CommonHealth | mass. health reform

New Board Begins Work To Control Health Care Costs

Fri, 16 Nov 2012 16:36:14 +0000

A new 11-member board began work today on what Governor Deval Patrick calls an historic effort to control the interminable problem of rising health care costs. WBUR’s Martha Bebinger offers this initial report:

The main goal of this board, including consumers, employers, providers and health care experts, will be to make sure Massachusetts meets the new goal of keeping health care spending in line with the state’s overall economic growth. Governor Patrick swore in commission members this morning.

“It’s important for them to realize that they’ve been called to this moment by history. We a model for national health care reform in terms of access. And in terms of cost control, we’re going to be a model for the country on how to crack that code,” he said.

The board’s chairman, Prof. Stuart Altman, a Brandeis economist, asked members to make sure they represent the interests of the state as a whole, not their special interests on health care spending.

Boros Named Director Of New Center To Implement Cost-Control Law

Rachel Zimmerman — Thu, 01 Nov 2012 15:31:22 +0000

This just in from the Patrick administration:

Governor Deval Patrick, Attorney General Martha Coakley and Auditor Suzanne Bump today selected Áron Boros to serve as the first Executive Director of the Center for Health Information and Analysis (CHIA), furthering the Commonwealth’s efforts to lower health care costs and make quality, affordable care a reality for all Massachusetts residents. Currently the Commissioner of the Division of Health Care Finance and Policy (HCFP), Boros has helped shape the development of the Commonwealth’s landmark cost containment law.

“Áron brings valuable experience and a proven commitment to this critical role,” said Governor Patrick. “This is another important step forward in the Commonwealth’s efforts to create a health care system that is as affordable as it is accessible.”

“The Center for Health Information and Analysis will play a vital role in continuing to increase transparency and understanding of the health care market,” said Attorney General Coakley. “We are pleased that Áron Boros will lead CHIA as we begin the next stage of health care reform in Massachusetts, with a strong focus containing costs.”

“Áron Boros is the right choice, given the leadership role he has played at the HCFP and his understanding that good data and analytics are the foundation upon which good public policy must be built,” said Auditor Bump.

“High quality information and analysis will provide the foundation for the Commonwealth’s efforts to improve the health care system,” said Boros. “I am looking forward to setting a high standard for transparency, reliability, and objectivity as the first executive director, and to working closely with a wide variety of partners inside and outside state government.”

Boros has been the Commissioner of HCFP since September 2011. He has co-chaired both the Provider Price Variation Commission and the Statewide Quality Advisory Commission. While serving as commissioner, Boros hosted the annual Cost Trends hearings, presided over the first release of the Division’s All-Payer Claims Database for state agency and research uses, and developed a long term strategic plan that recognizes the Division’s role as a ‘hub’ of data and analytic services for a wide variety of partners.

Prior to joining the Division, Boros worked at MassHealth as the Director of Federal Finance, and as an attorney at Boston law firm Foley Hoag. He is a graduate of the University of Michigan and Amherst College, and lives in Jamaica Plain with his spouse and their two children.

The Center for Health Information and Analysis (CHIA) is established by the historic health care cost containment legislation that the Governor signed on August 6, as the successor agency to the Division of Health Care Finance and Policy. CHIA is an independent state agency that collects health care cost and quality information and provides objective analysis of this data to assist in the formulation of health care policy. CHIA maintains a number of the Division’s responsibilities, including the compiling of the state’s annual cost trends reports, managing the state health data repository, and monitoring the financial stability of hospitals and health plans. CHIA also maintains a consumer health information website to enhance the transparency of the quality and cost of health care services in the Commonwealth.

CHIA is led by an Executive Director. The Executive Director is chosen by a majority vote of the Governor, the Attorney General and the State Auditor for a term of 5 years. Chapter 224 will be effective on November 5, 2012.

Last month, the Administration launched a website dedicated to the cost containment law, with detailed information about the law and notices of upcoming events related to the law’s implementation. The site serves as a clearinghouse for information on efforts to control health care costs, creating a transparent home for updates on progress, and other information important to consumers throughout the Commonwealth.

