Time to get MassHealth house in order

Business leaders says improper incentives, guardrails must end

ELEVEN YEARS AGO, Chapter 58—also known as RomneyCare—was signed into law.  The landmark law was passed on the premise that there was a shared responsibility among all of us to be insured, offer affordable coverage, control costs, and to eliminate free riders in the system.  It was also passed with the promise that the Commonwealth will make it a top priority going forward to control growing health care costs, and to get consumer and taxpayer-paid expenses under control.

While nearly achieving the important objective of universal coverage, there were certainly significant problems along the way.  Chief among those in the early years were skyrocketing small business premiums, and the lack of health care provider expense controls.  Important efforts to fix those problems occurred in the following years at the state level.  But then the Affordable Care Act (ACA) came along, preempting the effectiveness of Massachusetts innovations such as small group rating factor reforms and small business insurance cooperatives. It also hindered state efforts to direct consumers into proper, affordable insurance plans, and to utilize quality and value-oriented health care providers.

It was well documented how the state’s exchange—the Connector—imploded in the early days of the ACA, with far too many individuals getting taxpayer-funded coverage that never should have qualified.  Beyond ineffective administration and gatekeeping, the Commonwealth was also put into a new, costly position under the ACA, forced to allow those who were offered affordable employer-based coverage to turn down the coverage in order to take cheaper, or often free, MassHealth plans.  These taxpayer-funded plans were far more generous than most small business plans.  Under RomneyCare, a gate was in place to prevent such movement for those non-disabled, working individuals from qualifying for Mass Health if they were financially able and were offered affordable employer coverage.

Most employees of small businesses do not receive long-term care coverage, many do not have dental plans, and virtually all must pay high deductibles and co-pays.  So it was certainly logical that many individuals elected to take coverage which allowed them to go to any provider and not have any costs; and so they, therefore, turned down their employer-offered plans.  But for those above the poverty line, we must ask ourselves if taxpayers can continue to afford to keep paying for improper incentives and guardrails, and rising provider expenses which far exceed the growth in our economy.

A once-in-a-generation opportunity now exists to protect our vulnerable populations, our small businesses, our taxpayers, and our providers with a delicately negotiated package put together through negotiations with the Baker administration, and with active input by the employer and provider communities.  Getting the house in order now will protect the state and our taxpayers from certain greater financial challenges in future years as federal budgets place greater constraints on states like Massachusetts.

The package of temporary employer assessments, long-term MassHealth reforms, provider-practice reforms, and consumer insurance market reforms and protections will set the Commonwealth on a long-overdue path to affordability and predictability for consumers, small businesses, taxpayers, and providers.  Reasonable MassHealth reforms will save costly provider reimbursement cuts both now and going forward.  Insurance market reforms and state rating factors flexibility will financially incent and reward consumers for choosing the high quality, yet value-oriented providers.  And the reforms will once again incent small businesses to grow vital jobs, and to raise wages.

Meet the Author
Meet the Author

Christopher Carlozzi

State director, National Federation of Independent Businesses
Meet the Author

Bob Luz

President and CEO, Massachusetts Restaurant Association
Employer organizations once again accepted more than their fair share with the temporary MassHealth assessments.  But that support for those temporary assessments is contingent on passage of the long-term reforms.  Otherwise there is no shared responsibility with the state and the providers, and taxpayers will once again be put in the place of providing more revenue without the hope of necessary and vital expense controls.

Chris Carlozzi is the state director of the National Federation of Independent BusinessJon Hurst is the president of the Retailers Association of Massachusetts, and Bob Luz is the president of the Massachusetts Restaurant Association.