Boston Herald

The health care dragon


While Congress continues to wrestle with the future of Obamacare, Massachuse­tts is pretty much on its own for the time being — a victim of its enormous success at getting its residents insured.

The good news out of Washington is that at least the state won’t be faced with an imminent loss of Medicaid funds (estimates had the state taking a hit of anywhere from $1 billion to $2 billion). The bad news is that the rate of Medicaid growth — of workers opting for MassHealth even when employer-offered insurance is available — is unsustaina­ble.

In a recent meeting with Boston Herald editors and reporters, David Torchiana, CEO of Partners Health Care, insisted that the genie was out of the bottle — that both employers and lowwage employees saw so much benefit in MassHealth coverage that there could be no turning back the clock.

In fact, the coverage is first rate, co-pays low, and for most it comes free. What’s not to like? Employers, he estimated, saved about $5,000 for every employee who opts out of company-based plans. And he conceded that as good as the health plan that Partners offers to its workers, some opt for MassHealth.

All of which helps explain the latest figures released by the state’s Center for Health Informatio­n and Analysis. It found 65 percent of Massachuse­tts employers offered health insurance to their workers — higher than the 56 percent national average.

However, of those employees eligible for insurance benefits through their employers only 74 percent opted to accept those benefits, lower than the national average of 79 percent. Some, of course, are covered through a spouse’s or parent’s benefit package.

But this latest report provided the data behind Torchiana’s well-informed suppositio­n — that the more low-wage workers employed by a firm, the lower its “take up” rate by employees of the company-offered plan. For firms with a high rate of lowwage workers the rate fell to 41 percent.

Now certainly state efforts to control Medicaid costs — some of which require federal waivers — are to be applauded. But they won’t address the surge of the working poor into Medicaid plans.

That’s where the Baker administra­tion, the Legislatur­e and the employer community will need to focus their efforts. If indeed employers save money every time a low-wage worker opts for MassHealth, then an employer assessment isn’t out of the question — although the figure is certainly up for debate. And the governor’s proposed freeze on unemployme­nt insurance rates for several years would make that less onerous.

Washington’s deadlock on health has provided breathing room. Lawmakers will need to do the rest.

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