Gov. Touts Health Reform: Prevention Up, Smoking & Cervical Cancer Down

Rachel Zimmerman — Thu, 18 Oct 2012 19:37:32 +0000

In a speech to the Massachusetts Medical Society today, Gov. Deval Patrick took the opportunity to crow about health improvements linked to reforms that started in 2006. There were the usual statistics about coverage: 98.2 percent of the total population and 99.8 percent of children in the state have health insurance. But the governor also cited some other, less familiar numbers. Here are a few (all quotes from Patrick’s prepared remarks):

– More businesses offer health insurance to their employees today than before our 2006 reforms took effect, some 78 percent of Massachusetts businesses as compared to the national average of about 69 percent

– Preventive care is up: more people are receiving cancer screenings, more women are getting pre-natal care and visits to emergency rooms have decreased. 150,000 people have stopped smoking because we expanded coverage for smoking cessation programs. A recent study by the National Bureau of Economic Research documents improvements in physical health, mental health, functional limitations, and joint disorders as a result of increased access to care in Massachusetts. Women, minorities and low-income people have experienced the biggest health improvements.

– Among Hispanic males, a notably underinsured population in Massachusetts before health care reform, the detection of testicular cancer has more than doubled and the majority of cases are now detected at an early stage.

– And with wider access to screenings, we’ve seen a 36 percent decrease in cervical cancer in women.

– Over 90 percent of our residents have a primary care physician, and 4 out of 5 have seen their doctor in the last 12 months.

Patrick then turned to the runaway cost of health care:

All in, spending on health care is $67 billion every year in Massachusetts; so, that means we spend somewhere between $13 billion and $20 billion annually that we need not be spending.

And he detailed some of the actions his administration took to control those costs, including creating limited network plans and rejecting rate increases by private health insurers.

But even with a sweeping, new cost-containment law in place, the governor said the only way to truly attain high-quality, lower-cost care is for government and the private sector to join forces (something that seems increasingly improbable nationally given the current political gridlock, but may have a chance here in the state). Here’s what Patrick had to say:

I am a capitalist. I respect the opportunity of people to create jobs and wealth, and have spent most of my working life in the private sector. I can’t imagine a world without the freedom of people to develop and test competing ideas. But I am not a market-fundamentalist. I don’t believe the market always gets everything just right. And the health care industry is most certainly not a perfectly rational market. Consumers don’t always know what they are buying, how much it actually costs, or what the intrinsic value or outcome will be. People just don’t choose a surgeon the way they do soap. For the sellers in the market there are huge barriers to entry. Most of the major players are not-for-profits. And the product sold or resource allocated by this market is often not optional. The fact is, we made this progress because the private sector and government worked together. And that’s critical to keep in mind.

A New Approach To Cutting MA’s Health Costs: Throw Spaghetti

Rachel Zimmerman — Fri, 04 May 2012 18:34:15 +0000

By Rachel Zimmerman and Carey Goldberg

When Massachusetts passed sweeping health insurance reform in 2006, a crucial piece was missing from the landmark legislation: how to control rising medical costs.

Today, state lawmakers unveiled an ambitious new proposal to do just that, including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state’s most expensive hospitals if they can’t justify their prices.

MIT economics professor Jonathan Gruber, an architect of the state’s 2006 health law and an advisor to President Barack Obama on the national Affordable Care Act calls the new House proposal “aggressive, broad and visionary.”

“This is an incredibly hard problem,” said Gruber, speaking on WBUR’s Radio Boston today. “What I like about this…is that it’s really taking the spaghetti approach to cost control; let’s throw a bunch of things against the wall and see what sticks. They’re doing a bunch of different things all of which might work.”

So, what does it mean for patients?

Rep. Steve Walsh, the House chair of the joint Committee on Health Care Financing, said the plan would save $160 billion over 15 years. As far as savings for patients, Walsh said: “The first thing I’d tell [a patient] is five years from now, her family plan is going to be $2,000 cheaper than it is today.” Walsh said businesses would also find their health costs cut significantly.

House Speaker Robert DeLeo added: “With this bill, I think everyone’s gotten a little something they want and everyone’s gotten a little something they don’t want. So that’s what this legislation is all about, but at the end of the day, most importantly what it’s going to provide is some real health care cost containment. That’s what the bill is all about.”

One of the greatest challenges, he said, was to contain costs while not undermining a key industry in the state, with 1 in 7 jobs here linked to health care. Clearly some folks will be disappointed that the plan didn’t go far enough. Gov. Deval Patrick introduced legislation in February 2011 that would have allowed greater government oversight of contracts between insurers and health care providers and moved more medical groups into global payment systems that put doctors and medical groups on a budget.

But DeLeo also made the point that once again, the state is in the forefront of health reform. “I look at this as Massachusetts being a leader once again in terms of what’s going on in the health care field in the country.”

Here are some details of the House bill, officially the Health Care Quality Improvement and Cost Reduction Act of 2012, presented today by lawmakers. The state Senate is expected to introduce its own version of the plan next week.

