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

Random Reactions: Re -- Romneycare

Random Reactions: Re -- Romneycare

June 24, 2005

Give Gov. Romney credit -- he's put a big idea in play with the Safety Net Care Plan he outlined this past week. A sitting Governor proposing a mandate on all individuals to purchase health insurance is a big idea. Others, such as former LA Senator John Breaux, talked about it. Romney's putting it into play for real. And it deserves attention. So let's give it some -- after several days reflection and discussion, in no particular order.

First, if the Administration wants the public and the policy community to take this seriously, they must be transparent in their thought process. This Administration thrives on giving us op-ed columns and powerpoint outlines, and nothing else. That doesn't cut it. Look at the Blue Cross Roadmap to Coverage report -- that's the kind of detail a serious gubernatorial initiative has a responsibility to provide -- back up for numbers, assumptions, detail. Otherwise, we have to consider the possibility they're just making up numbers to look good on the screen.

Second, connected to the first. Remember in April, Romney released the first part of his health plan -- Commonwealth Care, the low cost insurance plan for higher income uninsured (over 300% federal poverty line -- $58K for a family of 4). All these plans would be out there with a price point of $200 per month for an individual policy. Again, details provided to the public going no deeper than a powerpoint and a bill that says far less than it discloses. The health plans, being nice to the Governor, say: "Oh yeah, we can do that." Two and a half months later, do we have even one insurer who has come forward and said -- we can do this, and here's exactly what such a plan will look like"? Nope. And Romney acts like he's put it all out there on Commonwealth Care. Not even close, not by a country mile.

Third, there's a troubling tone to the Governor's comments on the individual mandate. On Wednesday, in talking with reporters, he likens it to "workfare" -- the requirement for folks on welfare to work. He suggests poor people are getting free care and getting away with murder. His chief policy aide, Tim Murphy, says to the Globe in May that hospitals are being too lenient in not collecting unpaid bills. And. outrageously, Romney suggests that the state set itself up as the collection agency for health care providers -- garnishing the wages of folks who can't pay off their hospital debts. Maybe it's just posturing or pandering to his conservative base, yet there's an edge here that's disturbing.

Why? First, about 80% of the uninsured are workers, who go to their jobs every day, pay taxes, I just wish, just once, Romney could show a scintilla of awareness of how difficult life is for folks in the bottom half of the income spectrum. Maybe we could lock him in a room and not let him out until he's read David Shipler's incredible book -- The Working Poor: Invisible in America. People getting subsidized health coverage don't get a single dime in their pocket -- they get medically necessary services approved by a licensed provider. The Governor's rhetoric makes it harder for folks to take his intentions seriously.

Fourth, the silence from the Legislature in response to Romney's announcement is absolutely deafening. A handful of legislators were in the audience -- Sen. Dick Moore, Rep. Jim Marzilli, Rep. Harriet Stanley, among others. Will this be greeted as a serious contribution or a passing fancy/campaign stunt from a guy heading for the door? Really hard to tell.

Fifth, Romney keeps saying that we must do this or we face the loss of big federal dollars beginning on July 1, 2006 in connection with the renewal of the state's Medicaid waiver. Knowledgable sources -- not me -- question this assertion and make reference to the actual waiver renewal document between the feds and the state. No doubt, the state has some financial rearranging to do in terms of money sources and uses -- yet I confess, I can't find anything in the document that requires us to come up with an entirely new structure for the health care safety net.

Sixth, back to the individual mandate. Here's the question -- Romney clearly has no trouble mandating all kinds of things on individuals -- as consumers, as patients, as taxpayers -- and throwing lots of penalties their way if they don't do the right thing. Why let employers off the hook? Why? Last February, the State documented that hundreds of large employers cost the state more than $50 million per year when their workers go to MassHealth or the Free Care Pool because employer benefits weren't adequate. Walmart is one of the most profitable companies on the planet -- why let them off the hook? Is it good policy or politics?

Seventh (related), we've put out the concern that Romney's plan creates a whopping incentive for employers to drop coverage and tell their workers to go into RomneyCare. Romney (and Murphy -- with me on NECN on Wednesday) say, "don't worry -- the federal ERISA law doesn't allow them to do that." Untrue. ERISA actually works in the other direction and makes it illegal for states to compel employers to provide insurance. Another federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) says employers can't offer different benefits to workers within the same class of workers. They can, however, provide much richer benefits to top brass and stinky or no benefits to the rest of the workforce -- so stinky, the workers will reject the employer coverage offer. We stand to be corrected -- we think the Gov is dead wrong on this one.

Sorry this went on so long. More to come. PLEASE send us your own comments and reactions.