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

Who Fact Checks The Fact Checker? (UPDATED to Reflect Changes in the Original Column)

Who Fact Checks The Fact Checker? (UPDATED to Reflect Changes in the Original Column)

November 3, 2011

who watches the watchmen
[Update: The Post revised their column in response to our request, after a conversation I had with the author. They removed some of the most egregious errors, but the column still reflects a hazy understanding of the goals and results of health reform here. Much of the blame lies with the Romney campaign, which defended Romney's statement with some confusing points. We'd encourage everyone to read the cogent comment to this post by Katherine, who clarifies the issues substantially. I've noted below in italics what was changed in the rewrite -Brian Rosman]

To be honest, I'm little tired of all the mistaken political yapping about Massachusetts health reform by people who don't know what they're talking about. That's why it was so refreshing to see FactCheck.org publish a report last week after talking to wide spectrum of knowledgeable Massachusetts-based health policy people (including, uh... me).

But now here comes the Washington Post's Fact Checker column with a load of Big Error on Romney's claim to have reduced free care in Massachusetts.

Mr. Fact Checker gives Romney "3 Pinocchios" (out of 4) for the claim, but in the process mangles just about everything you can. It's all wrong.

Let's look at the real facts. The column interprets the claim as referring to free riders, and not free care per se, since Romney also mentioned people "gaming the system."

If Romney's claim is taken to mean "free care," chapter 58 has been very successful. Massachusetts health care reform dramatically reduced use of the uncompensated care pool (now called the Health Safety Net), which reimburses hospitals and community health centers when low-income uninsured people show up for care without coverage. The goal of the law was to move people from unmanaged catch-as-catch-can Pool users to real coverage, with comprehensive insurance covering primary care, specialists, drugs, and other benefits. On this score, the state reports show a dramatic drop. Between (pool years) 2005, pre-reform, and 2009, free care-reimbursed hospital inpatient visits dropped 32%, hospital outpatient visits dropped 52%, and emergency room bad debt visits dropped 54%. The total number of pool users fell from 478,000 to 274,000. [Update: this is now acknowledged in the column, but its context is not made clear]

(In fairness, visits and users went up again in 2010, certainly due to the recession. They are still way below the 2005 levels)

In the Post column, the discussion only looks at the amount spent on HSN, which is a meaningless indicator. The payment methodologies changed over time, the spending and shortfalls go up and down based on state appropriations, and medical cost growth makes cost comparisons illegitimate without controlling for inflation. If one looks at visits, which are down, chapter 58 succeeded and Romney is right. [this is still there]

Second, the column tries to look at the growth in the number of health care "free riders." The column's count includes low-income people receiving MassHealth, Commonwealth Care as somehow "free-riding" on the system. That's ludicrous. The column sets up an utter straw man: "If one of the goals of RomneyCare was to reduce the state’s burden of subsidizing health care, it failed." But the goal was the opposite - to increase insurance subsidies to low income people. That's why the law created Commonwealth Care, and provided sliding scale help so low-income people could afford insurance. [this is still included too. The column doesn't seem to understand that MassHealth is just our Medicaid, which all 50 states operate]

The "free riders" would be higher-income people who could afford coverage, but don't obtain a plan. They have gone down dramatically since 2006, steeper in percentage terms than low-income Bay Staters. The uninsurance rate for people over 300% of poverty fell from 5.3% in fall 2006, to 1.1% in fall 2008. That's real progress.

There are many other errors. The most egregious is the author's take on the Commonwealth Care budget: "The Boston Globe projected that the price tag for Commonwealth Care alone would reach $1.35 billion by 2011, up from just $158 million in 2007." How many ways is this wrong? For one, "The Boston Globe projected" links to a 2008 story that turned out to have no relation to reality. It would be easy for a reporter to look up the 2011 Commonwealth Care budget - $807 million - just ask in-state experts. But don't use a 2008 press projection, that turned out to be off by 40%. And it's meaningless to compare the 2011 CommCare cost to 2007, when the program was just phasing in and had yet to even start full-scale enrollment. [thankfully the column removes the plain wrong 2008 Globe link, but now compares the 2008 and 2009 CommCare budgets. In any case, this is irrelevant too, to Romney's point, and the column doesn't explain why it is relevant]

Fact checking campaigns is tough work, and partisans are always unhappy (see this nice overview in Politico). But this sloppy example needs to be corrected, pronto. [we appreciate the corrections, but it's still a mess, in our view]
-Brian Rosman