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MassFiscal Scorecard Update: Budget Rules

by: MassFiscal

Thu Apr 10, 2014 at 15:04:09 PM EDT

(the scorecard - promoted by Rob "EaBo Clipper" Eno)

There's not a lot left to mention that hasn't already been said about the debate-stifling rules (H. 3999) adopted by the House of Representatives on Tuesday for debating the FY2015 budget.

Needless to say, MassFiscal is scoring four of the most problematic votes taken during the debate. They are listed below along with brief commentary. As always, we welcome your feedback at

Allowing amendments dealing with local aid (Roll call #324): The amendment offered by minority leadership (Reps. Jones, Peterson, Hill, Poirier, and deMacedo) sought to remove the restriction on proposing changes to local aid levels. MassFiscal strongly SUPPORTED this amendment. House leadership opposed this effort on the grounds that local aid levels have already been set in prior legislation. It failed 31-115 (D: 2-115 [Reps. Garry and Zlotnik]; R: 29-0)

Allowing amendments dealing with EBT and welfare reform (Roll call #325): The amendment offered by the minority leadership sought to remove the restriction on proposing reforms to EBT and other similar programs. MassFiscal strongly SUPPORTED this amendment. House leadership opposed this effort on the grounds that an EBT reform bill is currently in conference committee.  It failed 31-115 (D: 2-115 [Reps. Garry and Zlotnik]; R: 29-0)

Allowing extra time to propose amendments (Roll call #326): The amendment offered by the minority leadership sought to change the deadline for filing amendments to the budget from April 11th (48 hours after it was released) to April 16th (1 week later). MassFiscal strongly SUPPORTED this amendment. House leadership opposed this effort on the grounds that it would make the budget process messier. It failed 29-116 (D: 0-116; R: 29-0)

Final passage of rules for debating the budget (Roll call #327): This was the final up-or-down vote on passing the resolution outlining the rules for debating the budget. In large part because of the failure the amendments described above, MassFiscal OPPOSED passage of the resolution. It passed 117-29 (D: 117-0; R: 0-29).

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Budget Votes Needed? Katherine Clark to be sworn in less than 48 hours from poll closing

by: Rob "EaBo Clipper" Eno

Thu Dec 12, 2013 at 10:22:56 AM EST

As we reported yesterday, John Boehner is holding a vote on the Murray-Ryan budget compromise bill today in the House of Representatives.  There has been a split in the GOP in DC over this bill, and progressive groups have also found fault in the bill.  That's why what is happening today is interesting.

In Massachusetts we've been through enough special elections to know that recently elected officials are not usually sat within 48 hours of the close of their elections.  The U.S. Senate waited waited a little over two weeks to seat Scott Brown.  Katherine Clark (D-MA) is being seated today, according to published reports.

This leads to the question, why the rush?  Is Clark being rushed for her vote for the budget compromise.

Photo Credit: CSPAN Tweet

Discuss :: (14 Comments)

$500M Tax Increase Passed, Deval Says Not Enough

by: Rob "EaBo Clipper" Eno

Thu Jun 27, 2013 at 07:46:20 AM EDT

Yesterday both the house and senate passed a $500M tax package, supposedly to pay for transportation projects.  The taxes include a 3 cent increase in the gas tax that will increase every year with inflation, this way the legislature will never have to vote on the tax again.  The house passed the bill by a vote of 106-47 (roll call not yet available).  The Senate only had six votes against.  

Also included in the legislation is a software services tax.  The tax, according to Geoff Diehl (R-Whitman) is poorly defined and will be subject to interpretation by the Department of Revenue, and must be enacted within 4 days of passage, to start July 1, 2013.

Deval Patrick has also said that he is going to refuse to sign the bill because it, wait for it, doesn't raise taxes enough.

In a statement issued by his office Wednesday evening, Patrick said he could not support the bill because it fails to account for a revenue source that will not be available in the future. While the statement did not specify that source, it was an apparent reference to tolls on the western portion of the Massachusetts Turnpike that are scheduled to be taken down in 2017.

Without those tolls, the Patrick administration believes the $805 million in new transportation funding that the bill promises by fiscal year 2018 would not be achievable.

