A Healthy Blog

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

Shhh, It's All About Us. (Should We Talk About Mass Health Reform?)

Shhh, It's All About Us. (Should We Talk About Mass Health Reform?)

May 12, 2009

I was just about to write a blog, to be titled, "National Health Reform Has Massachusetts Written All Over It." The impetus was the release tonight of the Senate Finance Committee's option paper (63 page pdf) on expanding health coverage. The paper lays out the options that the Committee will talk about on Thursday as it figures out (in private) this part of its version of the health reform bill.

The hook was that again and again, the paper mentions Massachusetts health reform as an example of a policy option to react to or learn from. The word "Massachusetts" appears 10 times in the paper, and Massachusetts programs are described extensively, while no other state policy is mentioned at all (except in passing, like describing an atypical DSH program in two states).

Just as I sat down to write the post, a friend (uninvolved in health care or policy) called. We talked about work, and I described the blog I was about to write. He asked, "What would someone in a midwest state think, if they learned that the national health reform plan was being based on what was passed in far-left Massachusetts? Should you be advertising this?"

We've always said that the national lessons of Massachusetts relate to the broad outlines of our health reform, and not the specifics. The Finance Committee paper looks towards a Medicaid expansion, sliding scale subsidies, a Connector-like exchange, and individual and employer mandates. These are the key elements of chapter 58. But the paper describes options that differ in details from Massachusetts policy in a number of ways, some better than our current law, some worse, in our mind. Examples:

  • sliding-scale subsidized coverage goes up to 400% of the poverty level, substantially better than the Massachusetts cut off of 300%.
  • no or nominal cost sharing is proposed for preventive care, something we've been advocating for years.
  • the paper proposes allowing age-rating price bands of 5 to 1, meaning older adults can be charged 5 times more than young adults. Massachusetts law is now 2 to 1, and we think that should be narrowed to lower the price differential for seniors.
  • the employer pay-or-play option would require a 50% employer contribution (better than the 33% here), and the proposed employer assessment amounts are much higher than the paltry $295 in Massachusetts.

We can't hide the key role Massachusetts health reform will play in informing the national debate. The Senate Finance Committee recognized this as it put its options together. Even more, Washington health reform players have repeatedly said that keeping the Massachusetts plan on track is critical to the success of national reform.

As the Massachusetts Senate begins its budget debate in the next few days, we urge them to not ignore the national context. There are lots of good Massachusetts reasons for continuing progress on health reform, but the national reasons are compelling as well.
Brian Rosman