1. Oversight: A new, quasi-governmental agency called the Division of Health Care Cost and Quality would oversee the transition to the new payment and delivery system with a board including consumer, government and industry representatives.

2. Cost-Cutting: To curb the increase in medical spending, the plan establishes a cap for health-care spending linked to the local economy, the Gross State Product, minus one-half a percent.

3. Leveling The Field: The state could impose a 10 percent “luxury tax” on pricey hospitals that charge more than 20 percent of the state median price for a given service without being able to justify that higher price. (Two earlier reports by Attorney General Martha Coakley found that certain hospitals exploited their market clout and charged higher prices without offering better quality care.) Hospitals would pay this penalty into a “distressed hospital” fund for institutions that serve a high proportion of poor and vulnerable patients.

4. Accountable Care Organizations would take on greater prominence, though the bill stresses that joining an ACO would be voluntary for patients and providers. The bill defines the size of an ACO as bigger than 15,000 people and no larger than 400,000. Patients would have the right to appeal decisions made by their ACO doctors, and have the right to a second opinion.

5. Shifting Payments: The state’s medical establishment would continue its shift toward global payments and away from fee-for-service systems. The measure would “transition the industry to adopt alternative payment methodologies such as global payments and bundled payments for acute and chronic conditions.”

6. Technology: Electronic health records would be required for all providers by 2017.

7. Greater transparency would be attained through detailed pricing available to consumers on the Web, as well as greater disclosure of out-of-pocket costs to patients up front.

8. Streamlining Care: The measure stresses greater coordination of care through primary care, and the establishment of “patient-centered medical homes” so that patients could have a single point of coordination for all types of care.

9. MedMal: New rules on medical malpractice would create a 180-day cooling off period while both side try to negotiate a settlement. Also, the measure would allow providers to freely offer an apology to a patient.

10. Tiering: Under a provision called “smart tiering” patients might pay more for more expensive services.

11. Upping The Rates: The bill would make several changes to Medicaid, including increasing MassHealth rates paid to providers.

12. Training: Funding for workforce training and development are included in the measure, and a provision would forgive loans to primary care doctors who practice in rural or underserved areas.

Joshua Archambault, director of health care policy at the Pioneer Institute, notes that many unanswered questions remain about the House plan. “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,” he blogs, wondering, among other things, “How will western Massachusetts comply with the state mandate of e-medical records in 5 years when many areas don’t have internet? Is it possible for the Commonwealth to get rid of fee-for-service payments completely if Medicare is still paying in that manner? There are numerous new trust funds being established in this bill. What revenues (taxes) will be raised to fund them, and for how much each year?”

But Amy Whitcomb Slemmer, Executive Director of the consumer advocacy group Health Care For All expressed optimism. “We are excited about the proposed changes to the current way doctors, hospitals, and other providers are paid,” she said in a statement, “so that incentives can be aligned to promote patient-centered care that focuses on health and disease prevention, lowering health care costs. Addressing the cost and quality of the care will allow us to transform the Massachusetts system from a sick care system to a true health care system.”

For readers slightly confused by the terminology here, we’ve started compiling a handy glossary of terms you should probably get familiar with. And if you’re interested in tracking how this bill has evolved after hundreds of meetings with stakeholders and a dizzying amount of politicking, see what Walsh envisioned for the proposal back in September.

Note: This post was updated at 5:30 pm

Breaking Report: House To Release Health Payment Reform Bill Friday

Rachel Zimmerman — Thu, 03 May 2012 19:27:28 +0000

This just in from Michael Norton at State House News Service:

Stepping in front of a planned announcement from state senators, House leaders late Thursday said they’ll unveil a long-awaited health care payment reform and cost control bill on Friday.

According to House Speaker Robert DeLeo’s office, the bill will be unveiled during a 2:30 p.m. press conference in Nurses Hall with Health Care Financing Committee Co-chairman Rep. Steven Walsh (D-Lynn) and other members of the committee.

Senate President Therese Murray said last week the Senate planned to debate its version of Gov. Deval Patrick’s payment reform bill, filed in February 2011, in mid- May, after the bill emerged from the Senate Ways and Means Committee. This week, Murray said the Senate bill would be released next week.

Rumors began circulating on Beacon Hill Wednesday that a House health care bill might emerge on Friday, before the Senate bill. Until Thursday afternoon, House aides either declined to respond or declined comment when asked to confirm those plans or whether committee members were voting on bill.

After 14 months of review, the Health Care Financing Committee last week released Patrick’s bill to the Senate, with Walsh (D-Lynn) saying the panel released the governor’s bill at the Senate’s request. Murray on Wednesday expressed surprise at Walsh’s assertion. On Thursday, committee co-chair Sen. Richard Moore (D-Uxbridge) said he was not aware of any plans by the House to release its own bill.

The Legislature and Gov. Patrick have passed a pair of major health care bills since Gov. Mitt Romney in 2006 signed the landmark law requiring Massachusetts residents to have health insurance or pay tax penalties. While both of those laws included components aimed at addressing rising health care costs, the payment reform bill is viewed as possibly the most aggressive effort to control costs while also striving towards the goal of improving and better coordinating patient care and reducing unnecessary testing.

For more, go to State House News, and if you don’t subscribe, maybe you should.

The Wonk Olympics: Sweeping New Health Cost-Cutting Plan Coming

Rachel Zimmerman — Thu, 03 May 2012 13:16:50 +0000

In health policy circles, it’s as big as the Olympics, with major players, major maneuvering and all eyes watching. It’s a sweeping new plan to control health care costs through radical changes in how doctors are paid and other measures that will be soon be unveiled by state lawmakers in the next chapter of health reform, reports WBUR’s Martha Bebinger. Here’s a bit of her preview:

The House and Senate are expected to build on movements that are already under way: global payments, electronic health records and the increased focus on primary care. The House point person on health care, Steven Walsh, has outlined his proposals in meetings with dozens of groups.

Legislators are considering some controversial moves.

The Senate has talked about taxing insurance company profits. One House leader has a proposal to close the gap in payments to rich and poor hospitals. There’s a vigorous debate about how aggressive the state should be in trying to hold down health care costs.

Health care is 18 percent of the Massachusetts economy. Trying to reorganize and reduce health care spending without hurting the health care industry is a high-stakes gamble. And, as Cutler pointed out, the nation is watching.

“A few years ago, Massachusetts was the first state in country to decide that we can and we will cover everybody,” Cutler said. “And then the rest of the country followed. Now is our opportunity to show that we can make the health care system work for everybody. And if we do that then the rest of the nation will follow as well.”

Nation Eyes Bay State As Cost-Cutting Health Reform Plan Emerges

Rachel Zimmerman — Tue, 01 May 2012 12:21:47 +0000

Here’s more evidence that as Massachusetts goes, so goes the nation. The Washington Post reports on details of the soon-to-be-released, highly anticipated Health Reform 2.0 bill, aka, the cost-control plan. Put succinctly by Brian Rosman, of Health Care For All:

“There’s a bit of Bay State pride tied up in this,” said Brian Rosman, research director for the Boston-based advocacy group Health Care for All. “We were the first to figure out universal coverage. Now we want to be the first to crack health-care costs.”

The Post report touches on various aspect of the wide-ranging cost-cutting plan, expected to be out later this month:

The payment-reform law that Massachusetts will soon debate could create new incentives for doctors, hospitals and providers to participate in a payment system that looks a lot like the Alternative Quality Contract.

In February 2011, Gov. Deval L. Patrick (D) introduced legislation that would have moved all Massachusetts health-care providers to value-based payments (arrangements like the Alternative Quality Contract) by June 2015. A new government entity, created by the bill, would facilitate that change, setting various benchmarks and timelines…

The legislation that the Senate will ultimately consider stands to be significantly different from the governor’s original proposal. It is expected to include a hard cap on state health-care spending, which will probably be tethered to growth in the gross state product.

“The thing we know is that they plan to set a spending cap for health-care spending that will be linked to the gross state product, minus some percentage,” Bigby said. “Some say 0.5 percent, some say 1 percent, some say 2.”

Some groups have protested a spending cap that is lower than overall economic growth, contending that it could harm patients.

“We don’t feel that’s feasible,” Young said. “It’s very important for us to do cost control, but we also need physicians to have some say in the direction.”

Mass. Taxpayers Foundation Responds To Critics On Health Reform Spending

Rachel Zimmerman — Thu, 26 Apr 2012 14:20:39 +0000

By Michael J. Widmer
Guest Contributor

A new Massachusetts Taxpayers Foundation (MTF) study finds that in fiscal 2011, the state’s share of spending attributable to the 2006 health reform law was $453 million, or 1.4% of the $32 billion budget. And, when you look at the first five years of state spending for health reform, the annual increase, year-to-year, averaged about $91 million. In short, health reform hasn’t been a “budget-buster” as some critics have claimed. Pretty good news, right? Well, the Pioneer Institute‘s Josh Archambault and Amy Lischko aren’t so sure. While they largely accept the way MTF calculated the cost of health reform, they’ve applied some creative accounting to challenge the report’s conclusions.

