Massachusetts residents have now had two full years to evaluate the leadership of Gov. Charlie Baker, whose victory over Democrat Martha Coakley in the fall of 2014 restored what passes for balance in the Bay State — a moderate Republican governor working side-by-side with a Legislature just to the right of Vladimir Lenin.
In evaluating Baker, only one measure matters, and it isn’t the price of lobster or the fortunes of the New England Patriots.
Thanks to former Gov. Mitt Romney, what matters most for any Massachusetts governor in the early 21st century is how he or she handles the cost of health insurance.
By that measure, Charlie Baker simply isn’t a moderate Republican. He’s a Democrat.
Baker earns his “D” not because the cost of the MassHealth program is skyrocketing, to an estimated $16.2 billion, or about 40 percent of Baker’s proposed $40.5 billion budget, in fiscal 2018. It is unfair to hold Baker responsible for a decade of healthcare history in the United States and Massachusetts.
Rather, Baker earns the “D” — and should earn a “D” among Massachusetts’ perennially disappointed Republicans — because his approach to controlling costs is indistinguishable from that of Democrats.
Baker, like his predecessor Deval Patrick, has pushed for and obtained Medicaid waivers that have meant billions of additional federal dollars for Massachusetts. But those dollars have simply masked the very real cost increases in the state’s Medicaid and MassHealth programs.
The noises that Baker makes about cost control, such as temporary moratoriums on mandates, tinkering with group contracts and “curbing waste and fraud,” are nothing compared to the deep structural changes that real Republicans are talking about, including:
- Tax credits that would allow those without employer-based insurance to buy the plans they want — including low-cost, “mini-med,” and catastrophic coverage plans banned under Obamacare.
- Permitting health insurers to sell their plans across state lines.
- Increasing the availability and flexibility of Health Savings Accounts (HSAs).
If Baker is or ever was remotely interested in such ideas, voters can be forgiven for failing to take note.
This January, Baker wrote to U.S. House Majority Leader Kevin McCarthy, R-California, to defend key portions of Obamacare, including the ban on denying coverage based on pre-existing conditions. And now, faced with a $600 million shortfall in the MassHealth budget, Baker is doing what all good Democrats do — proposing a tax increase.
He’s not calling it a tax increase, to be sure, but the effects are the same: Baker’s fiscal 2018 budget proposal would reinstate a $2,000-per-full-time-employee penalty on companies with 11 or more employees who have less than 80 percent participation in their employer-sponsored health plans.
On paper, the penalties would raise about $300 million for MassHealth.
But why should private-sector employers be penalized for failing to offer enough of a given economic commodity — healthcare insurance, in this case — which is akin to many other commodities, but is treated as a basic right simply because of political and social pressure?
Sure, healthcare coverage is a good thing, and making it available to poor and uninsured individuals and families improves and saves lives. Advocates argue it should even save money, since previously uninsured people will, in theory, use primary care doctors before the emergency room. (That hasn’t worked out particularly well thus far, but that’s another story.)
Nonetheless, the nobility of a cause does not justify the extortion of resources from one group — private-sector employers, in this instance.
Doing so is particularly offensive when one of the chief obstacles to those employers reaching the 80 percent threshold Baker has set is the easy availability of those cheaper MassHealth plans in the first place.
The Baker administration’s own figures show this. The administration noted in January that between 2011 and 2015, 118,000 additional full-time workers in Massachusetts were not getting insurance from their employers, 80,000 of whom dropped employer plans in favor of MassHealth.
That shift alone cost taxpayers a net $511.5 million in the fourth quarter of 2015. And that trend continues to accelerate.
Basic economics tells us that making more of a commodity available at a low price will increase demand for it. But robbing businesses to pay for the spiraling costs of a program they can neither control nor compete against should not occur to any thinking person, Republican or Democrat.
For that, you really need a socialist.
Charlie Baker can’t solve healthcare reform alone, but if he’s a Republican, he could prove it by acting like one, and by giving Republican ideas serious consideration. After all, if voters in 2014 had wanted more Democratic answers, they would have elected Coakley.
Chris Sinacola is a Worcester Sun columnist. His observations on politics, current events, history and more appear every Sunday.