Category: Health Care

Understanding Baker’s Health Care Package

At the end of June, Governor Charlie Baker introduced a health care package that boasted Medicaid (MassHealth) reform and cost savings in an especially tight budget year. At a glance, the proposal seemed like a standard Republican response to the current financial state of the Commonwealth, but after a closer look, juxtaposed with Baker's generally supportive views of the Affordable Care Act nationally, it paints a bleak picture for working families in Massachusetts.

If you have any additional questions, feel free to contact my Legislative Aide, Caitlin Duffy (

What did Baker's original MassHealth plan contain?

The Governor's Health Care Reform Package introduced this Summer served as a Phase 2 of a larger reform. Phase 1, which was supported by the Obama Administration, was an effort to transform much of MassHealth (the State's Medicaid program) into "accountable care organizations." According to Commonwealth Magazine, Accountable Care Organizations (or ACO's) aim to focus hospitals, physicians, and other providers on improving population health, care integration, and efficiency. Back in November, days before the election of President Trump, Massachusetts was awarded a grant by the Obama Administration to carry out the program, which aligned with the out-going administration's mission to move US health care away from expensive fee-for-service payment and toward value-based financing that rewards quality and efficiency.

Gotcha. But what is included in Phase 2 of the Health Care Package? More Obama approved reforms?

Unfortunately, no. Phase 2 of Baker's plan is a bit more complex and requires more focus. It includes 5 key changes:

  1. Temporarily reestablishes employer responsibility for health insurance through two new assessments.
  2. Closes access to MassHealth for otherwise income-eligible individuals and families who have access to affordable coverage through their employers.
  3. Seeks to transfer 140,000 lower-income, non-disabled adults from MassHealth to the ConnectorCare program, as well as transfer 230,000 non-disabled parents and caretakers from MassHealth Standard to CarePlus, effective January 1, 2019.
  4. Seeks to align MassHealth benefits more closely with those of commercial insurance plans by encouraging limited network products, by eliminating non-emergency transportation to medical appointments, and by using commercial tools such as closed formularies in selecting outpatient drugs.
  5. A series of reforms to state commercial insurance laws 
Okay, so what does this mean for employers?

Employers would be responsible for a higher rate of "Employer Medical Assistance Contribution" (EMAC) from $51m to $71m effective January 1, 2018. EMAC is what funds  subsidized health care to low-income residents of the Commonwealth. Finally, Employers will be required to pay 5 percent of annual wages for each non-disabled employee who obtains public health insurance coverage (from MassHealth or the Massachusetts Health Insurance Connector), up to the annual wage cap of $15,000, or $750 maximum. 

This is bad news for business, but the Baker administration lessened the pain by a $334 million drop in the unemployment insurance rate schedule to make up for it. That deal is likely why groups like the Associated Industries of Massachusetts and the Massachusetts Taxpayer Association are on board with this plan. Also, the assessments would be only effective for 2 years.

Interesting. I've heard people talking about "employer assesments" before. What are they and what is their significance?

Employer Assesments are reports submitted by companies regarding the health care plans that they offer and the eligibility percentage of current employees. Unless you're incredibly interested in all things Health Care Policy, you probably first heard the concept mentioned back in 2006 during Massachusetts's Universal Health Care debate. The Affordable Care Act also included an employer responsibility assessment, set to take effect in 2014, but it was never implemented. Anticipating the ACA assessment, Gov. Deval Patrick and the Legislature repealed the 2006 mandate in 2013. Baker proposed a more costly assessment last January, which is part of the reason why businesses are on board for these reforms.

That's great for businesses, but what does the package change for families and individuals already on MassHealth?

Well, this is where Baker's policy gets a little bit more treacherous. This plan would close access to otherwise income-eligible individuals and families who have access to healthcare plans deemed "affordable" by the government at their current job. The trouble is that health care costs add up and this could be seen as a huge burden on working people. Advocates worry that many low-income adults will be dropped from coverage, though the Baker Administration claims that they will provide assistance to those affected in finding affordable coverage. Until this assistance is proven to be adequate, moving ahead on this policy would be incredibly risky for vulnerable families and individuals.


What about the 140,000 people that would be shifted from MassHealth to Connector Care, or the 230,000 non-disabled parents and caretakers that would be shifted from MassHealth Standard to Care Plus? Should they be worried?

When you look at what would theoretically qualify a person to be deemed eligible for MassHealth in this regard, the 140,000 individuals especially should be alarmed. These are all people whose income is 100 to 138 percent of the federal poverty level. In other words, you'd have to be a lot more poor to qualify for MassHealth and families that fall between those benchmarks would have to rework their financial situation to afford subsidized care (which, can truthfully be costly). The disparity gap between plans becomes a significant hurdle for working families. The loss of coverage could also affect MassHealth recipients with dental plans and other elements crucial to caring for one's health that may not carry over to ConnectorCare.

