Commentary: A Not-So-Rosy View Of Mass. Health Reform

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Hundreds of healthcare journalists will be attending the Association of Health Care Journalists' (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict “extreme premium increases” for many small businesses under Obamacare.

In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision.

Josh Archambault of the Pioneer Institute (Courtesy of JA)
Josh Archambault of the Pioneer Institute (Courtesy of JA)

The small business community has been paying more for health insurance since the commonwealth’s 2006 reform merged sicker individuals into the same risk pool. The legislature has also added to costs by passing 12 additional mandated benefits since then, a cost borne completely by small companies and individuals.

Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years. That translates into employers and consumers in Massachusetts paying $213 million in 2014 and $3 billion more over the next decade.

Conference speakers will be sure to mention that the Connector was created to help small companies obtain competitively priced insurance, and other states will experience this benefit in the exchanges required under the federal law. Only one problem, the rhetoric doesn’t match reality in Massachusetts.

At the end of 2012, after spending tens of millions on advertising, the Connector covers less than 1 percent of the small business market and premiums are similar to those outside the exchange.

Finally, those in attendance will hear about a promising law passed in July that will save the Commonwealth $200 billion over 15 years. Yet its approaches are rehashed old ideas. State government gets a steroid shot of market oversight and permission to write regulations freely. The law is heavy with groups of “experts,” requiring 278+ new appointees, with some instructed to “rationally distribute health care resources.” Is this the future of Obamacare?

Requesting a waiver from the ACA implies that Massachusetts deserves to be treated differently. What about the dozens of states nationally where premiums will spike anywhere from 30 to more than 100 percent, especially for young adults?

Massachusetts has embarked on a seven-year health care experiment. It has worked on some fronts and not on others. To argue that we are special because we are leading the way on cost containment is premature and begs the question of whether the ACA’s “one-size-fits-all” approach is misguided to begin with. Let's hope visiting reporters see the clear picture.

Josh Archambault is the director of healthcare policy at Pioneer Institute, a think tank in Boston.

This program aired on March 12, 2013. The audio for this program is not available.