A little background might be helpful: With our focus on the state budget, tax policy, and the Massachusetts economy, MTF’s engagement in health reform goes back many years. Prior to enactment of the 2006 law, we concluded that the state would have to increase spending by about $100 million a year to achieve the goal of nearly universal health insurance coverage. In 2008, with implementation well underway, some critics of the law began predicting “massive cost overruns” – up to $2 billion over ten years – with “back-breaking costs to the taxpayers.” So, in 2009, and again this year, MTF decided to take a look at the numbers and report on what was really going on. Specifically, we wanted to know how the health reform law was affecting state spending over time. Where has spending gone up because of the law and why; where has it gone down; what has been the net change year-over-year; and is it manageable in the context of the overall state spending?

Now, with the rate of uninsured in Massachusetts dipping below 2%, we have some answers. The amount Massachusetts spends to help low-income, uninsured residents gain access to needed health care has increased from $1.04 billion before the law was enacted to $1.95 billion after five years of reform. Since the federal government picks up approximately half the cost, the state’s share of the increase was $453 million. In separate blogs, Archambault and Lischko have raised a series of questions about how the spending figures should be interpreted. For instance, why didn’t MTF calculate the cumulative cost of reform and average that over five years? My answer is that, although the answers to their questions can be easily derived from the report’s detailed spending chart, they aren’t meaningful in the context of sound budget analysis.

Let me illustrate what I mean with an example: I’ve made a commitment to heat my home, so I have to buy heating oil. Let’s say that in 2010, my oil bill was $1,000, in 2011 it was $1,250, and in 2012 it rose to $1,600. In order to maintain my commitment to a heated house, I had to budget $600 more in 2012 than in 2010. In other words, on average, I’ve had to add $300 to my heating oil budget each year. With this knowledge, I can decide if my budget is manageable. The methodology suggested by Archambault and Lischko would have me add the difference between 2010 and 2011, which is $250, to the difference between 2010 and 2012, which is $600, for a total of $850. Divide by two years and you have an average of $425. As Lischko says in her blog, “Huh?”

The MTF analysis of increases and decreases due to the law is factual and transparent, and our calculation of the average annual change in state spending – $91 million – is a valid and accurate way to look at the budget impact. MTF has been doing this work for decades, and we’ve earned the trust of policymakers, politicians, and advocates representing many different viewpoints. We’ll stick to the basics and continue to provide sound, objective budget analysis.

Michael J. Widmer is President of the Massachusetts Taxpayers Foundation.

Five Myths About Massachusetts Health Reform (By A Former Romney Executive)

Rachel Zimmerman — Thu, 19 Apr 2012 12:13:37 +0000

Updated at 4:11 PM, April 20th, 2012

Amy M. Lischko
Guest Blogger

Myth Number 1: Uninsured rates in Massachusetts are 2% compared to nation’s 16%

This is like comparing apples to oranges since the 16% is from the federal current population survey and the 2% from the state’s own survey. The two surveys use different methodologies making comparisons impossible. I do not understand why people keep using MA numbers from the state survey and comparing them to the federal US numbers. Isn’t the true and legitimate comparison impressive enough? And, although I’m a fan of the state’s survey, I question the 2% number when I see the health safety net numbers on the rise.

But, for those keeping score: In 2010, US = 16.3% and MA = 5.6%…down from 2006 reported rates of 9.6%.

Myth Number 2: There has been no evidence of crowd-out in Massachusetts

According to a report from the Robert Wood Johnson Foundation, crowd-out has been defined in multiple ways but the most common definition: “compares the reduction in the share of the population with private coverage to the increase in the share of the population with public coverage due to the expansion.” Citing self-reported increases in employer offer rates is interesting, convenient, and certainly serves political interests but it is not evidence of the absence of crowd-out. We have yet to see any definitive studies conducted on this issue that fully assess the cause(s) of the observed increase in public and decrease in private coverage in Massachusetts since the reform. (Various reports from Division of Health Care Finance & Policy report the numbers differently but all reports note that public coverage has grown more than private coverage.) Whether more employers are offering or not is NOT part of this calculation.