Of course the Governor threw his temper tantrum while out of the state.  There is no news if it involved a bottle of chardonnay and a nap.

Discuss :: (2 Comments)

Republican Budget Amendments Part 4 - Brad Jones Republican Leadership Office (II)

by: Rob "EaBo Clipper" Eno

Sat Apr 13, 2013 at 08:48:40 AM EDT

The amendments coming out of the Republican Leadership office are mighty wordy.  We were only able to put 4.5 amendments in the last post before reaching the character limit in our software. So here's another section of GOP Leadership Office Amendments.

See them after the jump...

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Republican Budget Amendments Part 3 - Brad Jones Leadership Office Amendments (I)

by: Rob "EaBo Clipper" Eno

Sat Apr 13, 2013 at 07:56:47 AM EDT

Here we will take a look at the amendments submitted by Brad Jones on behalf of the Republican Leadership Office.

These bills were all filed by Brad Jones and cosponsored by members of the caucus who are listed in each amendment.

The amendments can be seen after the jump.


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Republican Budget Amendments Part 2 - Reform Amendments

by: Rob "EaBo Clipper" Eno

Sat Apr 13, 2013 at 07:20:21 AM EDT

Part 2 of the series on Budget Amendments will look at Republican reform amdendments, most of which were filed by Marc Lombardo (R-Billerica), Shaunna O'Connell (R- Taunton), Geoff Diehl (R-Whitman), Kevin Kuros (R-Uxbridge), and Jim Lyons (R-Andover).

Take a look after the jump.

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Republican Budget Amendments Part 1

by: Rob "EaBo Clipper" Eno

Sat Apr 13, 2013 at 06:29:50 AM EDT

The House budget for Fiscal year 2014 is out, and can be read at this link.  In addition, amendments to the budget were due yesterday at 5:00 PM.  Here at Red Mass Group, over the weekend, we will list all Republican Amendments.  They will be listed in amendment number order.  

You can see the first set of amendments after the jump.

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Jobs and the Economy Still a High Priority

by: MassFiscal

Tue Feb 19, 2013 at 08:10:47 AM EST

Paul D. Craney of Mass Fiscal Alliance has a column in today's Taunton Daily Gazette and Fall River Herald and makes the point about the single issue that unites Democrats, Republicans and unenrolled voters, read it here.

Discuss :: (0 Comments)

The Tipping Point Timeline

by: Dan Winslow

Tue Feb 12, 2013 at 21:29:07 PM EST

(Charts and Graphs... - promoted by Rob "EaBo Clipper" Eno)

I'm issuing a "tipping point timeline" of  the key fiscal events during the campaign that will highlight Washington gridlock that is putting the Nation’s economic recovery at risk.  Washington isn’t working.  Too often the Washington insiders talk past each other rather than work together to solve problems.  The scope of the problem is clear: at the current rate of spending, the size of the federal debt will soon surpass the size of the national economy.  What isn't clear is Washington’s will to fix it.

 photo 17904111-2880-4179-94e1-baedfea055fa_zpsdd33bd56.jpg

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Romney routs the President. The GOP has chosen wisely.

by: Karl Marx

Wed Oct 03, 2012 at 23:08:52 PM EDT

( - promoted by Rob "EaBo Clipper" Eno)

Mitt Romney re-introduced himself to the nation with a stunning performance that even David Axelrod, with a very thin reed upon which to praise his boss, gave the former MA governor points for style.

But it was Romney's substance that rolled over Obama throughout the 90 minute debate. On taxes, the budget and health care, Romney was well-briefed, intelligent and exceptionally crisp. His strong convention speech was strong but soon forgotten in the noise of the campaign. The debate performance lost none of the August enthusiasm. The resilient Romney has come alive when it matters the most. Game-change is a term that doesn't capture the energy coming from the once-skeptical base from last night's showing.

In contrast, Obama was off his charming game, stumbling, stretching for facts, grasping for flashes of me-too responses. Obama favors cutting taxes. Did you hear that?  The debate showed that Obama has spent too much time on the night-time shows and The View, away from the gritty details that spell success. Can we thank Romney stand-in, Senator John Kerry for bad preparation? And can we now praise Sen. Rob Portman for any sagely advice given to Gov. Romney?

