A Healthy Blog

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

Senator Baucus Unveils Health Reform Plan Patterned After Massachusetts

Senator Baucus Unveils Health Reform Plan Patterned After Massachusetts

November 13, 2008

Today's guest blogger is Michael Miller, Director of Strategic Policy for Community Catalyst

When Massachusetts passed it groundbreaking health reform initiative in 2006, few people anticipated the enormous influence it would have on subsequent policy debate across the country. Since then however, the “Massachusetts model” has been the basis for discussion in state houses across the country and increasingly in the nation’s capitol.

Yesterday, in another testament to the power of the reforms being tested in Massachusetts, Senator Max Baucus (D, MT), Chair of the Senate Finance Committee, unveiled his "Call to Action" - a detailed blueprint for health reform that embodies the principles of Chapter 58 and in some cases draws directly on the Massachusetts experience.

The proposal released by Senator Baucus is significant because the Finance Committee, which Mr. Baucus chairs, is one of the main Senate committees that will have jurisdiction over health reform legislation. The early release of a well thought out, comprehensive plan is a signal of the seriousness with which Senate leaders are taking the issue. Far from backing away from the issue, Senator Baucus argues that our current economic distress makes health reform more urgent than ever. This sentiment was echoed in a recent report by PricewaterhouseCoopers.

Like reform in Massachusetts, the plan envisioned by Senator Baucus is based on the principle of shared responsibility—government, employers and individuals would all have to contribute toward the cost of coverage for all Americans and legally present immigrants. The plan builds on and strengthens public coverage—Medicaid and SCHIP—for low income individuals by making Medicaid available to all adults below 100% of the FPL and Medicaid and SCHIP available to all children up to 250% FPL, while leaving states with the discretion to cover people at higher income levels. For those with income too high for Medicaid, subsidies would be available to allow them to purchase insurance on a sliding scale, similar to Commonwealth Care.

Also like Massachusetts, the plan would establish a connector (called an Exchange in the Baucus plan) to rationalize the insurance market and make cross-plan comparisons easier. The Exchange board is charged with tasks similar to those addressed by the Connector in Massachusetts, such as how to define “insured” and “affordable.” As had been previously done in Massachusetts, Senator Baucus proposes to eliminate pre-existing condition exclusions and experience rating in health insurance and limit variation based on other factors.

Many of the proposed measures to improve the quality and cost-effectiveness of our health care system, such as investing more in primary care, requiring disclosure of gifts to providers by the pharmaceutical industry, and beginning to reorient the payment system toward value rather than volume have also been addressed in Chapter 58 or Chapter 305, the quality and cost containment legislation passed this year.

While the Baucus plan is a discussion paper, not a legislative proposal, and leaves many details unspecified, it is clearly an important contribution to the debate on reform and signals that we are off to a good start. For more good analysis, check Ezra Klein's recent posts (on policy and politics).
Michael Miller, Community Catalyst