Myth Number 3: The individual mandate is responsible for lowering premiums in the individual market

By far, the single most important factor contributing to the decline in premium rates in the individual market following the reform was its merger with the small group market. Some economists like to talk about the importance of the mandate in increasing the number of healthy lives brought into the risk pool but this has had little impact on the lowering of premium rates in the individual market. Around the margins the individual mandate may have brought in some healthy lives, however, they were spread out over the different markets (CommCare, CommChoice, Young Adult and small group), and the impact of those lives vs. the merging of the markets had to be pretty small.

Myth Number 4: The 2006 reform was never about costs

Of course it was about costs! The whole idea behind Governor Mitt Romney’s exchange was to bring more transparency of health care costs and quality, more choice, and more affordable products to small businesses and individuals. I recall talking about this to national audiences around the time the reform was passed with a slide titled, “Health Care Reform: Coverage and Cost Containment.” That these elements of reform were not emphasized by the Patrick administration during the reform’s implementation does not surprise me. However, to talk about the reform as if it was never intended to address costs is simply convenient revisionist history.

Myth Number 5: The additional state cost per year of the reform has averaged $91 million a year
Huh? Does anyone out there understand the logic of presenting the $91 million figure highlighted in the recent report by Massachusetts Taxpayers Foundation on the cost of Massachusetts’ reform? While the author uses reasonable data and assumptions, the headline conclusion, “Over the five full fiscal years since the law was implemented, the incremental additional state cost per year has averaged $91 million…” is not straightforward or very useful. Why not just talk about the not so unreasonable additional costs of reform?

Here is Table 1 from the report:

These data concur with data reported by Administration and Finance which were reported in Chapter 7 of Pioneer Institute’s recent book The Great Experiment: The States, the Feds, and Your Health Care which I co-authored with Josh Archambault. Around the edges there may be some inconsistencies (they don’t report the $25 million start-up costs for the Connector, for example) but these numbers present an accurate picture of the reform’s cost to government.

However, the conclusions could be reported in one of the following ways which readers might find easier to understand: 1) cumulative cost of the reform; 2) the average annual cost of the reform; 3) the difference in costs pre vs post reform or, 4) the total cost of insuring the low-income population.

Let’s look at each option below.

Cumulative cost of reform: Readers may want to know how much additional costs the state and federal government have paid for Massachusetts’ reform. Comparing each year’s reform costs to the baseline year’s costs, a cumulative cost of $3.69 billion is found. The state costs are somewhat less than 50% due to increased federal participation during the recession years of SFY 2009 and 2010. So, additional cumulative state costs, if you assume federal reimbursement at 60%, are in the neighborhood of $1.48 billion.
Average annual cost of reform: Similarly, using data from Table 1, if the total state cost of reform are summed and divided by five, an average annual additional cost over the 2006 baseline, is $738 million, with a state share of approximately $369 million per year.
The difference in costs pre vs. post reform: can be found directly in Table 1 and is accurately reported as $906 million with a state share of $453 million. And, this represents only 1.4% of the state’s $32 billion budget. This is hardly a budget buster so why dress it up so it appears even smaller?

It is also important to keep in mind that Massachusetts was already spending a lot of money on its safety net prior to reform. So, it may be important for some analysts to add together the pre-and post numbers, which amount to greater than $2 billion per year and represents 4) the total cost of securing access to insurance for Massachusetts low-income residents.

Amy M. Lischko, Ph.D., is an associate professor of public health at Tufts University School of Medicine, a Fellow at the Pioneer Institute and former Commissioner, Division of Health Care Finance and Policy and Director of Health Policy under Governor Mitt Romney.

Mitt Romney And Mass. Health Care: The Inside Back-Story

Carey Goldberg — Tue, 20 Dec 2011 16:52:27 +0000

Mitt Romney’s role in Massachusetts health reform is not just a political football, it’s a political ping-pong ball: various versions bounce crazily from side to side, so contentious that they trigger official fact-checks and name-calling of the “pants-on-fire” variety.

When facts are in such dispute, who you gonna trust? I don’t know about you, but number one on my list is WBUR’s Martha Bebinger, a longtime, dispassionate and shockingly well-versed observer of the labyrinthine process of the state’s health reform. So it’s a special treat that she’s out today with an authoritative, and surprisingly colorful (who knew that “Animal House” was involved?) version of Mitt Romney’s leadership role in the landmark 2006 health reform.