Romney was presidential and thoughtful. He put in a performance that not only revived his candidacy but the Republican Party. Romney reminds us that he is a GOP presidential candidate who can string together a coherent sentence freeing use from the despair of candidates who don't get the power of language.The party faithful who early on put their faith in Romney have been vindicated. The cantankerous Tea Party should realize the stakes on November 6. Romney's citation of the 10th amendment and its wrap-around defense of RomneyCare was a shrill call to those worried about the breaching of the constitution by executive order.

The President's performance was so listless and unfocused that the compliant mainstream media refused to spin on his behalf. It too must think of its credibility on occasion.  

The President  declined for some reason not to sting Romney on the supposed weak links of the GOP recapitulated time and time again by the media:  no mention of the Romney 47% gaffe, no talk on budget items favoring women i.e. health care and family planning. There was the usual pandering to college students by President who blamed the fee-gauging bankers, those middle men in the student loan chain. But the President could not connect.

More critically and more specifically the superior Romney performance exposes the pathetic liberal media bias that has dominated the news cycle since the end of the conventions. Romney has called them out. He has the details. He has the style. He has the chops.

Look for the media to sober up and assume its natural default position boosting Obama in the next debate.

A post-debate insta-poll from CNN showed 67% believed Romney had a superior night.

Game on!

Discuss :: (8 Comments)

Beaty Asks Governor Patrick, Murray & Others, To Sign 'Taxpayer Protection Pledge'

by: RonaldBeaty

Wed Feb 01, 2012 at 19:11:34 PM EST

For social justice reasons, and simply as one of the tens of thousands of registered voters and citizens of this Commonwealth, I am writing to openly, respectfully and impartially call upon Massachusetts Governor Deval Patrick, Senate President Therese Murray, House Speaker Robert DeLeo, State Senator Dan Wolf, as well as all federal, state, county & municipal public office incumbents and candidates in Massachusetts to sign the Citizens for Limited Taxation, "Taxpayer Protection Pledge."

Bearing in mind the ongoing tough economic times that we all face, the aforementioned pledge provides a measure of good faith by said office holders and candidates to the taxpayers and constituents of their respective geographical areas and to all people within the Commonwealth of Massachusetts. Furthermore, it clearly indicates that they shall oppose and vote against any and all efforts to increase taxes during their tenure in office, if elected.

Cape Codders, along with the other citizens of this state, need to be reassured that their interests are going to be looked after and protected by the individuals they vote into public office. They do not need to have any further economic burdens thrust upon them in the form of increased taxes of whatever type for at least the next several years at a minimum.

Thank you.

West Barnstable, MA  

Discuss :: (0 Comments)

"Mandatory Spending" a Cowards Cop-Out

by: Rob "EaBo Clipper" Eno

Thu Jan 26, 2012 at 12:53:37 PM EST

Over the past couple of weeks we've heard countless officials talk about the "fixed cost", and "mandatory spending" problem we face as a Commonwealth.  Nothing could be farther from the truth.  We don't have a problem of that magnitude, because under our constitutional system a crisis of that type cannot exist.  What we have is a cowardice on the part of leaders to take on a rapidly spinning out of control model of government.

The Massachusetts constitution is clear.  The legislature appropriates, each year, the spending of the Commonwealth and the Governor approves it.  No where in the constitution does it say that we must outlay anything of a mandatory nature.  

The "fixed costs" that Governor Patrick, and his administration carp about are statutory requirements of law.  Laws which can be changed at any time, if our leaders had the courage to do so.  

The growing ranks of Republican legislators on Beacon Hill would do well to remind the governor and his Democratic allies in the legislature of this fact as budget season progresses.  It would show the public that the GOP is pushing for real change.

Continuing down the path we are on is not "mandatory".  It is cowardice on the part of those we elect to actually lead.

