Surprise: ObamaCare Could Roil Mass Health Reform

If the national law’s Medicaid expansion goes into effect, and the state takes up a new option to move some poor residents into a Medicaid-like program, the Connector will lose 70 percent of the people it currently covers…
The big question, though, is what happens to the Connector’s power to negotiate with insurers if more than two-thirds of its members are plucked from the insurance pool in less than two years.

More from Jason Millman in Politico.

Comments (7)

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  1. Joe Barnett says:

    It seems unlikely that moving people from one government program to another would undue Mass. The question is whether the state pays more for an insured under Medicaid or more under a subsidized Connector policy. Rationally, it will attempt to minimize the cost to the state and get either the federal government, individuals, employers or providers themselves to provide the subsidies.

  2. Matt says:

    Wow, have heard a lot of stuff like this. Will be interesting to see how it shakes out.

  3. Devon Herrick says:

    Massachusetts has had a difficult time attracting cash-paying enrollees who are willing to commit their own money to purchase health insurance in the Commonwealth Connector. Something like three-quarters of all people newly covered in Massachusetts is either in a state-provided Medicaid plan, a state subsidized plan or in an employer-subsidized health plan. Enrollees in plans offered through the Commonwealth Connector increasingly have problems finding doctors willing to treat them.

  4. Linda Gorman says:

    Totally confused by the Politico article. The Connector doesn’t provide coverage. It brokers coverage. Like the ObamaCare exchanges.

    We’re told Massachusetts already has everyone covered, so what will change? Maybe low income adults will end up on Medicaid rather than in subsidized Commonwealth Care or have their policies subsidized by the Feds rather than by the state and the state fraction of the Medicaid cost will exceed current subsidies?

    It isn’t as if private sector alternatives are going to open up and steal all of the exchange business away–all of the 39,382 people paying the full cost of their connector based policies in April.

    Hoping someone will explain what I’ve missed.

  5. Dennis Byron says:

    @ devon

    Not sure of source of your data. According to most recent (through December 2010) seasonally consistent Cmmonwealth of Mass. data, almost all the NET new insured in Massachusetts since passage of RomneyCare are on Medicaid or free RomneyCare. A small percent are highly subsidized RomneyCare (on average, a $500 a month policy for less than $100 if you make between 200%-300% of FPL). About 30,000 — .5% of Massachusetts population — additional people are covered by individually purchased insurance (some of that through the Exchange) but at least the same amount if not more (maybe as many as 100,000) have lost employer sponsored insurance (possibly due to recession and not RomneyCare crowd out)


    As for the Politico article, it’s kind of much ado about nothing, an internal bureaucratic tug of war in Mass. between the well-established nieces and nephews of pols at MassHealth (Medicaid) and the goo-goo academics at the Connector, who have no idea how to play Massachusetts politics (rule number one: don’t plant a story in Politico). MassHealth holds all the cards as the long standing and much larger bureaucracy. From the get go in 2006 and continuing, if you wanted RomneyCare from the Connector, you first have to apply to and get turned down by the bureaucrats at MassHealth. The Connector/RomneyCare subsidies and free insurance is paid for by a Medicaid waiver. The Connector tends to use outside state suppliers (violating another rule of Mass. politics). The Connector gave a single broker an exclusive to run its small group business, the thing the article correctly reports is failing (and breaking another Mass. political rule).

    It was always crazy to have two separate bureacracies doing the same thing (not that that means it doesn’t happen a lot up here).

  6. Linda Gorman says:

    @Dennis Byron–thanks for the explanation.

    Basically same rules as ObamaCare, then. You must demonstrate that you are not eligible for Medicaid in order to purchase subsidized, means-tested, health insurance through the monopoly broker otherwise known as The Exchange.

    And small group will fail everywhere as it is a “market” that didn’t really exist until the academics and regulators created it.

  7. Dennis Byron says:

    @ linda gorman

    Sorry I don’t know the Obamacare rules but to get RomneyCare (called Commonwealth Care) from the Connector, you apply to MassHealth. Most people are doing it to get free insurance, though, not the subsidized version. (My point being that I’d turn your wording around: if you are one of the few applicants unlucky enough not to get free insurance, you can buy subsidized insurance).

    Also, just so I did not mislead. The Connector selected a particular broker to work with to reach the small group market but that broker does not have a state monopoly. Other brokers can interact directly between insurers and business, small or large, outside of the Connector mechanism (which is supposedly why the Connector approach to small business isn’t working if you read between the lines of the Politico story). However the rules the Connector puts out (like minimum creditable coverage rules) have to be followed by everyone.