The wrecking ball of Romneycare: A retrospective

Printed from:

“Is it getting better,
or do you feel the same?”
— U2, “One”

Like a marauding, unrepentant thief in the night, Romneycare, turning 10 this month, continues, unabated, its stealthy larceny and stony legacy. It is the giant wrecking ball of public policy that is smashing into oblivion any semblance of fiscal discipline in Massachusetts.

Known formally as the Act Providing Access to Affordable, Quality, Accountable Health Care (2006), a name long on promises but short on pragmatism, otherwise known as Romneycare (for its principal architect, former Massachusetts governor Mitt Romney) it spawned, of course, another massive government intrusion: The Patient Protection and Affordable Care Act (“ACA,” 2010), otherwise known as Obamacare, that had to be read to be believed. Together, they were thought to be the political pixie dust that would cure much that ailed the healthcare system, locally and nationally.

Defenders of these reforms cite “progress.” In Massachusetts, however, can one justifiably call it progress with a universal healthcare system that is not universal, a system designed to contain costs that sees costs continuing to rise and a system created to offer choice and accessibility that now penalizes its people for choosing not to participate?

For some perspective, consider some history.

In 1988, Beacon Hill passed “universal” healthcare. Scheduled to be implemented in 1992, most of its key provisions, such as employer mandates, were ultimately repealed by 1996. A tiny minority of Republican state legislators and then-Governor William Weld, with support from business leaders, slowly dismantled and defunded substantial portions.

The Commonwealth tried again. In January 1997, The New England Journal of Medicine said that effort represented “an ambitious plan to expand access to healthcare services for children and to restructure Medicaid. Elements of that initiative could be used as a model for other states and for the federal government in charting the next stage in the process of improving access to healthcare.”

In 2006, the Bay State passed its third major healthcare reform, Romneycare. According to Health Affairs, its sweeping features “include[d] a shift of federal Medicaid dollars from institutional support to individual subsidies, establishment of an insurance ‘Connector,’ individual and employer responsibility, a small-firm and individual insurance market merger, and provisions to address racial and ethnic disparities.”

Such overreaching grandiosity was subject to surprising skepticism from left leaning media. In an April 2006 editorial, The New York Times suspected “lots of details must still be worked out, and there are already concerns that the financial underpinnings of the plan are shaky.” In March 2009, the Institute for America’s Future concluded, “Since the Massachusetts plan does not contain any mechanisms for reigning in the rapidly increasing cost of healthcare, the plan has limited potential for long-term sustainability.”

Dr. Rachel Nardin, Assistant Professor of Neurology, Harvard Medical School, published in 2009 “Massachusetts’ Plan: A Failed Model For Health Care Reform,” remarkably prescient and devastating. It should have been read by the entire Massachusetts congressional delegation before voting on the ACA.

Her analysis, even then, empirically refuted much of what the reckless legislation had guaranteed locally. Her verdict will, in retrospect, also presage what is becoming evident in the federal program.

Of Massachusetts: It “has not achieved universal health insurance coverage.” Only 10.4 percent of its population was lacking coverage before the law, one-third lower than the 2006 national rate of 15.8 percent. “The reform has been more expensive than expected.” Further still, “cuts to safety-net providers have reduced health resources to the state’s remaining uninsured …” Finally, “the law reinforced the economic and political power of health insurance firms … failed to reduce over reliance on expensive, high technology services.”

The report concluded then — and still true today — that the reform law “is not providing universal access to care even in a state with highly favorable circumstances, including previously high levels of spending on healthcare for the poor, high personal incomes and low rates of uninsurance. It is not a model for the nation.”

Transitioning Romneycare to conform to Obamacare’s ACA myriad rules and regulations in 2013 has also been a calamity, estimates Pioneer Institute. And who can forget former governor Deval Patrick’s quip that, upon the crashed Mass Connector website, that ACA was not a new law, but a “values statement”? Or that passage of national healthcare — based upon the flawed Massachusetts model – was dependent on “the stupidity of the American people”?

After a decade, Romneycare itself is a code blue patient.

Only five years after its implementation, there were reports of a critical shortage of doctors due to rising costs, greater patient accessibility and administrative hurdles. It also gave rise to longer wait times and an increase in concierge doctors and, arguably, an over reliance on specialty care, not primary care. In this environment doctors in Massachusetts in 2014 wrote 4.6 million prescriptions for opioids in a state of 6.7 million residents.  Last year it was estimated that 3.6 percent of the Commonwealth population still remains uninsured, and affordability remains an issue.

Perhaps most importantly, Romneycare needs a quadruple financial by-pass.

For many years, healthcare spending at the state level was only being sustained because of generous federal subsidies, Medicaid waivers and stimulus money. State expenditures on healthcare today account for approximately 45 percent of the budget, up from 30 percent from a decade ago (more than $15 billion is allocated to the state’s Medicaid program, known as MassHealth, which provides healthcare coverage to a quarter of all Commonwealth residents; the state budget is $39.6 billion). And the 2015 Cost Trends Report, issued by Massachusetts Health Policy Commission, suggests a troubling future if changes are not made.

In Ernest Hemingway’s The Sun Also Rises, the fictional character Bill asked, “How did you go bankrupt?” To which the character Mike replied, “Two ways. Gradually, then suddenly.” Today’s incarnation of Romneycare is a frightening prospect of life potentially imitating art.

James P. Freeman

James P. Freeman

James P. Freeman is a New England-based writer and a former Cape Cod Times columnist. Read his past columns here.