Health Reform in Massachusetts: Self-Serving For Mitt But Also True
Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.
Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.
Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.
Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.
Other significant accomplishments:
The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.
The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.
The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.
Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.
There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.
Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.
What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.
Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.
The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.
By: Editorial, The New York Times, May 20, 2011
Of Course Newt Gingrich Supported A Health Care Mandate
Mitt Romney continues to face all kinds of heat over his support for a health care mandate, in large part because he continues to defend it. But Sam Stein notes this week that disgraced former House Speaker Newt Gingrich, a Romney rival for the Republican presidential nomination, was just as ardent an advocate of the idea.
In his post-congressional life, Gingrich has been a vocal champion for mandated insurance coverage — the very provision of President Obama’s health care legislation that the Republican Party now decries as fundamentally unconstitutional.
This mandate was hardly some little-discussed aspect of Gingrich’s plan for health care reform. In the mid-2000s, he partnered with then-Sen. Hillary Clinton (D-N.Y.) to promote a centrist solution to fixing the nation’s health care system. A July 22, 2005, Hotline article on one of the duo’s events described the former speaker as endorsing not just state-based mandates (the linchpin of Romney’s Massachusetts law) but “some federal mandates” as well. A New York Sun writeup of what appears to be the same event noted that “both politicians appeared to endorse proposals to require all individuals to have some form of health coverage.”
Neera Tanden, an aide to Clinton at the time who went on to help craft President Obama’s law, said she couldn’t recall exact speeches, but “strongly” believed that the both Clinton and Gingrich backed the individual mandate. Either way, she added, “Gingrich has been known as a supporter” of the idea for some time.
A simple newspaper archive search bears this out.
Gingrich endorsed the individual health care mandate over and over again, in public remarks, in media interviews, and in policy proposals. Ironically, he even explained the importance of the mandate in a book entitled, “Winning the Future.” Gingrich didn’t just grudgingly go along with the measure as part of some kind of compromise; he actively touted it as a good idea.
And he was right.
But that was before President Obama decided he also agreed with the idea, at which point the mandate became poisonous in Republican circles.
The point to keep in mind, though, is that Gingrich’s support for the idea isn’t at all surprising. Indeed, it would have been odd if Gingrich didn’t endorse the mandate.
For those who’ve forgotten, this was a Republican idea in the first place. Nixon embraced it in the 1970s, and George H.W. Bush supported the idea in the 1980s. When Dole endorsed the mandate in 1994, it was in keeping with the party’s prevailing attitudes at the time. Romney embraced the mandate as governor and it was largely ignored during the ‘08 campaign, since it was in keeping with the GOP mainstream.
In recent years, the mandate has also been embraced by the likes of John McCain, Chuck Grassley, Orrin Hatch, Bob Bennett, Tommy Thompson, Lamar Alexander, Lindsey Graham, John Thune, Scott Brown, and Judd Gregg, among many others. Indeed, several of them not only endorsed the policy, they literally co-sponsored legislation that included a mandate.
During the fight over Obama’s reform proposal, Grassley told Fox News, of all outlets, “I believe that there is a bipartisan consensus to have an individual mandate” — and there was no pushback from party leaders. This isn’t ancient history; it was a year and a half ago.
Newt Gingrich touted the same idea? Well, sure, of course he did.
By: Steve Benen, Contributing Writer, The Washington Monthly, May 13, 2011
Pandering To The Extremists: Mitt Romney In A Time Warp
There was something almost quaint about Mitt Romney’s speech on health careThursday, as if we were watching early sound footage of Theodore Roosevelt.
Republicans no longer talk about the virtues of government social programs, especially if they intend to run for president in a party that now considers Medicare the first cousin of socialism. Yet there was Mr. Romney defending a mandate to buy health insurance as passionately as in any similar speech by President Obama.
When he was governor of Massachusetts, of course, Mr. Romney created a health care system very similar to the one championed by the president. He could have walked away from it, as he did in the 2008 presidential race, or fecklessly repudiated it, as Tim Pawlenty, the former governor of Minnesota, did in the Republican debate last week regarding his earlier support for a cap-and-trade system to reduce greenhouse gases.
This time, to his credit, Mr. Romney is standing by his record, perhaps hoping there might still be a few primary voters who appreciate candor — assuming he doesn’t pivot again in the heat of the right-dominated primaries.
