Mass. health architects in demand
Other states seek help to comply with US law
HARTFORD — Kevin Counihan, an architect of the online insurance exchange that was key to expanding health care coverage in Massachusetts, found himself playing a familiar role this week — briefing state officials on how to create a new health insurance marketplace.
“We’re going to get it done,” Counihan promised the nodding bureaucrats. He ticked off plans to tap federal grants, hire administrators, and make people aware of coverage choices.
But he wasn’t outlining his strategy on Beacon Hill. Counihan was addressing the Governor’s Health Care Cabinet in Connecticut, which like many states is scrambling to build from scratch the insurance apparatus called for in President Obama’s new health care law.
Nowhere is there more experienced talent for the job than in Massachusetts, which developed the nation’s first and only universal health coverage system six years ago. That means there is a gold rush on to hire people who helped implement the Massachusetts plan.
Counihan, who consulted on insurance exchanges for 40 states before accepting a post as chief executive of Connecticut’s Health Insurance Exchange, is among more than a dozen former Massachusetts health officials cashing in on the need for their expertise. In one way or another, all were pioneers of the expanded coverage at the heart of the health care overhaul championed by former governor Mitt Romney.
Under the US health care law upheld by the Supreme Court, states are required to establish insurance exchanges — places where people, especially those now without health insurance, can shop for and buy coverage. In Massachusetts, it’s called the Health Connector.
“The fingerprints of the Massachusetts Connector are clearly visible in the work going on everywhere,” said Jon Kingsdale, former executive director of the Connector Authority. Kingsdale has worked with 15 states in the past two years as managing partner in the Boston office of Florida-based Wakely Consulting Group. This week, he flew to Oregon to talk with representatives of 10 states about their exchanges.
The Connector, established under Massachusetts’ landmark 2006 law to develop a one-stop shopping website for subsidized and unsubsidized health insurance, has become a “seedbed” for similar efforts now taking shape across the nation, Kingsdale said. The program has helped reduce the ranks of the uninsured to about 2 percent in Massachusetts.
Other former Massachusetts health officials also find themselves in demand. Some were employed under Romney, the presumptive Republican presidential nominee who opposes the federal law. Others worked for his Democratic successor, Deval Patrick. A few straddled both administrations.
While they are keenly aware of the tensions surrounding health exchanges in some states, the former Bay State officials take pains to avoid identifying themselves by political party. They say their primary role is to help get national health care up and running.
“It’s a mix of policy and politics,” said consultant Tom Dehner, former director of the state Medicaid program known as MassHealth. “That’s why it’s complex, that’s why it’s not easy to implement. These are issues that have significant fiscal and political ramifications, and we help states navigate that.”
Just as Counihan, once the Connector’s chief marketing officer, was making his debut before officials in Hartford this week, health care policy veteran Christine Ferguson, who formerly oversaw both the Department of Public Health and the Division of Health Care Finance and Policy, was settling into her new office in Providence. Ferguson was recruited to be director of the Rhode Island Health Benefits Exchange.
In Montpelier, the deputy state health commissioner charged with building an exchange for Vermont is Lindsey Tucker, a former policy manager at the Blue Cross Blue Shield of Massachusetts Foundation and the Boston consumer advocacy group Health Care for All. Tucker campaigned for the Massachusetts overhaul.
Other Massachusetts players are among the strategy, technology, and implementation consultants advising officials from Maryland to California. For instance, Patrick Holland was the Connector’s chief financial officer and now works with Kingsdale as managing director in the Boston office of Wakely. Dehner, the former MassHealth director, is managing principal for the health care consulting firm Health Management Associates.
“Strategic planning is not the exclusive province of people who used to work in Massachusetts,” Dehner said. “But there’s some real value to having watched reform unfold here.”
Two other former Connector officials — Melissa A. Boudreault, who directed its Commonwealth Care health plan, and Robert Nevins, the Connector’s chief information officer — are vice presidents for state health solutions at CGI Group, a worldwide technology consulting firm that is helping states build health insurance exchange portals. “It’s almost as if lightning struck twice,” Boudreault said. “I love to build and implement. I got to do that in Massachusetts, and now I’m getting to do it again.”
Ex-Connector chief operating officer Rosemarie Day hung up a shingle in Somerville as president of Day Health Strategies, but she also works with other consulting firms. And Bob Carey, once the Connector’s planning director, is principal at RLCarey Consulting.
“We’re really the only state that has a full-fledged insurance exchange,” Day said. “That’s really valuable experience. People who have lived it know where the potential pitfalls are.”
The band of consultants offering advice extends to academia. MIT economics professor Jonathan Gruber, who was an adviser on the Bay State and US health care initiatives, is peddling computer modeling of health insurance trends to Minnesota, Colorado, Maine, Wisconsin, and Michigan.
“You’ve got a hot commodity,” said Tufts Health Plan chief executive James Roosevelt Jr., referring to the state officials-turned consultants. “Given the success of the Massachusetts exchange, not just in getting people covered but in being fiscally responsible and not breaking the budget, I think that makes Massachusetts a model.”
But the consultants acknowledge that some states don’t view Massachusetts as a model. “A lot of it depends on where you go,” said Boudreault. “When I first went to Texas, I didn’t get the same warm reaction I got when I went to California.”
In fact, consultants say states generally fall into three categories: One group, including Rhode Island, Connecticut, and Vermont, is pushing forward with the health care exchanges that are required to be in place by Jan. 1, 2014.
A second group is resisting the federal law. Texas Governor Rick Perry, for instance, sent a letter to Health and Human Services Secretary Kathleen Sebeliusthis week vowing his state would not participate in a health exchange or the expansion of Medicaid to cover more residents, a provision of the US law that the Supreme Court said is optional for states.
“Governor Perry has made it clear that he has no interest in turning the state of Texas into a subcontractor of Obamacare,” said Perry spokesman Josh Havens, “or [in] subscribing to a program where rules and costs are yet to be determined.”
A third group of states remains on the sidelines, weighing the costs of following the law against the risks associated with noncompliance.
Even among the states enthusiastically signing on, there are differences in the mechanics, such as how many qualified health plans and products they will allow. Vermont’s Tucker said officials there eventually want its health benefits exchange “to be the platform for single payer,” meaning an insurance system administered by the state.
Opposition to the exchanges and other aspects of the federal law — especially the requirement that people buy insurance or pay a fine — illustrates how contentious the debate remains, as well as ways it has changed over the years.
Before her tenure in Massachusetts, Ferguson was policy aide to the late John Chafee, a former Republican senator from Rhode Island. Chafee helped draft the Dole-Chafee health care bill that was a GOP alternative to Hillary Clinton's proposed overhaul in the early 1990s. That legislation contained an individual mandate, then a Republican idea, which was adopted a decade later by Romney in Massachusetts.
“Almost every policy idea has belonged to one party or another at one time or another,” Ferguson said. “But we’ve made steady progress in expanding coverage.”
Robert Weisman can be reached at firstname.lastname@example.org.