It's important to remember that the poverty level is calculated on a national level.  It does not account for higher cost states, like Massachusetts, or higher cost cities, like Boston or Cambridge.


Okay. Well, what about the steps Baker is making to make MassHealth look more like Commercial models of insurance?

The Baker administration seeks to do this with MassHealth by encouraging limited network products, eliminating non-emergency transportation to medical appointments, and using commercial tools such as closed formularies in selecting outpatient drugs.

What about his efforts to reform Commercial Insurance? What would that entail?
  • Imposing a 5-year moratorium on new health insurance mandates;
  • Providing consumers with price information for common procedures and services;
  • Increasing premium differentials for tiered network insurance plans from 14 percent to 28 percent; and
  • Expanding the scope of practice for nurse practitioners, optometrists, and podiatrists, while creating a new mid-level provider called “dental therapist.”
This sounds like it could be devastating to families on MassHealth. What's the pay off? How much does the governor claim that the State would save if we did this?

Baker's team claims that these reforms would save $314 million in fiscal year 2018, which starts July 1, and more beyond. Those savings would be great, but it seems to be on the backs of the working poor in Massachusetts.

Well, what does Jay think about these changes?

As an advocate for working families and individuals, I was incredibly disturbed by Baker's proposal and the lack of public process in determining the details. It felt like businesses and insurance companies got a seat at the table whereas MassHealth recipients did not get to voice their input/concerns. I understand that this was and remains to be a tight fiscal year, but I do not believe that working families and individuals should be first on the chopping block at their expense. After hearing about the proposal and getting sense of a momentum on the issue, I teamed up with Representatives Barber and Balser to pen an op-ed in Commonwealth Magazine about these changes. I've been part of a vocal opposition to any changes made to balance the budget on the backs of the working poor. 

Alright. What happens now? Is this a done deal? What can still be done?

Recently, the House rejected the Governor's MassHealth Reform package in the form of a budget amendment, 41-116, with seven Democrats joining all but one Republican in supporting the governor’s plan. The Senate followed suit on a party-line vote of 6-31. One more vote is required in the Senate to return the budget sections without MassHealth reform to Baker. Baker will have to choose whether to accept the employer assessments without reforming MassHealth and risk alienating the business community, or veto the assessments and I will continue to fight against any similar proposals that would leave the people of Massachusetts without the health care support they need at this time of uncertainty at the federal level.  I am currently working with other representatives on solutions to MassHealth costs that do not involve cuts to benefits or services.


Reforms Or Rollbacks? Baker Battles Dems Over MassHealth

As the U.S. Senate voted to open debate on the Republican plan to repeal the Affordable Care Act, state lawmakers began their own review of potentially significant changes to Massachusetts’ health insurance for the poor. In the interests of balancing the budget an insuring the viability of state health aid, Gov. Charlie Baker is making a big push to rein in Medicaid spending. The result: some Democrats are offering more vocal opposition than Beacon Hill is used to hearing – at least since Baker moved into the corner office.

The cost of MassHealth, the state’s Medicaid program, has ballooned by almost 50 percent over the last 10 years. Baker’s plan would transfer around 140 thousand non-disabled adults from MassHealth to their employer’s plan or to subsidized coverage through the Health Connector. Health and Human Services Secretary Marylou Sudders says there would be little change to coverage and premiums, but co-pays could rise to around $500 a year.

“I’ve read some things recently that suggested that we’re actually cutting people off of access to eligibility. Nothing could be farther from the truth in our proposals before you,” Sudders told a joint hearing before the Legislature’s budget and health care financing committees Tuesday.

Because the cost of MassHealth is growing much faster than state tax dollars, Baker’s finance officials insist eligibility must be paired back to preserve the program for the neediest residents and to maintain the state’s near-universal coverage rate.

“In 2006, we passed universal health care reform, providing the path to the [Affordable Care Act] and today we need to find the path to preserve and protect our gains in coverage,” Sudders said.

Over one quarter of Massachusetts residents, almost 2 million people, rely on MassHealth for at least some health care coverage, according to Sudders. Baker’s plan would affect MassHealth enrollees earning 130 percent or less of the federal poverty line, or about $16,000 a year.

According to Baker’s office, the changes to the program would save the state around $200 million a year.

Democrats on the panels are concerned that forcing people off MassHealth and onto the connector would mean the loss of some dental and long-term care coverage, as well as push the state away from its long-standing commitment to expanding access to health insurance.

Ashland Sen. Karen Spilka, the Senate’s top budget writer, said there need to be solutions to the cost problem that don’t include limiting local Medicaid enrollment, which was expanded under the Affordable Care Act.

