The honeymoon for Massachusetts’ pioneering health care law is over as two gubernatorial candidates say they would pull the plug on the four-year-old mandate.
The leading contenders for the corner office are squabbling over the cost and benefits of the state law, with independent Timothy Cahill and Republican Christy Mihos trying to tap into the same voter anxiety over health care that vaulted Scott Brown in to the US Senate last month.
Cahill, the state treasurer, said in a column that appeared in CommonWealth magazine’s winter issue that the health care law is “an unsustainable financial burden that poses a long-term risk to the state’s fiscal health.”
Mihos, who made his money running a successful chain of convenience stores, says the public was sold a bill of goods when the law was passed and it’s time to admit the mistake. “This is going to be a budget buster,” he said. “I’d offer somewhere between major surgery and C-4 [explosives.]”
But Gov. Deval Patrick and Republican Charlie Baker, along with the state’s health care czar, Jon Kingsdale, say Cahill’s numbers are wrong and that the program is meeting its goal of near universal health coverage at a cost of just 1 percent of the state budget.
“The great story of health care reform is that a whole host of different interests came together to create it,” Patrick said last week. “It is sustainable and affordable and, by the way, if we walk away from it, as Tim Cahill proposes, think about what it means for people who get sick and have to worry about going bankrupt because they got sick.”
Baker, former CEO of Harvard Pilgrim, doesn’t think the entire program should be dismantled, but he is proposing a major overhaul through regulations and executive orders to change how the law is administered. He says nothing has been done to control provider costs, which he calls the biggest problem in affordability. Patrick has filed legislation to require the disclosure of provider costs, but Baker (photo at right) says the current Commonwealth Connector can set the regulation without the need for legislative approval.
Baker is also proposing a managed care model for MassHealth, the state plan for low- and moderate-income people.
“We promised people when we did health insurance reform that they would get affordable coverage and cost containment. . .and we did exactly the opposite of what we said we would do. But that doesn’t mean blowing it up,” Baker said. “Did it cover more people? Yes. Did it create lower costs alternatives? Did the state welch on a whole series of commitments? It’s kind of a mixed bag.”
Cahill started the debate when he penned the op-ed for CommonWealth. The treasurer, who declined through a spokesman to discuss his stance further, cited a bond issuance as proof that the cost of the law was at least 50 percent higher than planned and said projections place the cost for fiscal 2012 at $1.35 billion.
Kingsdale, along with Baker and Patrick, said Cahill’s figures are outdated and do not take into account a number of federal reimbursements and waivers. In addition to taking issue with his numbers, Baker says Cahill is exhibiting a lack of leadership.
“I would argue that he raises a whole series of questions or concerns about the program but he doesn’t offer one single solution,” Baker said. “Any middle manager can tell you what’s wrong with something.”
State budget numbers seem to undercut Cahill’s claims. According to state figures, Commonwealth Care, the subsidized program, cost $628 million in fiscal 2008, not $1.1 billion, as Cahill asserts. It cost $805 million the following year, nearly $500 million less than what Cahill cited. And for this year, it is budgeted at $723 million for the traditional Commonwealth Care program and another $40 million for legal immigrants covered under a bridge program.
The first two years’ figures were higher than anticipated, Kingsdale said, because of the success of the program, but they then tailed off to go under projections because less people had to take advantage of the coverage.
Also, a study by the Massachusetts Taxpayers Foundation showed the average annual cost to the state was about $100 million after taking into account federal contributions and Medicaid waivers, as well as the reduction in spending from the so-called free care pool, which went to pay for emergency room visits from patients who had no coverage.
Kingsdale said the cost of abandoning the program would be greater than what is being paid out now, a line that is expected to be repeated by Patrick and, to some extent, Baker.
“The cost of the state has been about 1 percent of the total state budget,” Kingsdale said. “It’s very modest and our rate of increase has been very modest. Now health care costs are out of control. This kind of [press] coverage actually focuses more attention on cost. The easiest solution is to go without, which is no solution at all. Our reform, I think, is actually making us grapple with the cost containment issue, whether you agree with it or not.”
Cahill (photo at right) also questioned how many people have actually been covered under the law. The US Census Bureau shows Massachusetts leading the country in coverage, mainly because of the health care mandate. Less than 3 percent of the state’s residents have no insurance, about one-fifth of the national average. More than 76 percent of Massachusetts residents are covered by private insurance, compared with nearly 67 percent nationally, according to a report released by the Census last fall. About 29 percent of Americans have some form of government insurance, compared with 31 percent in Massachusetts. But nearly 97 percent of those under 18 have health insurance in Massachusetts, versus 90 percent nationwide.
Clearly, Massachusetts’s law has had an impact, but Brown’s campaign raised a crucial question: At what cost? Cahill may be tapping into the voter anxiety that observers say Brown successfully rode into the seat once held by the late Sen. Edward M. Kennedy. Cahill’s stance and his place on the ballot in November could make what was once considered settled law in Massachusetts into one of the most resonant issues in the upcoming race.
Brown touted his support for the state law while hammering the federal plan, which was modeled after Massachusetts’s law, as unaffordable and unworkable during his campaign for the Senate. (Interestingly, while he says he voted for the state law, Brown was not present and did note vote in the final state Senate roll call on the bill in 2006 because of a doctor’s appointment.) Polls show a similar schism among Massachusetts voters when it comes to the near-universal health care coverage.
Surveys taken by the Commonwealth Connector (www.mahealthconnector.org) show consistent support, as high as 69 percent in favor just last summer, for the state law. In November, a Suffolk University/7News (http://www.suffolk.edu/research/1450.html) poll showed 53 percent of voters favored changing the state Constitution to make health care a right and in another Suffolk poll in January, just five days before the special Senate election, 54 percent said they supported the state’s health care mandate.
But those polls also found that a majority of voters — 54 percent in November and 62 percent last month — said the state can’t afford to pay for it. David Paleologos, director of the Suffolk University Political Research Center, said that is no mixed message.
“Like same-sex marriage, once it came on the books, the strength of the opposition dissipates because it is now law,” said Paleologos. “Where it becomes an issue is the affordability issue. . . People are thinking if this is going to be a budget buster, than what am I willing to give up? Everyone’s self-interest is the greater interest ultimately.”
Celia Wcislo, assistant division director of 1199SEIU United Healthcare Workers East and a member of the Connector board, said there may be backlash among voters who see their premiums rise while families making comparable wages — but with no access to health care through their jobs — receive subsidized insurance.
She said Cahill’s presence in the race guarantees the fears tapped by Brown will continue into the state election.
“People are still really happy with [the state law], which is pretty phenomenal given all this hysteria,” said Wcislo, who served on other health care task forces under Republican governors. “Even Scott Brown didn’t trash the state law. But [to campaign against the congressional bill] was a cheap shot appealing to people’s gut fears. I think people in their hearts have come to believe people who don’t have health insurance should have it, but then in their normal political fears think, ‘Can we afford it?’ If people hear it being questioned, they will begin to question it.”
