To the editor:
This past Tuesday night at about 9:30 as the House of Representatives was debating the 2011 budget, the taxpayers of the commonwealth lost a chance to save between $700 million and $1.1 billion over the next five years.
What's worse than the fact that an opportunity was missed to free up money that might have covered a portion of the $200 million-plus in local-aid cuts that will be included in the state budget, is that the opportunity was missed without even taking a direct vote or having a debate.
It is called "further study," and it is a procedural maneuver used with alarming frequency by the majority party on Beacon Hill to avoid votes they'd rather not take and debates they'd rather not have. At the top of the list of votes and debates to be avoided in the Statehouse are usually those that would bring meaningful, cost-saving reform or provide tax relief for citizens.
The specific "further study" in question was applied to a plan offered by the House Republican caucus that would have the state move MassHealth (the state's health insurance program for financially-needy individuals and families) recipients from a fee-for-service or Primary Care Clinician (PCC) arrangement, to a Medicaid Managed Care Organization (MMCO) arrangement.
The reasoning is simple: These Managed Care arrangements have proven effective in helping to control costs of caring for Medicaid recipients by utilizing extensive care management and preventative programs to produce, on balance, better care and outcomes and greater access to programs for patients than the alternative PCC programs. Thirty-seven percent (and rising) of Massachusetts MassHealth members are already in a MMCO and at least 14 states and the District of Columbia have ended the PCC programs in favor of the managed care arrangements.
No doubt this is an issue that needs study and careful consideration. Medicaid spending is one of the most complicated parts of the budget due to its interaction with federal funding and other overlapping entitlement programs. It also happens to be the largest single area of spending in the budget: MassHealth spending comprises over a third of the state budget and totals in excess of $9 billion every year.
So, on the surface, further study sounds like a prudent step — except when you learn that the issue has been studied to death already.
In 2006, an independent study of other states that had moved to managed care found the potential for five-year savings of $1.05 billion for Massachusetts. In 2007, a second independent study pegged the savings at close to $700 million over five years.
In 2009, the Pioneer Institute noted that MassHealth is an area in "particular need of systemic reform" and included the MMCO reform as part of its "Countdown to Fiscal Sanity" policy brief, which made recommendations on over $1 billion in cost-saving reforms to balance the 2010 budget. (The legislature chose to raise taxes instead.)
But on this night, the Legislature determined that more study, not debate or an up-or-down vote, was needed. Of note for Beverly's voters, it was their current state representative who stepped to the rostrum to make the closing argument to send the plan for further study, avoiding debate and a direct vote.
Unfortunately, this is the state of Massachusetts under one-party rule: Trying to sneak through a property-tax increase while ignoring a major municipal reform on Monday, and then refusing to debate or directly vote upon a major cost-saving reform for the largest portion of the state budget on Tuesday.
I'm afraid to know what the rest of budget week might bring. For the sake of the state's taxpayers, here's hoping that November's elections will bring more balance, more debate and more reform to Beacon Hill.
Brett Schetzsle
Candidate for State Representative
Beverly
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