent on a national scale would be $1.65 billion. Never were shortages of time, expertise, or resources allowed to stand in the way of meeting legislated deadlines.
Lots of deadlines were missed. The small business push came 3 years into the effort and fizzled. Transparency of information (cost and quality) is a punt — so no cost containment.
3. Coordination: Somebody has to be on point to drive implementation across federal agencies and the other organizations needed to execute this undertaking. The Health Connector used multiple consultants and outsourcing strategies, while staffing up, to meet deadlines. With 50 states and far broader legislation, the federal effort will require a Herculean coordination effort.
Sounds like Jon wants that job!
4. Experiment and evaluate: This effort is new and not everything will go as planned. For example, running an exchange means offering customers what they want to buy, but that’s neither obvious nor unchanging. Massachusetts’ exchange is a learning organization. Key initiatives were launched as pilots, and we have not been afraid to revise them and try again.
Yes. But the experiments were largely top-down and missed many of the lessons we have learned from Utah in just one year of operation. UT = 2 bureaucrats, 55K small biz employees signed up, and literally dozens and dozens of options. MA = dozens of Connector bureaucrats at big bucks, 1500 small biz employees signed up, and dismally few and disappointingly similar product options.
5. Transparency: The biggest challenge Washington faces in “helping’’ Americans gain access to care is their distrust of government. Transparency is the antidote: making tough decisions in public; meeting endlessly with employers, unions, insurers, clinicians, and citizens; and both talking and listening out there, in at least 15,000 communities. These are essential to building trust.
As we have worked on the “Interim Report Card” series on the MA health care reform, we’ve frankly been astonished at the lack of data collection and availability on key metrics. We still have a ton to learn – and the Connector has not done its job in seeking to measure its performance and make the info available.
6. Harness the market: State exchanges are essentially stores that sell insurance, combining government’s responsibility to protect consumers with a retailer’s need to serve customers. Brow-beating various industries may be good partisan politics, but the Health Connector has worked diligently at creating solid, long-term working relationships.
Again, UT does a much better job working with its broker community. The MA Connector is way too top-down in its approach, and it has too few products that brokers can sell to the small biz community.
Congress and the president have labored mightily to bring forth national reform, modeled after Massachusetts. Now the executive branch has 3 1/2 years to work with 50 very different states in bolstering popular support and executing effectively. That will require massive amounts of technical expertise and project management, combined with public outreach and creative communications.
The real campaign has just begun.
As a great marketer, Jon has just submitted his resume in a novel way — a Globe op-ed.