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Deval: Take It From Bill Gates

by: DeanCavaretta

Thu Aug 18, 2011 at 14:27:27 PM EDT

Back in February, Bill Gates gave an interesting lecture regarding the effects of unsustainable State Budgets on public education. He brings up a key point, one which lawmakers everywhere, but especially Massachusetts, should take note of - unfunded liabilities will not be remedied by increased revenues, but by increased reform. You can see the video here -

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Lehigh Takes Brown Down for Dishonesty and Cowardice

by: ConcernedVoterInMass

Wed Aug 17, 2011 at 10:28:14 AM EDT

Leave off the last T for "Takedown" as Scot Lehigh crushes Scott Brown.

We all read Scott Brown's dishonest, fantasyland, revisionist history op-ed from a few days ago.  You know, the one in which Massachusetts never raised revenues to close budget gaps and that Standard & Poor's upgrade of Massachusetts' credit rating had nothing to do with tax increases.

The folks over at the Blue Blog from which Red Mass Group "sampled" its name wasted no time in poking holes in Brown's revisionist history.

In today's Globe, Scot Lehigh goes even further to point out Brown's dishonesty and outright cowardice when it comes to straight talk on taxes, other revenues, and budget balancing:

No it wasn't easy. Nor was it done simply by cutting spending.

In fact, in 2002, the Legislature passed a revenue package worth about $1.1 billon - tax increases that took effect on Jan. 1, 2003. That was part of a balanced approach that saw the state reduce spending, raise taxes, and tap rainy day reserves, notes Michael Widmer, president of the Massachusetts Taxpayers Foundation. [...]

Instead, spokeswoman Marcie Kinzel called shortly thereafter. She said the senator was talking specifically about action taken under Mitt Romney, who became governor on Jan. 2, 2003. And to be fair, later in the column, Brown does write that "when the Legislature was faced with those daunting deficits in 2003, we didn't panic and increase taxes.''

That's certainly a convenient starting point, ignoring as it does the big tax hike that began to benefit state coffers that very year. But even then, the notion that once Romney took the helm, Beacon Hill simply cut spending is misleading. Under Romney, the state hiked fees for permits and licenses and closed corporate loopholes to raise hundreds of millions in new revenues.

Those fees and loophole closings (closings that businesses certainly viewed as tax hikes) brought in more than $600 million. Include other one-time dollars, and the state used about $800 million in additional revenue to close the budget gap, Widmer says. Add in the fact that the budget problem turned out to be a third smaller than the preliminary projection of $3 billion, and the truth is clear: New revenues were a substantial part of the solution.

Scott Brown's spokeswoman spins the lie by saying that even though the budget gap was closed by a huge tax increase that took effect in 2003, it doesn't count - heck, it doesn't exist! - because it was passed in 2002.  That's a "heckuva" way to govern, Scotto.  No cooking the books there to attempt to make an utterly weak and mathematically indefensible point.

And then there's still Romney historic pile-on of fees!  Desperate to raise anything that could be nominally called a tax, Romney hikes fees and closes loopholes.  Which are revenue!  And which Brown oh so conveniently ignores to attempt to make an intellectually and factually dishonest point.

Then, Lehigh throws down the most important of gauntlets to test Brown's supposed "courage" and "independence":

If he were interested in that kind of clear-eyed analytical approach, he wouldn't be contending that Massachusetts had solved its budget problems through cuts alone. Instead, he'd acknowledge that new revenues, be they the 2002 tax hike or the Romney-era fees, loophole closings, and one-time measures, were also a big part of the solution.

And if, with that truth acknowledged, Brown was still gutsy enough to hold Massachusetts up as a model? Well, then, he'd be showing real independence of mind by breaking with the GOP's no-new-taxes absolutism and forthrightly advocating the kind of balanced approach most fiscal experts recommend.

Hey, Scotto, got guts?  Want to put some oomph behind your heretofore weak claim of being an independent voice?  Call for new revenues!