Tearing it down might help him politically, he said, but “it wouldn’t be honest.” He said he did what he “thought would be right for the people of my state.” A mandate to buy insurance, he said, makes sense to prevent people from becoming free riders, getting emergency care at enormous cost to everyone else.
Where he went off the rails, however, was in not acknowledging that that same logic applies to the nation. Mr. Romney tried desperately to pivot from praising his handiwork in Massachusetts to trashing the very same idea as adapted by Mr. Obama. His was an efficient and effective state policy; Mr. Obama’s was “a power grab by the federal government.”
He tried to justify this with a history lesson on federalism and state experimentation, but, in fact, said nothing about what makes Massachusetts different from its neighbors or any other state. And why would he immediately repeal the Obama mandate if elected president? Because Mr. Obama wants a “government takeover of health care,” while all he wanted was to insure the uninsured.
That distinction makes no sense, and the disconnect undermines the foundation of Mr. Romney’s candidacy. At heart, he is still the kind of old-fashioned northeastern Republican who believes in government’s role while trying to conceal it under a thin, inauthentic coating of conservative outrage. But in its blind abhorrence of President Obama, the party has also left behind former centrists like Mr. Romney, and it is unlikely that any amount of frantic pandering about the free market will change that. He is trapped not only between the poles of his party but between eras, a candidate caught in an electoral time warp.
By: The New York Times, Editorial, May 12, 2011
Health Care Reform in Massachusetts: State Model for the Affordable Care Act Is Working And Broadly Popular
The Affordable Care Act was signed into law one year ago. It is modeled in large part on the landmark Massachusetts health reform law enacted four years earlier in 2006. Opponents of the Affordable Care Act often attack it by distorting the facts about the Massachusetts experience. They selectively alternate between snapshots of and trends in Massachusetts and comparisons between Massachusetts and the United States.
The most appropriate way to assess the impact of the Massachusetts law is to compare changes over time in things like health coverage and premium costs in Massachusetts to changes over time in the United States as a whole. We use that approach below to debunk many of the myths opponents propagate regarding Massachusetts’s experience with health care reform.
Massachusetts increased health coverage while coverage declined in the rest of the country.
Myth
The Massachusetts law failed to significantly reduce the ranks of the uninsured in the state.
Fact
The Massachusetts health reform law dramatically increased the insurance rate in the state over a period when the national health coverage rate declined. As of the end of 2010, 98.1 percent of the state’s residents were insured compared to 87.5 percent in 2006 when the law was enacted. Almost all children in the state were insured in 2010 (99.8 percent). In comparison, at the national level the health insurance rate dropped from 85.2 percent in 2006 to 84.6 percent in 2010.
Employers continued the same level of health coverage in Massachusetts while dropping people in the rest of the country.
Myth
The Massachusetts health reform law is eroding employer-sponsored health insurance.
Fact
The number of people in Massachusetts with employer-sponsored health insurance has not dipped below 2006 levels since passage of the health reform law. Approximately 4.3 million people in Massachusetts obtained health insurance through their employer in 2006. This figure increased to 4.5 million in 2008 before returning to 2006 levels in 2010. In comparison, the number of nonelderly people in the United States with employer-sponsored health coverage declined from 161.7 million in 2006 to 156.1 million in 2009.
Since passage of Massachusetts’s health reform law, a larger share of the state’s employers have offered health insurance to their workers when compared to the United States as a whole. At the national level only 60 percent of employers offered health coverage to their employees in 2005. This is significantly lower than Massachusetts’s rate of 70 percent at that time. The Massachusetts rate increased to 76 percent in 2009, which is 7 percentage points higher than the national figure for 2010.
People buying insurance on their own in Massachusetts are paying lower premiums. Premiums in the nongroup market have increased in the rest of the country.
Myth
Massachusetts residents are paying higher premiums in the nongroup market as a result of the health reform law.
Fact
Nongroup health insurance premiums in Massachusetts have fallen by as much as 40 percent since 2006 because health reform brought healthy people into the insurance market. In contrast, at the national level nongroup premiums have risen 14 percent over that period of time.
More than 98 percent of Bay Staters met the law’s individual insurance requirement.
Myth
A significant portion of Massachusetts residents are ignoring the mandate and only purchasing health insurance when they need care.
