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Massachusetts health care — wonky, with a healthy dose of reality

Health Reform Travelogue: Learning in OK What Might Have Been

Health Reform Travelogue: Learning in OK What Might Have Been

April 14, 2007

Friday at the University of Oklahoma on a MA health reform panel: yes, they want to understand what we did. Oklahoma has about half the MA population (3.4 million) and more than 600k uninsured (over 20%). Hosted by UofO President David Boren. Health policy trivia – how many remember Sen. David Boren and the Boren Amendment? Answer below.

Four speakers at the Forum: me, former MA HHS Sect. Tim Murphy, Georgetown Health Policy Dean Judy Feder, and Cato Institute Michael Tanner.

Here was the most interesting part for me. Murphy gets to ask me a question, and he notes that in Romney’s original health reform bill, “minimally creditable coverage” for purposes of complying with the individual mandate was defined as any health insurance policy that included at least $100K in hospitalization expenses. Nothing more. How, he asks me, could we have let the minimum definition become so expansive that it will require improvements for many with existing coverage?

Frankly, I had forgotten that piece of info myself, and it made me ponder how differently health reform implementation would have proceeded under Gov. Romney or Gov. Healey. Advocates made a gamble that the hardest implementation details would be hammered out by a Democratic Administration (Patrick, Reilly, or Gabrieli) and we would end up with -- in our view -- a much more appropriate definition of minimum coverage. Could have been a quite different process and result. Thank heavens for the Patrick Administration!

Trivia Answer from the Urban Institute: From 1980 to 1997, federal law directly linked Medicaid nursing home rates with minimum federal and state quality of care standards. As part of the Omnibus Reconciliation Act of 1980, the "Boren amendment" required that Medicaid nursing home rates be "reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable state and federal laws, regulations, and quality and safety standards" (Section 1902(a)(13) of the Social Security Act). State Medicaid officials overwhelmingly came to oppose the amendment as impossible to operationalize, believing that they were forced by the courts to spend too much on nursing homes at the expense of other services.

By the way, Boren says he never intended the requirement to favor the industry -- he was trying to help states control spending(!) Be careful what you wish for...
John McDonough