The House and Senate released their proposals in May. Both set targets for spending and pushed providers and insurers into new ways of paying for health care that emphasize prevention, but the House version went farther in its spending limits. Hospitals and physician groups roundly criticized Walsh’s proposal, calling it a threat to health care jobs. The bill was “overly ambitious,” reflecting Walsh’s “inexperience and youth,” says Michael Widmer, president of the Massachusetts Taxpayers Foundation. One provision, in particular — a touch of Robin Hood ethic — drew ire. Walsh proposed a “luxury tax” against the highest-priced providers. The money would be redistributed to struggling hospitals. It was a “crazy concept,” Chandra, the economist, says. But even as Senate leaders made it clear they would not go along with the tax, Walsh held on.
When the bill was finalized in July, the lawmakers had reached a middle ground on the spending target and the tax was gone. Instead, the bill included funds for preventive care and health care technology, also Senate priorities, and a one-time surcharge against all hospitals and health plans that have more than $1 billion in assets and less than half of their revenue from public programs. The charge is expected to raise $135 million for distressed community hospitals to make changes to keep up with the market. “From the get-go we were playing chess,” Walsh says.
Walsh has been traveling in recent months to conferences around the country for legislators and trade groups, giving speeches about how the bill was made. He’ll put that work on hold for awhile. Myles, now a gentle-mannered toddler, will be a big brother soon, as the Walshes are expecting their fourth child. Meanwhile, an 11-member board stacked with nationally renowned health care experts — Cutler among them — and responsible for putting the law into action began its work in November, with heavy expectations.
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