In 2006, the Massachusetts legislature passed “The Massachusetts Mandated Health Insurance Law”, which was signed by then-Governor Mitt Romney. As most of our readers undoubtedly know, this law subsequently served as the model for the Affordable Care Act (ACA). The ACA is now popularly known and widely referred to as ObamaCare.
While the 2006 Massachusetts law has been labeled “RomneyCare” by many people, it’s not at all clear that that is an honest label. As described by Avik Roy in his The Apothecary blog, although Governor Romney signed the bill, he wanted it to apply only to catastrophic coverage and specifically vetoed several of its key provisions, including an employer mandate forcing companies with more than 10 employees to provide them with health insurance or pay fines. These vetoes were immediately overridden by the Democratic legislature, and it fell to Romney’s Democratic successor Gov. Deval Patrick to implement and modify the provisions of the law in a way that set the final example for ObamaCare. As it happens, Governor Patrick is a prominent figure in President Obama’s re-election campaign, and the two appear to see eye-to-eye on how healthcare should be implemented and regulated in this country. It might therefore be more accurate if we referred to the state of Massachusetts’ approach to healthcare by a more generic label such as “The Mass Mandates”. For when you come right down to it, the Massachusetts approach mostly consists of a large series of mandates: mandates to individuals and businesses to buy insurance for yourself or others, mandates to insurers to provide unlimited insurance coverage wherever and whenever it is desired, and mandates to healthcare providers to do whatever is asked of them regardless of whether it’s profitable or not.
While The Mass Mandates have produced the highest rate of health insurance coverage in the nation (some 98% of Massachusetts residents are covered by some form of health insurance), like ObamaCare the original law deliberately did nothing to reduce costs or the incentives to spend more for healthcare, even as it broadened the pool of people capable of making claims upon the system. One predictable result has been an explosion in healthcare costs and spending within the state. Massachusetts has among the highest health insurance premiums in the country. As recently described by an article in the New England Journal of Medicine:
Massachusetts spent more than $61 billion on health care in 2009, a figure that places it among the highest-spending states in the country. In the past 5 years, growth in health care spending has consistently exceeded economic growth, resulting in challenges both for lawmakers dealing with a constrained state budget and individuals required to purchase coverage privately. In fiscal year 2012, health care will consume 54% of the state’s budget, up from 49% in fiscal year 2009, with the bulk going toward Mass Health (Medicaid) and individual subsidies for purchasing health insurance. For individuals, monthly premiums for a minimal (“bronze”) plan purchased through the Commonwealth Choice connector (the state insurance exchange) increased from about $175 in 2007 to $275 in 2012 (a 57% increase), despite slowed growth in overall health care spending since the start of the recession in 2008.
One might add that there have been other adverse consequences as well. According to an annual survey by the Massachusetts Medical Society, the waiting time needed to see a family physician has been rising steadily – from 29 days in 200 to 36 days in 2011 to 45 days in 2012. About half of internists and family practitioners are not taking new patients.
Of course, if the original Mass Mandates law had done something about healthcare spending at the time that it was proposed, it probably would have sparked so many objections that it never would have been passed by the legislature. Voters like healthcare coverage – especially if someone else is paying for it – but they get cranky when you tell them that there will be some sort of limitations on their coverage such as overt rationing, not being able to see a doctor they like within a reasonable period of time, or formulary lists filled with cheap and relatively ineffective second or third-line drugs. As a result, it has taken until this summer for the other shoe to drop, and for Phase II of the Mass Mandates to take place. For on August 6th of this year, Governor Patrick signed a new law that shows how the next phase of ObamaCare is likely to play out if the current administration continues to hold the keys to the American healthcare system after the November 2010 election.
It’s been remarkable to us that so little attention has been paid to the contents and nature of this new law (dubbed “An Act improving the quality of health care and reducing costs through increased transparency, efficiency and innovation”, and officially identified by the rather more prosaic name of “Chapter 224 of the Acts of 2012”. The passage and signing of this bill into law was something of a big deal for news outlets in Massachusetts, but more or less regarded as just a footnote in the rest of the country. But this is not just some “local yokel” healthcare initiative occurring in an out-of-the-way state. The people running this thing belong to the same political party and healthcare philosophy as the folks currently running the White House, Department of Health and Human Services, Department of Justice and the Internal Revenue Service. There is an excellent chance whatever is done in Massachusetts right now is going to be translated directly into national healthcare policy. After all, the ACA law provides the Secretary of HHS with an enormous amount of discretion as to how, where and when to implement whatever plans that (s)he may wish to put into place. And as The New York Times recently reported, many healthcare businesses seem to be betting that Mr. Obama will get his four more years.
With that in mind, we’ve recently wasted spent quite a few hours reading and trying to comprehend the new 2012 Mass Mandates that have just been signed into law. This is no trivial task. The text of the modifications that have been made run to an extraordinary 349 pages, with much of it in legalese and references to other documents that are virtually incomprehensible to the average person. Here is just a small sample:
SECTION 5. Section 16 of chapter 6A of the General Laws, as appearing in the 2010 Official Edition, is hereby amended by striking out, in line 52, the words “pursuant to section 2A of chapter 118G” and inserting in place thereof the following words:— under section 13C of chapter 118E.
SECTION 6. Section 16E of said chapter 6A is hereby repealed.
SECTION 7. Sections 16J to 16L, inclusive, of said chapter 6A are hereby repealed.
SECTION 8. Section 16M of said chapter 6A, as appearing in the 2010 Official Edition, is hereby amended by striking out, in lines 3 and 4, the words “commissioner of health care financing and policy” and inserting in place thereof the following words:- executive director of the center for health information and analysis.
In an effort to make things more comprehensible, we tried to extract from the law what seemed to be the major actions and initiatives. By simply cutting and pasting, we have created the nearby 39-page document that appears to contain the most notable parts of the legislation from the perspective of patients, providers and those who will have to pay for all of the initiatives described.
Over the next week or so we will write more about the new Mass Mandates law in general, and some of its specific elements in particular.