Fact
The size of Massachusetts’s individual market more than doubled after passage of the health reform law. This boost and the accompanying drop in the average cost of individual premiums were due in part to more healthy—and previously uninsured—individuals entering the market. Only 1.3 percent of the state’s 4 million tax filers who were required to and did report their coverage status were assessed a penalty for lacking coverage in 2008, the last year for which complete data are available. About 26,000 of these 56,000 people were actually in compliance for part of the year.
The cost of health care in Massachusetts is in line with expectations.
Myth
The Massachusetts law is bankrupting the state.
Fact
The fiscally conservative Massachusetts Taxpayers Foundation, or MTF, finds that under reform, “State spending is in line with what [the organization] expected.” An MTF report released in 2009 found that state spending on health reform increased from $1.041 billion in fiscal year 2006 to a projected $1.748 billion in fiscal year 2010—an increase of $707 million over the four-year period, half of which is covered by the federal government.
Higher-than-expected enrollment in Commonwealth Care, the state-subsidized health insurance program, initially raised fears that policymakers had dramatically underestimated the number of low-income uninsured in Massachusetts. These concerns, however, were unfounded. Commonwealth Care enrollment peaked in mid-2008 with 176,000 members. The MTF attributes the initial rapid growth in Commonwealth Care enrollment to the state’s early success in getting residents signed up for the program.
The majority of people in Massachusetts like the health reform law, and it has gotten more popular over time.
Myth
The Massachusetts health reform law is highly unpopular among members of the public, the business community, and policymakers.
Fact
Support for the law is strong among members of the public. Sixty-one percent of the Massachusetts nonelderly population approved of the law when it passed in 2006. Two years later, 69 percent of nonelderly adults viewed the law favorably. In a survey of employers conducted in 2007—shortly after passage of the health reform law—a majority of Massachusetts firms surveyed agreed that “all employers bear some responsibility for providing health benefits to their workers.”20 A survey of employers conducted a year later—after the individual and employer mandates were implemented— found that a majority of firms believed the law was “good for Massachusetts.”
The Massachusetts health reform law was also a bipartisan achievement, drawing support from both sides of the aisle throughout the process. The law was passed by a Democratic legislature with support from its Republican members and then signed by GOP Gov. Mitt Romney.
Massachusetts is building on its 2006 reforms to promote better quality care at lower costs.
Myth
Current Gov. Deval Patrick is proposing to ration health care in Massachusetts.
Fact
Gov. Patrick’s proposal would make Massachusetts a leader in nationwide efforts to reform health care delivery and bring down costs. The governor has proposed new tools for achieving integrated care—by holding providers accountable for working with each other and their patients to coordinate and delivery higher-quality care at a lower cost.
These innovative tools encourage providers to deliver better care—replacing the current payment system’s set of incentives that provide more care regardless of value. Indeed, more care can sometimes be harmful to patients. Hospital-acquired infections and medical errors are among the most common causes of preventable deaths and injuries in U.S. hospitals. Medical errors accounted for 238,000 preventable deaths in Medicare and cost the program $8.8 billion from 2004 to 2006. A recent study found that sepsis and pneumonia caused by hospital-acquired infections resulted in 48,000 deaths in 2006 and cost the program $8.1 billion.
Conclusion
The Massachusetts health reform law is a success story from every perspective. The state has expanded health coverage to almost all of its residents, maintained a strong market for employer-sponsored health insurance, gained the support of the business community and the public, and is moving forward in containing costs. We can look forward to a similar positive experience across the nation as we implement the Affordable Care Act modeled in large part on the Massachusetts law.
By: Nichole Cafarella and Tony Clark, Center for American Progress, April 13, 2011
“Revere America”: Another Conduit For A Super-Wealthy Family To Influence Elections
On March 23, 2011 a group called Revere America issued a dire-sounding PRNewswire press release titled, “Americans Fear Loss of Freedom on Anniversary of Health Care Reform Law.” It warned that “a majority” of Americans view health care reform as “a threat to their freedom” and cited a poll by Bill McInturff of Public Opinion Strategies to prove it. The release came well after Revere America had spent $2.5 million on attack ads in the 2010 mid-term elections to defeat Democratic candidates in two states — New York and New Hampshire — who had voted in favor of health care reform. Just prior to the mid-term elections, in the autumn of 2010, Revere America ran a a slew of false and misleading attack ads against the health care reform bill that erroneously called health reform “government-run healthcare” (a Republican and insurance industry buzz-phrase). The ads said that the new law will result in higher costs and longer waits in doctors’ offices. In another false claim aimed at inducing fear, the ads told viewers that “your right to keep your own doctor may be taken away.”
