Baker faces Medicaid conundrum

Is half a loaf better than none at all? Usually the answer is yes.

But Gov. Charlie Baker doesn’t seem so sure when it comes to his proposal to deal with ever-rising Medicaid costs in the state.

Baker laid out a plan in January that would have hit employers who don’t meet certain benchmarks for employee coverage with big assessments. After facing blistering opposition from business leaders, he came back with a revamped plan that lowered the hit to businesses and included a sweeping set of cost-cutting reforms of the state Medicaid program, known as MassHealth. The budget plan adopted last week by the Legislature includes the employer assessment, which would bring in about $200 million, but not the other program reforms Baker was seeking.

Yesterday, the governor was noncommittal when asked whether he would sign the assessment provision of the budget. “We’re going to keep talking,” he told reporters.

“I haven’t heard the Legislature say they’re opposed to this,” Baker said. “What I’ve heard them say is that they didn’t have much of a window here to process this. I grant that, but it took us awhile to get to the point where we finished our assignment and came up with a proposal that people in both the health care community and the business community could support, so it’s my hope that one way or another we’ll be able to implement the package.”

A coalition of business groups that supported Baker’s revamped plan says it strongly opposes the Legislature’s move to maintain the employer assessments while leaving out the program reforms. That potentially puts the Republican governor back in the bad graces of business groups that are his natural allies.

Health policy expert John McDonough wrote about the Baker proposal two weeks in CommonWealth, praising elements of the administration’s plan, but also raising a caution flag about the attempt to enact major changes in health coverage for poorer residents through the budget without any public hearings or chance for the proposals to be fully aired out.

Among other things, Baker’s proposal would shift 140,000 lower-income, non-disabled adults from MassHealth to the state ConnectorCare program, and also transfer 230,000 non-disabled parents and caretakers from MassHealth Standard to CarePlus, a plan for those who don’t qualify for standard Medicaid coverage.

“Because no open public process has been used, the Baker administration will get things wrong in spite of its best efforts,” wrote McDonough, who teaches at the Harvard Chan School of Public Health. “Altering health insurance coverage for 370,000 low-income citizens should not be a last-minute afterthought.”

A Boston Herald editorial says the Legislature’s health care approach — to hike fees on businesses without addressing the cause of those assessments  — makes no sense. And it chided Senate Ways and Means chairwoman Karen Spilka for throwing stones from her glass house. The reform proposals should go through “the proper process,” Spilka said.

The editorial called that “laughable excuse-making, from the same people who negotiated the final budget entirely in secret, and called for a vote less than six hours after releasing it to members.”

One thing is certain: Whether state leaders deal with them now or kick a can a little down the road, the MassHealth cost challenges aren’t going away.



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A conservative immigration-policy think tank leader says says Gov. Charlie Baker seems “wishy washy” on the issue of Massachusetts becoming a so-called “sanctuary state.” (Boston Herald)

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Medicaid provision hits high-cost states such as Massachusetts the hardest. (Eagle-Tribune)


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A Lowell Sun editorial praises US Rep. Niki Tsongas for pushing legislation that would cut off fentanyl coming into the United States.

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