Heck, if Brown made a floor speech in the U.S. Senate with some compromise position on taxes - say "$250,000 is just middle class in some areas, but we can all agree that an annual income of $1 million is well-off enough to contribute more in income taxes, so let's return incomes of $1 million+ to the Clinton era 39% marginal rate, when America's economic grew at its fastest rate in history, which, along with spending cuts, will help close the federal deficit and get our fiscal house in order; and I urge Speaker Boehner and the House GOP to take up this measure, too, in the name of economic integrity" - Brown would instantly be hailed as a bipartisan leader, a true independent, and a real force for compromise and achievement in Congress.

But, then again, Brown isn't really an "independent" voice, is he?

Discuss :: (16 Comments)

Beacon Hill's Budget MassHealth Mirage

by: Josh_Pioneer

Fri Jul 01, 2011 at 11:17:39 AM EDT

(You mean to tell me that the powers that be on Beacon Hill aren't telling the truth.  I'm shocked, shocked I tell ya. - promoted by Rob "EaBo Clipper" Eno)

Today the Legislature will vote on the final state budget.

I wanted to take one last opportunity to highlight the unrealistic assumptions that are being used for the MassHealth (Medicaid) program. If the state is unable to achieve these “savings” and instead follows historic spending trends, it could be looking at a $900 million gap, just for MassHealth.

For years, Medicaid costs have advanced robustly, at roughly 7% per year which is a big number given that it’s building on a base of billions. See Pioneer's work on this here.

The Legislature is hoping for the state to drive down its per Medicaid enrollee costs by 3.5% next year. How have we done at that recently? On average, per enroll costs have gone up by 5% per year and it has never been negative over the past seven years.

Medicaid projections

First introduced in the Governor’s budget, both chambers followed his lead to include close to $1 billion in “savings” to decrease spending on the program. (The Senate didn't reach the same level, because of additional spending on adult day health and children's behavioral health, among a few others)

The most certain of the cuts–reductions in reimbursements rate to providers– may be in jeopardy given recent comments from the Obama Administration.(See my blog on the issue here) However, reducing reimbursements rates only exacerbates the access problem Medicaid patients face to find a doctor that will take their insurance.

Other sections of the final budget that pertain to MassHealth and should be noted are:

1) The inclusion of a forecasting office, because MassHealth has such a poor record in this area.

2) $1,000,000 for the expansion of auditing activities in MassHealth.

Before the Legislature and the Governor--assuming he signs the budget without amendment-- can claim a balanced budget, they need to address the real issues in the MassHealth program.

Discuss :: (1 Comments)

Conservative Darling Paul Ryan Lining His Own Pockets

by: ConcernedVoterInMass

Sat Jun 18, 2011 at 15:56:05 PM EDT

A Daily Beast investigation discovers:

Ryan's Shrewd Budget Payday
Exclusive: The congressman stands to make money from his stakes in four businesses that lease land to energy companies which would benefit from $45 billion in tax breaks and subsidies in his proposed budget. Daniel Stone reports.

When House Budget Committee Chairman Paul Ryan unveiled the GOP blueprint for cutting government spending, he asked Americans to make sacrifices on everything from Medicare to education, while preserving lucrative tax subsidies for the booming oil, mining and energy industries.

It turns out a constituency within his own personal investments stood to benefit from those tax breaks, Newsweek and The Daily Beast have learned.

The financial disclosure report Ryan filed with Congress last month and made public this week shows he and his wife, Janna, own stakes in four family companies that lease land in Texas and Oklahoma to the very energy companies that benefit from the tax subsidies in Ryan's budget plan.

Ryan's father-in-law, Daniel Little, who runs the companies, told Newsweek and The Daily Beast that the family companies are currently leasing the land for mining and drilling to energy giants such as Chesapeake Energy, Devon, and XTO Energy, a recently acquired subsidiary of ExxonMobil.

I assume everyone here at Red Mass Group will be tripping over themselves to call for Paul Ryan's resignation, or at least his stepping down from his Chairmanship of the House Budget Committee for this blatant conflict of interest with a lawmaker abusing his position to line his personal bank account and the bank accounts of his family, right?  Or will there be silence since Ryan is a Republican?

