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Lead Story

Q&A: MA State Senator Richard Moore, Senate Chair of the Legislature’s Joint Committee on Health Care Financing

MA State Senator Richard Moore

In 2006, Massachusetts passed the Health Care Reform Act, the first comprehensive health insurance plan in the United States. The plan requires all individuals to have healthcare, with the State stepping up for those unable to afford it. It creates a “Connector,” an agency that helps individuals to find an affordable plan, and allows individuals to opt out—for a while—with a set of defined reasons and a penalty clause.

Two years later, it’s working. Yes, “working.” PT spoke with MA State Senator Richard Moore, one of the program’s architects, to find out why.

PT: What is the basic theory underlying the Act?

Senator Moore: The theory behind the plan is the government is playing a role, which varies by people’s ability to pay. The plan is working with employers—it’s still an employer based plan. Therefore, they’re paying the fees. And finally, crucial to the plan is the individual mandate—that each person should be covered or provide a reason why they aren’t able to find an affordable plan.

We still have some people who haven’t signed up. The only people we could be missing are those who aren’t paying their taxes, but we usually catch up with them.

PT: The Massachusetts health care plan has—is—succeeding. Why?

Senator Moore: The enrollment is currently at 650,000, which is better than half of our uninsured number. These are people who had been using the emergency room as their primary care giver. The access issue has been improving as well.

The Urban Institute just released a report that covers the period between September 2006-September 2007. In 2006, we had 13% uninsured. A year later, that figure had fallen to 7%. Since the real push to sign people up was in the September-December period of last year, we think this figure is now much closer to 4%.

PT: Could you be more specific on the factors involved?

Senator Moore: There are several reasons for its success. The first is the cost issue: we have been able to keep it affordable — affordable for people at the lower end of the socio-economic scale. Second, through our Commonwealth Health Insurance Connector, we have been able to get people to find affordable plans that are not necessarily subsidized. The agency has worked with different plans to achieve this result. And finally, the individual mandate has been a factor. A number of people have opted to pay the penalty of $219 per person/per year. In January of this year, that started to get a little more expensive, up to over $900 per year. So, we’re hoping they will choose to be covered since each month the penalty will be imposed up to the maximum of $912 for the year.

PT: Have there been any problems?

Senator Moore: Well, it’s still an employer-based plan, and approximately 72% of employers have been cooperative. We’ll now start focusing on why some large employers are relying on encouraging their employers to access their health insurance through a taxpayer subsidized program. Employers are now paying $295 annually per person. We’ll look at seeing whether this amount is sufficient to cover the costs.

We’re also looking at an increase in the cigarette tax by $1 pack to help pay the difference.

PT: The other side of the issue is the increasing costs of healthcare. What is the State doing about that?

Senator Moore: Yes, we’re focusing on costs: legislation has been approved in the State Senate and will be taken up in the House in the next few weeks. We have proposed spending $25 million to help people get connected electronically—electronic health records, computerized physician order entry and e-prescribing. That will reduce errors and save money and lives.

Transparency is another issue: we’re asking insurers why they have a rise in costs. We’re seeking transparency in reporting of health care provider charge increases as well as looking at why health insurance premiums are increasing. We’re helping to educate the public and payers by asking the providers and insurers to keep them informed.

Through electronic records, transparency, and other issues, we’re seeking where the costs drivers are and hoping to get a handle on the high cost of care.

Doctor and patient

PT: Senator, you mentioned that success also has its costs—in this case the plan is costing the State more. Could you explain that?

Senator Moore: The costs are higher than anticipated, because we have successfully enrolled more than half of our uninsured population. There’s been no crowding out of private sector insurance. Compliance with individual mandates seems good. People are getting better care. There have been a number of inspiring success stories. Overall, the plan is working quite well

PT: Senator, could you quantify that number?

Senator Moore: We estimate that the program will cost $170 million more than we anticipated so about $859 million. And, that’s been incorporated in the budget. Healthcare in all forms—Medicaid, Commonwealth Care, state employee coverage—is about half of our state budget. Everything else competes with health care. So far, the Governor, Legislature, business community, and other stakeholders have all been behind it.

PT: Would you compare Massachusetts’s plan with those of California, and the Presidential candidates McCain and Obama?

Senator Moore: I really haven’t studied these other plans that carefully. California is certainly larger. The biggest difference between the plan proposed by Senator Clinton and the one by Senator Obama is the individual mandate. Otherwise, both plans have some of the features that are in the Massachusetts plan.

The reason for the individual mandate is that it’s necessary to get to universal coverage. People in the under 30 age category think they’ll never get sick or hurt. They need to be part of the plan. Rates in this group are less. Everybody must have insurance if they can find an affordable plan. If they don’t, they can seek a waiver that grants them exemption from any penalties. Most people who are qualifying for the waiver are in the 50-64 range. But, they are also at risk. [Editor’s Note: Senator McCain endorses a pre-tax subsidy to individuals to pay for their health insurance.]

PT: MA has taken the lead where the Federal government has been unable to put together a plan. Any thoughts on that?

Senator Moore: We didn’t see the Federal government solving the problem any time soon. There are so many different interests competing at that level. Our primary hope is that the Federal government continues to be a partner in the health reform plan. We have our Section 1115 waiver to help pay part of the plan. [Editor’s Note: Section 1115 waivers exempt states from certain provisions of the federal Medicaid plan.]

We will continue to be partnering through the Medicare waiver. Our concern is that there are so many restrictions. We’re hoping to make these less restrictive and continue a reasonable level of financial support.

PT: How does the program interact with Medicare/Medicaid?

Senator Moore: There’s not a direct interaction with Medicare. New programs don’t go beyond age 65.

Certainly, some of the programs in Medicare are important such as assistance with graduate medical education. Healthcare is heavily dependent upon Federal assistance. The degree to which the Medicaid gets more restrictive, it creates problems for states in addressing the primary care issue. There is need for both Medicare and Medicaid to increase reimbursement rates for primary care providers since they are critical to holding costs down and promoting prevention and screening.

Prescriptions are also an issue. We need to move more to electronic prescribing to reduce errors and save money. Drug enforcement agencies are still wed to paper for controlled substances. The bill that Senate Baucus (MN) is currently pushing to cut Medicare costs includes electronic prescribing incentives that Senator Kerry (MA) and others have co-sponsored that will provide for reimbursement of electronic prescriptions.

PT: In closing, what would you say is the plan’s most important aspect?

Senator Moore: The most important part of the success of the plan is the near universal support among the stakeholders. Everybody wants to see it work. Every time we hit a snag, we seem to be able to work around it.

PT: Senator Moore, thank you for your time.


Socialized health care
written by AlanR, June 17, 2008
It's not surprising it went over-budget, government has no incentive to stay within when the bureaucrats can just request that the legislature steal... tax more money for the short fall. In fact, the Governor has upped the estimate; 2008-2009 costs will be more like $1.1 billion––a 50% increase over the original estimate from less than two years ago!

And now they've succeeded in driving even more low-cost insurance companies out of Massachusetts with the increased regulation... even less choice for everyone else.

The program has increased demand for health care services without increasing the supply of providers. As a result, patients are having trouble finding providers and waiting lists (Canada here we come) are beginning to develop.

This would be a horrible thing to see happen here in California. I don't want to be forced to have health insurance and be fined if I don't comply. What happened to liberty?

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EDUCATION POLICY: Equality, Knowledge, and Federalism

CA Senator Jack Scott

“Education is the future,” says CA State Senator Jack Scott, who chairs the State's Senate Committee on Education. Everyone agrees “that all Americans deserve a quality education,” but most political leaders launch into the ‘how?’ before answering the ‘what?’ in defining education policy. The 2008 Presidential candidates' position statements, for example, have focused on who sets educational goals and standards: parents or government? (Teachers, students anyone?) Who pays? And, for what? And, where do the federal, state and local governments fit into the equation?

But their proposals beg the question of core principles – ultimate objectives – of what the country’s education policy is seeking to achieve. To gain some perspective, PT spoke with Senator Scott, who brings 16 years as a teacher and 18 years as a College president to the legislature. He was elected to the CA State Assembly in 1996 and the CA Senate in 2000.

Equality

PT: What should be the basic goal of our education policy?

Senator Scott: I go back to our founding principles, that “all men are created equal.” Students come to school with inequalities, so what we really mean by that is “all people are entitled to equal opportunity.” One of the most effective ways to reach that goal is through education.

PT: How does this translate into specific programs?

Senator Scott: What this means are financial aid programs, compensatory programs including special education for students who have learning disabilities and school lunches. We’ve also learned that it’s more difficult to teach students who don’t speak English as a native language.

PT: Is there a key to getting this done?

Senator Scott: All of this requires good teachers and good facilities. We can’t control socioeconomic factors, but we can look to equality of teaching. Any steps towards good pay, good working conditions, and elevating the status of teaching profession are in the right direction. I also believe there should be differential pay for teachers.

Knowledge

PT: Let’s talk about test scores vs. creative thinking. NCLB, the College Boards, and school curriculums are all oriented towards test taking. In a previous article, a number of educators told PT that, “creative thinking” had suffered in the process.

Retro classroom

Senator Scott: There has to be a balance. No test is perfect, but there is a value in testing. But, we have to be careful that in our headlong rush to more testing, real learning doesn’t suffer. We’ve gone a little too test happy and have taken away instruction time. What students should gain is the means by which to gain more knowledge.

PT: In a recently published book, author Susan Jacoby talks about the long history of “hostility to knowledge” in American culture. But, she says there’s now been a new development: “not only are citizens ignorant about essential scientific, civic and cultural knowledge, but they also don’t think it matters.” In part, she lays the blame on a failing educational system. “Although people are going to school more and more years, there’s no evidence that they know more,” she said. Senator Scott: There is a need to create a national culture that says you should get as much education as possible. Education is the future. Our greatest resource is our human resources—the intellectual capital. I’ve been very impressed by Asian cultures. There’s an emphasis on learning, a culture that prizes education.

Federalism

PT: That brings up the subject of NCLB (“No Child Left Behind”).

Senator Scott: I haven’t faulted NCLB on the basis of testing, but on an unrealistic goal that “all kids will be proficient.” There’s no way that a school in an inner city can match the test results of an affluent suburb. A state with a homogenous population will have an easier time meeting certain standards than one with a very heterogeneous population.

There are so many variables that impact education. Testing students for proficiency may not provide all the right answers, but there are ways to measure whether students are making an improvement.

I have also criticized NCLB because it was insufficiently funded. Obviously, we have not emphasized education as much as we should. Improving the quality of teachers and insuring that classes are well equipped with the latest technology are crucial to improving standards, but NCLB never took those costs into account.

PT: So, what are the respective roles of Washington and the state governments?

Senator Scott: I became involved in education in the 1950s—when we decided that separate is not equal. The Federal government could well serve a purpose by rearranging its priorities, providing some broad guidelines, and better funding certain programs, e.g., special education.

If you talk to people, they’re not anti-education. They are looking for guidelines, special funding that would empower them to improve our educational system.

PT: What about the states, California in particular?

Senator Scott: The state has primary responsibility for education, for providing quality K-12 and higher education. Money isn’t the only thing, but CA ought to be spending more money. Education is the No. 1 responsibility for the state. It’s the largest item in the state budget.

As a state we have to say this is high priority. It has to do with the success of our state. In CA, there’s a study that says by 2020, we will need 40% of our population with a college degree. But projections say only 33% of the population will have a Bachelor's Degree.

We ought to be willing to raise taxes to pay for education. Otherwise, we will pay in other ways—more prisons, higher unemployment. We have a choice of being a high tax, high service state. Or low tax, low service state. We can’t have it both ways. To raise taxes, we have to get a 2/3 vote of the Legislature. We could reform our property tax, as long as it made sense.

PT: Thank you for your time Senator.


Mayor
written by Larry Hartwig, April 15, 2008
Education should primarily be funded and controlled at the local and state level. The federal government should fully fund all aspects of special education as their financial responsibility and beyond that serve in an advisory capacity and resource to state departments of educaton. We should never forget the adage, "he that pays the piper calls the tune."
Fullerton School District Board Trustee
written by Mr. Minard Duncan, April 15, 2008
I concur with Senator Jack Scott on what needs to happen in California in regard to education. The one issue I am unsure about is differential pay for teachers. Do we have a fair way to differentiate?
Another issue that I believe needs to be rectified is the differentiation in pay between elementary and secondary school teachers. Historically, secondary school teachers have received higher pay than elementary teachers. I have taught in both levels and teaching elementary school is harder than teaching secondary because elementary teachers have many more subjects to prepare for each day. Typically, secondary teachers have a prep period and elementary teachers do not. Many years back a secondary teacher had one more year of preparation to receive their credential. That is not true anymore.
...
written by Spatula, April 23, 2008
Senator Scott's answers to the problem of education are typical of politicians and educationalists, that is, "yes and no." Thus, he argues both that we need to establish national standards yet, at the same time, allow states and local districts to control curriculum. This plan is mutually contradictory. Then, he argues we both have to establish a one-size-fits-all program, NCLB, but realize that all school districts are unique with unique problems that NCLB can't address. Senator Scott is correct, however, when he contends that we need to a address the "what." The "what" that we want should be students who think critically and think for themselves. Our fourth graders are the equal to fourth graders around the world. By twelfth grade they are pathetically behind the major industrialized states. The "what" that needs to be fixed is the entire eduational system whose sole purpose is to create cogs for the machine rather than individual citizens. As a college professor, I've seen the deterioration of student preparation. Within the past two years, under the onslaught of NCLB, I've seen the total collapse of the preparation of my students. The majority can't learn and certainly don't want to learn. This rant is over; you may return to your normally scheduled programming.

http://aspatula.blogspot.com/2008/02/teaching-our-kids-to-be-idiots.html

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Feature Story

Headshot of a man

Policy Today talks with Kansas State Senator John Vratil about the future of education in Kansas and the problem of educational inequality in America.

PT: The United States' public education system has long been considered one of its greatest achievements and the bulwark of our equalitarian society. Is ensuring social and economic equality still among policymakers' priorities when it comes to education?

Vratil: I feel that it is. I believe that there is a major nationwide emphasis on providing equality of opportunity in our public school system. But I think it's important to distinguish between the bold statement of "equality" and the more refined statement of "equality of opportunity," because we cannot guarantee that every student will be equal. In fact, I think I can guarantee that every student will not be equal. But we can strive toward that latter goal so that every student has the opportunity to succeed.

I think it's an extremely important distinction to make because many people will look at discrepancies in student performance and attribute it to inequality. That is absolutely untrue.

PT: It sounds as though our society may have some misconceptions about what equality actually means. Do you think that misconception carries over into policy debates about types of education, such as technical/vocational vs. university education? Is the former viewed as unequal to or less worthy than the other when it comes to funding and outreach?

Vratil: Yes, I think that has been the case for the last couple of decades. We have tended to emphasize the goal of sending all students to two- or four-year postsecondary education, but I think we're now beginning to realize that this isn't necessarily the best path for each and every student. Furthermore, we need technicians, craftsmen, and other skilled positions that don't require a two- or four-year degree. They need to be trained in vocational and technical aspects that are every bit as important to our economy as scientists and mathematicians.

PT: What is Kansas doing policy-wise to fill these needs and support students who choose not to pursue a two- or four-year degree?

Vratil: We actually have a technical/vocational education commission that has been appointed by the governor. They're studying our system and looking at things like systemic governance, coordination and collaboration between various institutions offering these courses, and financing. They have not made recommendations yet, and in fact some bills have been introduced in our legislative session that are actually out ahead of the commission with respect to governance.

The problem in Kansas is that we have a very disjointed technical education system. Moreover, it has no coherent funding mechanism.

PT: The lack of a coherent funding mechanism raises another question: What role do you see the federal government playing with respect to education policy? Are the states better able to ensure equality with minimal federal interference, or can the federal government more effectively "legislate" equality of educational opportunity from Washington?

Vratil: Well, I see a role for the federal government, but it is a relatively limited role. I think that ideally, it should provide financial resources to emphasize those areas of our educational system that they feel are neglected or of greater priority.

I also see the federal government providing research to the states on best practices in education. What I'm fearful of is a gradual takeover of our educational system by the federal government, which I believe would be absolutely disastrous.

PT: No Child Left Behind is obviously controversial in its implementation, but most people agree with the general premise behind it—that we want every child to be able to read, write and function in our society. Do you think the policy adequately addresses the problems it proposes to solve, or do you think there's a better way to approach it?

Vratil: No, I think there's definitely a better way to approach it. I agree, I don't think there's anybody who doesn't agree with the goals. On the other hand, I don't know of anybody with any knowledge of our education system who thinks that 100% proficiency is achievable. So, I think that NCLB is a little misguided in this aspect.

I think there is a much better way of achieving the goals of NCLB in a more realistic, flexible manner in which you really have a partnership between the states and the federal government. Right now, that partnership doesn't exist.

The states and the U.S. Department of Education are at odds more often than not.

PT: What's causing the relationship to break down if we can all agree on common goals?

Vratil: The breakdown is that many of the requirements of NCLB are unrealistic and others are completely disingenuous or misguided. I think that the disaggregating of student assessment data is a good thing, but you have to be realistic about it.

One of the subgroups includes children who speak English as a second language. Like everybody else, NCLB requires those non-English-speaking students to be 100% proficient by 2014.  Well, that's so absurd as to be laughable, because once those students achieve proficiency in English, they drop out of the group. So, by definition the only students in that group are students who are not proficient. How can you achieve 100% proficiency for students who are in that group because they are not proficient? The U.S. Department of Education won't acknowledge that.

PT: Would you say that part of that mindset comes from that distorted view of equality that you mentioned earlier, that we can make equal outcomes through legislation like this?

Vratil: Yes, absolutely. The goal of No Child Left Behind is total equality, which I said at the beginning is both unrealistic and will never happen. If the goal of No Child Left Behind was equality of opportunity, and that principle guided the policy, it would have been structured in a much different manner.

PT: With more emphasis on that state/federal partnership and educational flexibility?

Vratil: Exactly.

PT: Senator, thank you for your time.


Kansas State Senator John Vratil represents Kansas' 11th Senate District. He serves as the chair of the Senate Judiciary Committee and the vice-chair of the Senate Education Committee.


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written by Ginette Huelsman, July 25, 2008
Interesting how Senator Vratil states that No Child Left Behind "is both unrealistic and will never happen. If the goal of No Child Left Behind was equality of opportunity, and that principle guided the policy, it would have been structured in a much different manner" and yet when I personally spoke with him about the legislation passed that limits well-qualified college graduates from being issued Teaching Certificates which is contributing to our shortage of good teachers, he couldn't recall the recent changes that are being mandated on our College Graduatates, nor could he even provide me a name of someone that could explain the legislation. In fact, had the Senator's objective of the recent change in KSBOE Teaching Licensure been to ensure better teachers for our students, "and that principle guided the policy, it would have been structured in a much different manner."

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