But who, or what, is Revere America? And how did it pull together enough money in less than a year to run a multi-million-dollar attack ad campaign, engage an expensive, professional polling firm and pump their message out on PRNewswire?
“Revere America”: Another Veil for a Wealthy Family
Revere America (RA) is a Delaware-based advocacy organization that sprang up in April, 2010. Like so many similar groups springing up after the Supreme Court’s ruling in Citizens United, RA is set up in a way that allows it to accept corporate donations, and that keeps it from having to reveal its funders. RA’s titular head at the time of its startup was former New York Governor George Pataki. The group pushes to repeal health reform, also known as the Patient Protection and Affordable Care Act, which Pataki described a “horrific” and “costly bungle.” Donations to RA are not tax deductible, which would seem to make donating huge sums of money to the group less attractive to large numbers of people if it was a real grassroots group made up of ordinary people.
The Collier’s Hamilton Yacht ClubBut it turns out that Revere America is not made up of ordinary people, and its primary funder isn’t all that concerned about money. According to Citizens for Responsibility and Ethics in Washington (CREW) and other sources, Revere America’s primary funder is Parker J. Collier of Naples, Florida, the wife of Miles Collier, a wealthy Florida land baron and real estate developer. Ms. Collier has given half a million dollars to the Republican Party of Florida, $60,800 to the Republican National Committee, and gave an overall total of $1,239,014 to Republican interests — and that was just in 2009-2010.
The Collier money flowing towards Republicans and Revere America is old family money. Parker’s husband, Miles Collier, is the grandson of Barron Collier, who bought over a million acres in south Florida in the early 1900s, and after whom Collier County, Florida is named. Through their company, Collier Enterprises, the Colliers develop tony yacht, golf and members-only country clubs in southwest Florida, where the rich play, dine and sail. In recent years, Collier Enterprises has even been developing entire towns in Florida.
Influencing Elections Throughout the U.S.
The Collier’s private, members-only golf clubFor the Colliers, though, it apparently isn’t enough to have all the amenities of uber-wealth. Through Revere America, the family’s apparent political front group, the Colliers have also been using their money to influence elections throughout the rest of the country. They have financially supported far-right Republican candidates not only in New York and New Hampshire, but in many other states, including Michele Bachmann (R-Minnesota), Senator Scott Brown (R-Massachusetts), and Republican Sue Lowden in her failed primary bid to gain the Senate nomination in Nevada, to name just a few. The list of Republican candidates RA funded and Democrats they worked to defeat in the 2010 election cycle numbers over 100, with some elections meriting six figure donations — amounts that far exceed what individuals can legally donate to influence an election.
The professional Republican pollster doing work for RA, Bill McInturff, conducted the message and advertisement testing for the infamous “Harry and Louise” television commercials that helped defeat the Clinton-era health care reform effort. Some of McInturf’s other clients include insurer Blue Cross Blue Shield Association, America’s Health Insurance Plans (the health insurance industry’s lobbying group) and drug maker Pfizer — all of which have a stake in undermining health care reform.
Pataki resigned as RA’s chairman in February, 2011, citing a Florida judge’s ruling the same month that the new health reform law’s federal mandate to purchase health insurance is unconstitutional. Pataki cited this ruling, and the House of Representatives’ symbolic vote to repeal health reform, as creating a good time for him to step down, and as proof that RA had been “successfully launched.” RA’s spokesperson and president is now Florida attorney Marianne R.P. Zuk, who is listed in Florida incorporation records as an officer or director for several Collier-owned companies.
Revere America is a “grassroots group” for the uber-wealthy Collier family in the same way that Americans for Prosperity is a “grassroots” group for the uber-wealthy Koch brothers. Such groups are conduits through which the super-rich are increasingly exerting powerful influence over elections nationwide. RA is yet another group that demonstrates the growing trend in which the wealthiest Americans — in the forms of both human beings and corporations — use their money to create fake “grassroots” front groups to hide behind and influence elections across the U.S.
Be on the look out for many more such groups to crop up in the future as the richest one or two percent of U.S. citizens come under increasing pressure to pay their fair share of taxes, and as we move closer to the 2012 elections.
By: Anne Landman, Center for Media and Democracy, April 8, 2011
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