TO NO ONE'S surprise, employers are responding with Bronx cheers to Governor Patrick's plan to get more fees from them for the state's subsidized health insurance program. The state's bid for increased assessments from businesses, insurers, and healthcare providers comes just as the economy shows signs of weakening.
In the spirit of keeping together these groups and others that have collaborated on the state's pioneering attempt at universal coverage, the governor's team should consider any reasonable alternatives to the new assessments. However, one that has been prominently mentioned - shifting more Medicaid members to managed care plans - seems unlikely to produce the immediate savings needed.
At the heart of the problem is the state's estimate that subsidized Commonwealth Care coverage and Medicaid will cost the state at least $120 million more than projected. To close the gap, the governor wants to collect an additional $33 million from insurers, $28 million from providers, and $33 million from employers who do not have health plans enrolling at least 25 percent of their workers and who do not pay at least 33 percent of workers' premiums. The state itself would provide up to $35 million from a fund for insurance for the unemployed. Commonwealth Care's members already began paying higher premiums and co-payments this spring.
As an alternative to new fees, a coalition of businesses and insurers thinks the state could save $160 million by enrolling all 1.1 million Medicaid members in managed care plans. Currently, 400,000 are in such plans. According to the Executive Office of Health and Human Services, managed care plans have historically served the healthiest Medicaid recipients but "have not yet demonstrated the capacity to serve large numbers of disabled members." The state is starting to bring in new plans with more expertise in serving members with complicated care requirements. But changes in this direction will have to be measured to work well and probably won't produce much savings in the short term.
The debate over closing the Commonwealth Care gap will inevitably have echoes in Washington, where the state and the Bush administration are negotiating over a Medicaid waiver with hundreds of millions of dollars at stake. The state's bargaining position will be stronger if it can demonstrate that all stakeholders in health reform - insurers, providers, consumers, and employers - are doing their part to make reform work. That means, on the state's side, considering all cost-saving proposals. But it also means that, in the end, everyone else might have to pony up more money.
