Behind the Bipartisan Kumbaya on Substance Abuse

[This op-ed was posted yesterday on the website of the Milbank Quarterly.] 

For several years, Republicans and Democrats alike have been concerned about the crisis of opioid and heroin addiction in the United States. It is hard to find anyone who rejects the notion of a serious problem that demands at least a partial governmental response. Across the nation, governors and legislatures are hard at work seeking solutions and avoiding partisan bickering. Numerous current and former presidential candidates in the 2016 campaign cycle got favorable attention explaining how the crisis has affected their families and friends in personal ways.

Behavioral health

The question is whether there is any meaningful difference between Republicans and Democrats when it comes to substance abuse (and, for that matter, behavioral health—the merger of substance abuse and mental health).

The answer is yes, and the difference comes down to the Affordable Care Act (ACA). Continue reading “Behind the Bipartisan Kumbaya on Substance Abuse”

Behind the Turnaround at the MA Health Connector

(This article was just published in the Spring Issue of Commonwealth magazine.)

It’s 11:59 PM on October 31, 2015, about 20 nervous state officials and contractors hunched around computer terminals in a non-descript office in the Charles F. Hurley Building near Beacon Hill. Among them was Louis Gutierrez, executive director of the Massachusetts Health Connector, appointed the previous February by newly inaugurated Gov. Charlie Baker. The launch of the third open enrollment since the 2013 implementation of the federal Affordable Care Act (ACA) was less than a minute away with lots on the line. Would months of hard preparation avoid another website calamity that could jeopardize health insurance for hundreds of thousands of Massachusetts residents.

As the website opened at midnight and kept humming without a hitch throughout the night and following days, sighs of relief were heard across the Commonwealth as a major governmental embarrassment was averted. By early February 2016, 201,000 state

Louis Gutierrez

residents had successfully enrolled in plans for 2016, including 36,000 new members. Today, the Connector is a marquee success for the still-youngish Baker administration — an ironic twist for a Republican governor who was never a fan of the ACA, Barack Obama’s marquee presidential achievement. Continue reading “Behind the Turnaround at the MA Health Connector”

Massachusetts Health Reform at 10 – A Surprising Look Back

April 12th is the 10th anniversary of the signing of Chapter 58, Massachusetts’ landmark universal health insurance law (An Act Providing Access to Affordable, Quality, Accountable Health Care) that served as a key model for the federal Affordable Care Act (ACA/ObamaCare) signed in March 2010. A more compelling example of states as “laboratories of democracy” is hard to find.

A lot of good material has come out in the past 24 hours: a literature review of evidence on the law’s impact from the Blue Cross Blue Shield Foundation of Massachusetts; 13 essays on the law by various Massachusetts health policy players (including yours truly) with an overview by WBUR’s Martha Bebinger; and a helpful retrospective from Health Care for All’s Brian Rosman.

Looking back over newsclips and materials from April 2006, I found an arresting editorial supporting Chapter 58 written by Ed Haislmaier, a Senior Research Fellow at the Heritage Foundation. His article was called “The Significance of Massachusetts Health Reform.” Here are some direct quotes:

“Some commentators, by getting wrong even the most basic facts of what the legislation actually does, have offered wildly inaccurate interpretations of the bill and its likely effects.”

“The basic insight behind a state-sponsored health-insurance clearinghouse or exchange (like the Connector) is that markets sometimes work more efficiently and effectively when there is a single place to facilitate diverse economic activity. Like a stock exchange, the health insurance Connector in the Massachusetts legislation will be a clearinghouse to match buyers and sellers efficiently and to facilitate the collection and transmission of payments, often from multiple sources.”

“The Governor and legislature have provided their citizens with the tools to achieve what the public really wants: a health system with all the familiar comforts of existing employer group coverage but with the added benefits of portability, choice, and control.”

“Other governors and legislators would be well advised to consider this basic model as a framework for health care reform in their own states.”

From today’s vantage point, it’s hard to believe this came from the Heritage Foundation, but then, maybe not so much. Heritage was founded in 1973 as a conservative alternative to the Brookings Institute and placed itself in the ideas vanguard of the 1980s Reagan revolution. Unlike other policy shops back then, Heritage proactively sought to connect conservative and libertarian thinkers with friendly members of Congress and Administrations. They nurtured ideas and sought champions for them.

Continue reading “Massachusetts Health Reform at 10 – A Surprising Look Back”