MassHealth Is a Mess

Published March 1, 2008

Proponents of government-provided health care continue to tout Massachusetts as a model for the nation. The state has enrolled some 300,000 people in free MassHealth, the heavily subsidized Commonwealth Care, and the unsubsidized Commonwealth Health Insurance Connector Authority.

All but 63,000 are in the first two programs, and how many remain uninsured depends on whether you believe the Census Bureau’s count of 657,000 uninsured before the program began or the state’s count of 395,000.

Still, it is quite an achievement for the first year of enrollment. In fact, the number of enrollees in the subsidized programs has surprised state officials–who now find themselves $147 million short on funding. The four carriers that provide the subsidized care estimate costs will rise 14 percent in the coming year.

In response, the state panel that runs the program has ordered carriers to “cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients will have to pay,” according to Alice Dembner in the Boston Globe. She quotes Jon Kingsdale, the panel’s chief financial officer, as saying, “There’s no justification to be paying [providers] more than Medicaid rates.”

But one of the reasons providers endorsed the idea in the first place was a promise that they would get paid more than Medicaid had been paying.

On the Connector side, participating carriers have been instructed to hold annual premium increases to no greater than 5 percent without increasing patient cost-sharing. The Connector Board is sure providers can do so simply by emphasizing generic drugs and steering patients to cheap doctors and facilities.

Of course, if patients don’t like these remedies, too bad; they’re required to buy the coverage anyway.

Greg Scandlen ([email protected]) is president of Consumers for Health Care Choices, based in Hagerstown, Maryland.

For more information …

Alice Dembner of the Boston Globe has done a marvelous job explaining the Massachusetts health care policy maze. Here are a few of her stories:

“Mass Panel Approves Changes to Subsidized Residents Health Plan,” Boston Globe, December 14, 2007:

“Nearly 300,000 in Mass Seek Coverage Under Healthcare Law,” Boston Globe, December 6, 2007:

“Panel to Press Insurers on Premiums,” Boston Globe, December 5, 2007: