Bettin on SCOTUS and Reform, Part Trois: More Myths from Massachusetts

April 17th, 2012 | Healthcare Reform | Seminars & Publications

As I continue to study the oral argument transcripts, I am troubled by the government attorneys’ seeming lack of understanding of insurance in general and especially, the Exchanges. I gather that the legal standard for such a proceeding is not what the facts are, but rather what the findings made by Congress in the legislative history are, which I gather are presumed to be facts.  This sets up a rather peculiar circumstance – at least to non-lawyers – of having a case decided not on its merits but on a one-sided legislative history for a bill that was rammed through Congress through a process known as Budget Reconciliation on straight party line votes. 

Returning now to the study of Massachusetts Reform by the Massachusetts Blue Cross and Blue Shield Foundation discussed in my two previous posts on this topic, here is the synopsis of the success of the Exchanges in saving costs for small business:

“The small business health insurance market in Massachusetts has traditionally been dominated by direct sales from insurers and sales through insurance brokers and other intermediaries.  A goal of the Connector has been to offer small businesses a simpler and less costly way to purchase employee coverage, but, as of August 2011, small business sales accounted for only about 6,500 of the almost 40,000 people enrolled in Commonwealth Choice plans. Two thirds of those – 4,217 – were covered through the Connector’s Business Express program, which is available to small businesses that want to offer a Commonwealth Choice plan to their employees and contribute to the premium.”

“Launched in early 2009, Business Express has been hampered by limited participation among the Connector’s Seal of Approval health plans along with opposition from some members of the state’s broker community who believe the Connector should not be involved in selling small business insurance.* After extensive negotiations with the state, all of the Seal of Approval health plans agreed to participate in Business Express during the 20112012 contract period. The Connector has lowered its administrative fee, which is deducted from premium payments, from 3.5 to 2.5 percent and, starting in 2011, small businesses that purchase coverage through the Connector may be eligible for state-funded premium subsidies of up to 15 percent if they offer an employee wellness program that meets certain evidence-based criteria. As of August 2011, 1,554 small businesses were using Business Express to buy employee coverage.”

*A 2010 state law added a seat for a broker representative to the Connector board as of July 2011.

Now, I would reiterate the quote from the Center for Studying Health System Change in my earlier post that found that businesses preferred using brokers, so I find the rather accusatory posture in the above quote to deviate from the facts of the marketplace.

 Oh Massachusetts, model for Reform, why have the facts forsaken thee?

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