It’s featured on WBUR.org here, but you can also read it below, and for skimmers, here’s the final paragraph and something of a bottom line:

How much credit Romney deserves for the law that some now call Romneycare is still up for debate. Speaker DiMasi is often seen as the key player in sealing the deal. He’s in prison now for an unrelated conspiracy and fraud conviction. Senate President Travaglini had the first public proposal. Romney was the first to propose key parts of what became law, the Connector, the individual mandate and subsidized insurance. A folder representing the health care law rests on a table next to Romney in his official State House portrait. It remains his signature accomplishment and the best way to evaluate how Romney works as a lawmaker.

By Martha Bebinger
WBUR

BOSTON — The issue that defines Mitt Romney’s years as governor of Massachusetts is health care. It is sometimes a political albatross for the governor as he campaigns for president. But it is also proof, Romney says, that he could bridge party divisions in Washington.

Health care was rising on Governor Romney’s agenda as he moved into the State House corner office in 2003. His friend Tom Stemberg, who founded Staples, had suggested that one of the best things he could do for the people of Massachusetts was to find a way to cover the uninsured. And Romney, in his second month on the job, talked about that interminable state budget buster, health care.

“We’re now seeing health care costs for the poor rising at double digit rates,” Romney said with characteristic intensity. “That’s something that has to be brought in line, in part with people picking up a small share of the cost of providing that service.”

Many of the people Romney thought could pick up a share of the costs were getting free care at hospitals and clinics. The state was paying the charge: More than a billion dollars a year through a free care pool.

“Romney decided the pool was broken,” recalls Amy Lischko who helped draft Romney’s bill. “This all started with trying to fix the free care pool. Many people forget that.”

Romney filed legislation that would use money from the free care pool to create subsidized insurance. Here was Romney, a Republican governor, floating a major health care overhaul before a legislature that was overwhelmingly Democratic.

“I doubt that my plan will be accepted without any changes,” Romney said at the time. “But I do believe that everyone recognizes that having a half million people who are uninsured isn’t good for them and isn’t good for the rest of our citizens who are paying taxes and paying for health care. We gotta fix this system to get everybody better health care coverage.”

Romney knew the legislature was interested. Several months earlier, Senate President Robert Travaglini had outlined a proposal to cover half the state’s uninsured. House Speaker Sal DiMasi was planning his strategy on the issue. Romney met weekly with DiMasi and Travaglini, but legislators felt like the rest of the members were not worth the governor’s time.

“Governor Romney did not let legislators into his office, you just did not come in.” Patricia Walrath, a Democrat, was the House point person on health care while Romney was governor. She recalls two, maybe three meetings with him. Walrath says the contrast with prior Republican governors was startling.

“He had a whole different understanding as to how government should work,” Walrath says. “He was the CEO and when he said do it, everyone marched in step. It was not finding consensus; that was not the model that he used at all.”

Romney’s style was to delegate work with legislators to a few top aides. Those aides, not Romney, also handled relations with a broad coalition of health care, union and religious groups that held frequent rallies at the State House. The coalition agreed with Romney’s goal of covering the uninsured, but they opposed the coverage he proposed, calling his plan “Yugo” healthcare. Romney’s strategy was to inform, but not negotiate with these powerful consumer groups, says Tim Murphy, Romney’s Health and Human Services Secretary.

“We were going to do what we were going to do, but we were going to share information,” Murphy says. “We were going to let people know what our vantage points were, we were going to be transparent about that, and we felt that that was a way to build trust in the community.”

Critics argue that Romney only reached out to opponents when it was politically expedient. The governor and the late Senator Ted Kennedy ran against each other in 1994 in a bitter U.S. Senate campaign. Now on the issue of covering the uninsured they formed a critical partnership. Romney needed Kennedy’s help in persuading federal officials to let Massachusetts use hundreds of millions of Medicaid dollars for a health coverage law. He thanked Kennedy publicly, many times.

But in the fall of 2005 the federal government was still threatening to withhold hundreds of millions of dollars. While Romney was in intense negotiations to secure the money, Speaker DiMasi filed a health coverage bill that Romney aides say made the governor’s job much more difficult. DiMasi wanted to tax employers who did not cover their employees. Consumer groups and some economists loved his plan, but Senate President Travaglini did not support the tax and Romney, in private, spoke vigorously against it.

In public, Romney was upbeat in response to DiMasi’s bill: “Let’s not let perfection be the enemy of the good. Let’s get something out there that moves us forward. We’re all speaking from the same book.”

Aides say that while Romney was quick to criticize the legislature on any number of issues, he did not do so with health care. “He intentionally took a different, more positive tone during the health care debate,” recalls an aide who would not identify herself for comment. “He did not want anyone throwing (verbal) bombs.”

