Irony abounds in health agency cuts

Sure, if you’re highlighting irony in this irony-filled world of ours, the easy stop is Cleveland, where the opening night of a GOP convention that is about to nominate a man who suggests Barack Obama is a cop killer-sympathizing Muslim turncoat featured that man’s wife delivering a heartfelt speech about her husband that cribbed heavily from the heartfelt 2008 Democratic convention tribute to said turncoat by his wife.


But a far wonkier case of irony closer to home caught our eye. In fact, this morning’s story by the Boston Globe‘s Priyanka Dayal McCluskey on the plight of a little-known state agency offers a triple dose of it.

After the state enacted its pathbreaking 2006 law expanding access to health care, everyone knew that addressing spiraling costs was the next big health care challenge. State leaders sought to tackle that with a 2012 law. The law set up two entities designed to help contain increases in health care costs: the Health Policy Commission, which monitors mergers and the overall performance of the health care system and the Center for Health Information and Analysis, which was set up to provide more extensive data on health care pricing and information on the health care market.

With costs continuing to climb — and with lots of fingers pointed at Partners HealthCare, the medical behemoth that has been able to command far higher prices for the same services as other health care players — a move was underway to put a question on this November’s state ballot that would have reined in price disparities between Partners and other health care providers. If passed by voters, the measure would have cost the health care giant some $440 million a year in payments.

In May, however, a deal was reached between Partners and SEIU, the health care workers union that was behind the ballot question. The union spiked the ballot drive in exchange for the right to possibly unionize more workers at Partners facilities and in consideration of $45 million being funneled over five years to lower-paid community hospitals. Helping to broker the closed-door agreement were top lieutenants of Gov. Charlie Baker, House Speaker Robert DeLeo, and Senate President Stan Rosenberg.

The first irony: The money to help community hospitals will come from cuts to the budget of the Center for Health Information and Analysis — the state office that is supposed to provide detailed data on hospital pricing to help drive greater transparency and competition in the health care market.

“We worry that by taking money out of CHIA, [lawmakers and the governor] are hurting the very cause that they’re trying to solve,” Brian Rosman, policy director at the advocacy group Health Care for All, told the Globe.

Irony No. 2: Some of those expected to lose jobs at CHIA due to the cuts are members of another SEIU unit, the National Association of Government Employees.

Some pushed back on the idea that the deal will hurt the ability to address health care pricing disparities. State Rep. Jeff Sanchez, the House chairman of the Legislature’s health care financing committee, told McCluskey, “It’s a good time for all of us in state government to reflect on what we’ve built and how we’re going to continue.”

Meanwhile, the Baker administration seems to be walking back an earlier vow to have CHIA create a consumer-friendly website with information on health care costs. Baker has long held out pricing transparency as the key to improving the functioning of the health care market. “Officials said CHIA’s reduced budget would allow the agency to ‘return’ to its core mission, without specifying how it may have strayed from that mission,” writes McCluskey.

Health policy expert John McDonough, who helped write the state’s 2006 health reform law and now teaches at the Harvard T.H. Chan School of Public Health, wrote in the current issue of CommonWealth about the deal hatched to avert the ballot showdown. He said Partners and SEIU both made out well, while avoiding the ballot fight was a relief to Baker, DeLeo, and Rosenberg. Whether SEIU’s originally stated goal of reining of health care costs in the state was advanced at all, he wrote, is different matter.

It what would be a final irony, it’s possible that the deal will actually set back those efforts if cuts to CHIA mean valuable information on health costs isn’t available.

Whatever the outcome, McDonough tells McCluskey, “The unfortunate thing is this was done without any public discussion about the consequences.”




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