Discuss :: (18 Comments)

Open letter to the Budget Conference Committee

by: AmberPaw

Fri Jun 17, 2011 at 11:24:10 AM EDT

( - promoted by Rob "EaBo Clipper" Eno)

June 17, 2011

RE: The FY 12 Budget, outside sections, and line item 0321-1510

Dear Senator Brewer, Senator Baddour, Senator Knapik, Rep. Dempsey, Rep. Kulik, and Rep. deMacedo:

Outside sections in the budget for FY 12 that create, destroy, or transform programs concern me.   Outside sections do not undergo the committee process.  Outside sections fail to provide notice to the public, do not receive comments, testimony or feedback from those they affect, and lack study and data.  Destroying and creating programs via outside sections adds to the public's perception of secrecy and corruption on Beacon Hill.

All of these problems are demonstrated with regard to line item 0321-1510 and the alleged "reform" of indigent defense to "save money".  No hearing was held.  No public comments were solicited.  No hearings were held to gauge or study the impact on local businesses of such an enormous change, nor were local businesses placed on notice publically.

Today, 90% of indigent residents receive politically independent and private representation.  This representation also provides jobs and business for secretaries, investigators, clerks, book keepers, copy shops, restaurants, office supply stores, landlords, and cleaning companies all across the commonwealth.  I submit that every new state attorney and state staffer to be created by the outside sections that seek to transform indigent defense will destroy at least one job elsewhere, to concentrate those jobs in Boston.

I contend that rather than "saving money" the so-called "reform" of indigent defense will destroy jobs, increase costs, and eviscerate small law practices and vendors in towns like Methuen, Palmer, Yarmouth and Shirley.  These small law practices will be forced, if they lose even 20% of their income, to lay off staff, downsize, or close.  Often, solo and small firm attorneys provide leadership in their towns, local access to legal services, and are sources of civic engagement serving as selectman, on school boards, and as unpaid members of local nonprofit boards.

Senator Gale Candaras was right that a change to a program providing so many benefits to both indigent citizens accused of crimes or removed from their parents or deprived of their children, and to local communities requires an economic impact study.   Transforming indigent defense behind closed doors is wrong, and will only add to public perception that Beacon Hill cares more about special interests than the needs of citizens as so sadly demonstrated in the tragic fall of Speaker Sal DiMasi. Please require an economic impact study before taking such drastic, and I believe, harmful action.  

Disclosure: I am a solo, family law attorney with part of my practice devoted to appointed child welfare cases at both the trial and appellate level.  I do not do criminal law at all.

Over the years I have seen case increases due to unfunded mandates.  Examples of such unfunded mandates are the passage of the Uniform Probate Code, which granted new rights to counsel or case law such as In RE Hilary, which expanded the right to counsel of parents of children in CHINS cases.


Deborah Sirotkin Butler, Esq.

cross posted on bluemassgroup

Discuss :: (17 Comments)

Prioritizing the Budget During the Great Recession

by: DeanCavaretta

Thu Jun 16, 2011 at 13:50:27 PM EDT

As most citizens are currently aware, due to the fiscal crisis, the Massachusetts Legislature is forced to take the hedge clippers to the severely overinflated state budget. However, in their haste to try to make everyone happy, they're missing the mark with their cuts, which include budget reductions in higher education, Local Aid, and social services. At the same time, this budget also includes a 3 percent pay raise for some 4,000 state managers. This proposed pay raise will add some $9.9 million dollars to the already massive budget, a budget that they've supposedly been trying their best to reduce. If they feel the need to spend this money, then it should be going elsewhere. Let's consider what's wrong with the current picture.
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Scott Brown: For Destroying Medicare Before He Was Against It

by: ConcernedVoterInMass

Mon May 23, 2011 at 12:26:42 PM EDT

At this point, everyone following national political news knows that the Paul Ryan budget is synonymous with eliminating Medicare.

Over the last month or so, Republican Scott Brown sounded all for it.  He said things like "I will vote for it" and "thank God" for Paul Ryan's Medicare-eliminating budget.

So Republican Scott Brown was in favor of voting to eliminate Medicare.  You might not like that fact, but it is a fact.

However, after his comments in support of eliminating Medicare, somebody must have let Republican Scott Brown know that, even though Medicare is a socialist "Big Government" giveaway program, people really, really, really like it.

