Tag Archive: Massachusetts

Massachusetts health reform template for California — and the nation

Romney aides gave advice on state health care law – SFGate.

This San Francisco Chronicle story is a retrospective on how omnibus Massachusetts health care reform enacted by the Romney administration in the middle of the previous decade became a template for California in 2007 and 2008.  When the California reform effort under then-Gov. Arnold Schwarzenegger faltered in the Legislature amid opposition to the individual mandate and concerns the state could not afford it, the Obama administration subsequently adopted Massachusetts model in crafting its Patient Protection and Affordable Care Act.

Had the U.S. Supreme Court not left the law largely intact last month, California may well have picked up where it left off in 2008 with leading policymakers voicing support for the individual mandate.  However, financing subsidies would have likely proven problematic just as four years ago as the Golden State continues to grapple with chronic budget deficits and high unemployment.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Massachusetts legislation would surcharge hospital fees above statewide median

Late last week Boston.com’s White Coat Notes reported Massachusetts House leaders are proposing legislation that would create new state agency to monitor health spending and order reductions in hospital and doctor fees it finds excessive.  Hospitals charging patients 20 percent or more above the comparable median statewide contracted price would be face a 10 percent tax surcharge that according to the article would support struggling hospitals.  The California HealthCare Foundation’s CaliforniaHealthline has more details on the bill, H 4070.

Whatever happens in the Bay State bears watching inasmuch as its 2006 omnibus health care reforms served as a prototype for the federal Patient Protection and Affordable Care Act.

Meanwhile, CaliforniaHealthline reports a California ballot initiative that if qualified for the November 2012 ballot would have limited hospital profit margins to 25 was dropped by its sponsor, the Service Employees International Union (SEIU).  The California Hospital Association had termed the measure along with another SEIU-sponsored initiative requiring nonprofit hospitals provide at least five percent of their care on a charitable basis a “thinly veiled negotiating tactic.”

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Medical providers fear price controls via insurance rate regulation

Kaiser Health News (KHN) provides a roundup of federal and state options to regulate health insurance premiums.  Reading between the lines, however, the story is really about a larger issue: regulatory action to hold down the cost of medical care that underlies the actuarial basis of premiums.  Either indirectly by giving insurance regulators more authority to approve or reject filed premium rates or more directly as KHN reports:

Tired of complaints that underlying costs are the problem, but hearing no consensus from the health-care industry on how to solve it, Massachusetts Gov. Deval L. Patrick (D) introduced a broad proposal to overhaul the way health care is paid for. Part of the proposal would allow regulators to reject premium increases if insurers pay hospitals, doctors and others more than a limit set by the state.

Either way, to providers it smells like price controls.  In California, that prospect has doctors so alarmed that they’ve allied with their traditional payer adversaries to oppose pending legislation (Assembly Bill 52) that would give the Golden State insurance and managed care plan regulators prior approval authority over health insurance rate filings and allow them to bar the use of rates deemed excessive, inadequate, or unfairly discriminatory.

Massachusetts Gov. Patrick’s concept bears watching and could have national implications insofar as that state’s health care reform served as a template for the federal Patient Protection and Affordable Care Act (PPACA).

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

New England is nation’s health care reform laboratory

New England is proving to be the nation’s health care finance reform laboratory.  In 2006, Massachusetts set up a state-run health insurance exchange and required all residents to have public or private coverage for medical expenses.  Those two essential elements of the Massachusetts legislation became the template for the federal Patient Protection and Affordable Care Act (PPACA) signed into law last year.  Barring intervention by the U.S. Supreme Court, those basic components of the Massachusetts plan will become the law of the land in 2014.

The latest New England health care finance experiment was launched this week with the signing of legislation that will put the state on a path to becoming the sole payer of all medical bills, known as “single payer.” The legislation creates Vermont’s state run insurance exchange, Green Mountain Care that opens for business on Jan. 1, 2014.  Under the legislation, three years later the state — and not private insurers and health plans — would cover health care costs of all state residents.

The legislation calls for Vermont to obtain a waiver from federal officials under a PPACA provision allowing states to offer “innovative” health plans starting Jan. 1, 2017 provided the plans provide coverage that is at least as comprehensive as required for plans offered through health benefit exchanges and provide coverage to a comparable number of state residents.

In California, legislation to create a single payer system called the California Healthcare System is stalled for the rest of this year, having failed to meet a deadline this week to pass out of a legislative committee charged with estimating the bill’s cost.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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