DiMasi’s demand that employers pay for health insurance or pay a fine turned into a possible deal breaker that threatened defeat for everyone.

“There was a logjam for weeks and weeks,” says Michael Widmer, president of the Massachusetts Taxpayers Foundation. “There were various options being considered but none of them satisfied both the House and Senate.”

Widmer drafted some of those options and shuttled them across the marble lobby between the offices of the Speaker and Senate President. Governor Romney was not part of the negotiations, but Widmer kept Romney’s Secretary Murphy in the loop.

“They were opposed to having any tax on employers,” Widmer says. “I remember talking to Tim and he said, ‘Do we really have to do this because the administration’s opposed to it.’ I said, do you want a bill or not, essentially, because that’s what it came down to and something was going to have to give.”

In addition to opposing the employer tax, Romney’s aides say he didn’t think the state needed any new revenue to fund a coverage law. But in January, during his State of the State, Romney said he realized, “Some of you have your doubts about that. I know that the uncertainty could stall our progress or even end it and for that reason I put aside $200 million dollars in a reserve account to fund our health care initiative.”

The money did not persuade DiMasi to give up the employer tax and strained relations between all three leaders continued. Romney grew increasingly frustrated. In late January, he made a rare personal appeal. Tim Murphy was out walking on a Saturday when his Blackberry went off.

“It was an email from Mitt,” says Murphy. It said, “I’m going to write this letter and this is what I want it to say and I want to go and deliver it and I just want you to check a few things.”

Romney delivered letters the next day, a Sunday, to Travaglini and DiMasi at home. The wrinkle free governor found Travaglini in sweat pants. DiMasi was not in to greet Romney. The letter, recalls Murphy, said let’s get going, we can’t have an employer tax but think about all the things that we could achieve.

“It was just one of those moments in time where he felt the need to personally intercede,” says Murphy. “That was not Mitt’s style. He did not walk down the hallways stopping in at offices, so when he does something like that, it has a little bit more weight to it.”

Romney’s letters did not end the stand-off between Travaglini and DiMasi. Jack Connors, the powerful chairman of Partners HealthCare, visited DiMasi’s office with a copy of Animal House and played the “nothing is over til we decide it’s over” scene. Travaglini and DiMasi finally started talking about an employer compromise after a dinner arranged by their wives. The final deal, drafted by a small group of business leaders, was a modest fine on employers (with 11 or more employees) who don’t offer health insurance. The bill sailed through the House and Senate.

At a well-orchestrated bill signing ceremony, ushers handed out programs and buttons while Governor Romney took the stage at Faneuil Hall.

“Massachusetts, once again, is taking a giant leap forward.” Romney told the audience of health care and business leaders. “And it’s our faith in you that gives us the confidence to do just that.”

Legislators were all smiles during the ceremony but minutes after, their mood soured. Romney aides told the press the governor would veto eight sections of the bill, including the legislature’s carefully crafted compromise on that modest employer fine. Legislators had become increasingly wary of Romney’s motivations around the health care bill. Senator Richard Moore suspected Romney vetoed the employer penalty because he knew it wouldn’t play well if he ran for president.

“This bill should have been based on what was best for the CommonHealth,” said Senator Moore, “not what would play well on a national stage. Those vetoes are just political vetoes.”

But Romney aide Tim Murphy argues that the governor was genuinely interested in covering the uninsured and that legislators knew Romney would not support the employer penalty. Murphy says Romney can claim, based on the health care law, that he knows how to work with bi-partisan groups to fix complicated policy problems.

“I look at Massachusetts health care reform and say, ‘This is your textbook example of how to do it effectively,’ and it really reveals, to me, the type of leader that Mitt is.”

Former Health Care for All director John McDonough, who pushed for many changes to Romney’s bill, gives him credit for compromising on a version that was more generous than the one Romney proposed.

“It indicates a keen sense of political reality and that he is willing to adjust on policy details to achieve his overarching policy goal,” says McDonough. “We can see this in his willingness to compromise on the health care reform law and on his willingness to separate himself from key parts of that law in his quest now for the Republican nomination.”

How much credit Romney deserves for the law that some now call Romneycare is still up for debate. Speaker DiMasi is often seen as the key player in sealing the deal. He’s in prison now for an unrelated conspiracy and fraud conviction. Senate President Travaglini had the first public proposal. Romney was the first to propose key parts of what became law, the Connector, the individual mandate and subsidized insurance. A folder representing the health care law rests on a table next to Romney in his official State House portrait. It remains his signature accomplishment and the best way to evaluate how Romney works as a lawmaker.