"Divided We Fall" by Dolores Mitchell

The other day I was asked, why I was taking a somewhat conservative approach to suggestions that eligibility for CommCare be expanded now. The excellent analysis presented to the Connector Authority (I am pleased to add that it was written by Bob Carey, a former GIC policy director) raised a number of questions about the fiscal implications of expansion, and the decision was made that the issue demanded further investigation and analysis — a sensible decision, in my view.

I’ve been giving this matter a lot of thought and it seems to me to present even larger policy issues. The distribution of state tax dollars across state sponsored programs, as we know, has changed over the years of health care inflation coupled with health insurance coverage expansion, be it Medicaid, state employees, or the creation of CommCare itself. And, while it is a matter of justifiable pride that we have covered so many of our fellow citizens with insurance that they didn’t have before, we need to keep our eyes on the other state needs that are competing for those dollars. The Governor’s new and exciting education program is just one example. As the administrator of one of the Commonwealth’s health care agencies — the GIC — and as a board member of another — the Connector Authority — I know I can support and feel very good about the health services that we can provide with every additional dollar we are given. But as a citizen of this Commonwealth, standing back and looking at all of the needs of our Commonwealth and its people, it is the obligation of every one of us to look long and hard at every expansion proposal that comes before us to make sure that it is well thought out, carefully costed out, and every alternative to saving dollars seriously considered.

State government is supposed to serve all the people and balancing their needs is a very tough job. I have worked on a governor’s staff, and I know how tough that balancing act is. Those of us who serve in one sector and those whose advocacy efforts are about one sector must not forget that they are also part of the whole. It’s hard to do, but it must be done, especially in times of economic uncertainty. Ever-increasing dollars spent on health care will not be available for other program needs. We need to keep those other needs in mind as we move into a new fiscal year.

Dolores L. Mitchell, Executive Director of the Group Insurance Commission of the Commonwealth of Massachusetts, the agency that provides life, health, disability and dental and vision services to over 285,000 State employees, retirees and their dependents.