“If we accepted the governor’s proposal on this, Massachusetts would be the first state in the nation to start rolling back Medicaid expansion. That is not a direction I would like to see Massachusetts going. We are a Commonwealth. We take care of our residents, particularly our most vulnerable residents,” Spilka told WGBH News.

Several progressive members of the House echoed Spilka’s position in an op-ed for CommonWealth Magazine earlier this week. Reps. Christine Barber, Ruth Balser and Jay Livingstone called Baker out for what they see as supporting policies at the local level that he’s condemned the national GOP for pursuing nationwide.

“These are exactly the types of cuts that the governor is publicly opposing in Washington,” the representatives wrote.

Baker insists the changes are needed to balance this year’s budget and keep MassHealth sustainable.

The MassHealth eligibility changes are paired with another proposal from Baker to increase how much employers pay into the system and to charge an assessment on companies that don’t provide affordable coverage to employees.


Testimony: H.2960 – An Act to protect access to confidential healthcare

Bill title: An Act to protect access to confidential healthcare

Filed by: Representative Kate Hogan of Stow

Summary: This bill pertains to the privacy of an individual whose healthcare information is disclosed in the explanation of benefits sent to the primary policy holder of a health plan

Heard by: Joint Committee on Financial Services

Date: May 16, 2017

Download (PDF, 58KB)


Proposal in wake of Longmeadow DPW worker’s death would extend death benefit to family of additional public employees


Cindy J. Cowles listens during a meeting Monday, May 1, 2017 at the Longmeadow Police Station about the railroad crossing where her brother, Warren P. Cowles — shown in photo at left — was killed in a collision with a train in March.(Greg Saulmon / The Republican)

Greg Saulmon | gsaulmon@repub.comBy Greg Saulmon |
Email the author | Follow on Twitter
on May 01, 2017 at 8:31 PM, updated May 01, 2017 at 8:39 PM

LONGMEADOW — A state senator will introduce a proposal to extend a death benefit for family members of first responders killed on the job to additional public employees.

State Sen. Eric P. Lesser, D-Longmeadow, spoke about the proposal Monday, ahead of a meeting with town residents about the railroad crossing where Department of Public Works foreman Warren P. Cowles was killed.

“He died in the line of duty,” Lesser said of Cowles, who was plowing snow for the town when his truck was hit by a northbound Amtrak plow train on March 14. The crossing where he was killed, at Birnie Road and Tina Lane, has been the site of several previous crashes and fatalities.

'Fix this': Family, neighbors of Warren Cowles urge safety upgrades at Longmeadow railroad crossing

‘Fix this’: Family, neighbors of Warren Cowles urge safety upgrades at Longmeadow railroad crossing

Efforts by the town to install new safety measures at the crossing have been underway, in fits and starts, since at least 1981.

Lesser said he would introduce his proposal in the Senate during the state’s upcoming budget discussions.

It will build off a bill first introduced by State Rep. Jay D. Livingstone, D-Boston, last year.


Livingstone’s proposal was referred to the legislature’s Committee on Public Service in January.

Lesser expressed optimism that the effort will gain traction. “I think circumstances have changed,” he said.

Gov. Charlie Baker in March signed a bill in March doubling the death benefit for first responders from $150,000 to $300,000. Currently, the benefit is available to the family of any firefighter or police officer — full-time or reserve — as well as public prosecutors, municipal or public emergency medical technicians and correction officers killed in the line of duty.

Livingstone’s bill expands the coverage to “any public employee working for state or county government, a Massachusetts public higher education institution, a municipality, public school department, or public school district or public authority who, while in the performance of his/her duties and as a result of incident, 8 accident or violence, was killed or sustained injuries which were the direct and proximate cause 9 of his/her death.”

As written, Livingstone’s bill set the benefit at $150,000. Lesser said he anticipated updating the amount to reflect the new law signed by the governor in March.

If the effort is ultimately successful, Lesser said he will push to apply the benefit retroactively to Cowles’ family.

Lesser and State Rep. Brian M. Ashe, D-Longmeadow, convened a meeting about the crossing Monday night at Longmeadow’s police station. Nearly 20 town residents, as well as family members and friends of Cowles attended.

The meeting was planned, Lesser said, to give the legislators a chance to hear more about the concerns residents have about the crossing.

“This is personal as well as professional for all of us,” Ashe said as the meeting got underway, noting that he knew Cowles from his time as a member of the town’s Select Board.

“It’s too late for me, but I can help protect others,” said Cowles’ sister, Cindy J. Cowles of Springfield, as she urged the officials to continue the pursuit of upgraded safety signals at the crossing.