What's that music?  Ah, it must be the cue for the big flip-flop.  That's right.  Despite saying earlier that he would vote for eliminating Medicare, now he's saying he'll vote against it.

Independent?  Integrity?  Nope.  Just uninformed, all-over-the-place, and flip-flopping.  That's Republican Scott Brown.

Discuss :: (7 Comments)

Gov. Patrick's Regulatory Regime for Payment Reform

by: Josh_Pioneer

Tue May 17, 2011 at 12:58:17 PM EDT

(Pioneer weighs in on Patrick's Medical Unification Board plan. - promoted by Rob "EaBo Clipper" Eno)

 The Legislature held a hearing on the Governor's proposal to change the payment methodologies for the delivery of health care yesterday.

Full Written Testimony is on the Pioneer Blog

Pioneer was there, summary below: 

The bill before the Committee today would, as currently written, set up a framework for unprecedented regulatory intervention in the health care marketplace, and possible significant adverse impacts on health care access and costs in the Commonwealth. The issues of greatest concern are:

1) The Heavy Hand of and Role of Regulation: The 26 + instances in which major policy decisions are left to be made in the regulatory process.

2) Accountable Care Organizations or Bust: The overreliance of the proposal on Accountable Care Organizations while the data on cost savings and health outcomes is mixed at best, and nonexistent for many quality measures.

3) Where is the Consumer?: The lack of serious engagement of consumers with decision making tools and financial incentives to empower them to be better consumers of both health insurance and health care services.

4) Timing & Expectations: The realistic timeframe for reform to have a reductionary impact in health care spending is at least 5-10 years, with an increase in spending likely in the short term. In other words, the Governor’s plan is a long term play. These reforms will mean little to small employers that are seeing double digit premium increases for the third or fourth year now, and that trend will not change under this plan.

5) Medicaid: The Medicaid program accounts for over 30 percent of the state budget, and is crowding out spending on other public goods and providing suboptimal access to health care services for the population served. From a state budget perspective, any health care spending containment strategy must tackle reforming this program.

Payment reform is a means to an end, not the end in itself. The goal of any bill should not be to establish a majority of (ACOs) or to have lots of different payment methodologies in place, it should be to provide the best quality care while simultaneously reducing health care spending.

The Governor’s bill relies too heavily on the regulatory process-- and the discretion of regulators and state officials-- to regulate and rate-set our way out of the health care spending problem. The economic issues of this approach are many and quite weighty. There is the real possibility of our health care market becoming less competitive and innovative, more consolidated, and much more expensive under the vision being laid out.

However, just to be precise, the Commonwealth doesn't have a cost problem, we have a spending problem. A cost problem suggests you should price set. Simply setting prices will just get you “less costly” procedures, with more price shifting of course, but not better care. Our spending problem is that we spend too much on procedures that people don’t value the outcomes of. It is estimated that 30-40% of spending is on unhelpful care. We need to organize a system in which the spending decisions are ultimately with the family and not a bureaucrat.

With this being said any effort to control health care spending needs to focus on engaging consumers, promoting transparency of cost and quality data, targeting the 20% of patients that account for 80% of health care spending.

One of the most interesting, and often overlooked findings of the Attorney General’s report on cost drivers, was that the method by which a provider was paid did not correlate with better quality care, or even less expensive care. An alternative approach is possible, one in which the Commonwealth lays out a very broad framework to incentivize integration, innovative service delivery, and rewards consumer engagement. This approach produces fewer economic issues and is much more likely to lead to long-term savings.

The caution Pioneer brings will be echoed by many others today, what we lack is a financial interest in the outcome of any bill that passes. We are here today to stress the importance of engaging consumers in any change of the health care delivery system. Without more informed quality and cost conscious consumers, we will return back here in 5 to 10 years to determine the next top down approach to contain spending. Our advice is to go slowly now, and get the incentives correct the first time. 

Full Written Testimony is on the Pioneer Blog.

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Red Mass Group is owned and operated by Robert Eno. It is not authorized or paid for by any candidate or committee.
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