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Decoding Baker’s Mass. Medicaid changes

Governor Charlie Baker. AP FILE PHOTO

Reforming MassHealth, the state’s giant Medicaid program, is about as exciting as it sounds — which is probably why the state Legislature wanted no part of such a thankless slog earlier this year. Instead, lawmakers passed the task off to Governor Charlie Baker in the spring, asking him to come up with changes that would bolster MassHealth for the 1.9 million poor, elderly, and disabled residents who rely on its coverage.

The result is the plan that Baker sent to the Legislature last week, which included an array of cost-saving and revenue-raising measures. It would help limit the growing cost of MassHealth, which already accounts for 40 percent of the state budget, without draconian changes to eligibility. It would move some residents now on MassHealth to subsidized Health Connector plans instead.


The administration also hammered out an agreement with the business community for a targeted new tax (er, “contribution”) for the next two years on businesses whose employees use MassHealth, a smaller version of the assessment it proposed in January.

Crucially, the administration says its proposal is a package, and wants the whole thing included in the state budget that’s expected to be finalized soon.

As with any complicated health care proposal with many moving pieces, though, there are elements in Baker’s plan that have critics crying foul. Labor unions don’t like the way it reduces unemployment-insurance rate hikes — the carrot that the administration used to get employers on board with the new tax. Insurers don’t like its mandate that they increase the spread between cheaper and more expensive plans in tiered networks. And some legislators, after electing to sit on the sidelines earlier in the spring, don’t like what they view as the administration’s take-it-or-leave-it attitude.

They’d like hearings, or for the administration to submit its proposals as a separate piece of legislation so they can be fully vetted in a public process.


Now, it’s hardly Baker’s fault that the Legislature passed the buck in the first place, but those asking for time to weigh changes that affect thousands of people do have a point. Some parts of the plan — the new employer assessment and the unemployment insurance adjustments — could go into effect right away in the budget. But other elements, like the changes to tiered insurance, ought to go through the more conventional legislative process. Since some of what Baker has proposed wouldn’t go into effect until next year anyway, there’s time for legislators to scrutinize his plans and make sure he got it right.

Hanging over the entire debate is the uncertain future of federal health legislation, which could upend the health care world in Massachusetts and beyond. It’s impossible to predict what, if anything, will emerge from Congress and the Trump administration.

In the meantime, though, Baker gave the Legislature what it asked for: a plan to stabilize MassHealth’s finances that brings in more revenue from employers. It needn’t all pass at once, but the proposal, or something very much like it, deserves approval.