Summer reading: The title of this post is only tangentially related to the topic. I just liked the quote (does it imply Romney is Anakin /Darth?). Extra credit to the first commenter to find the connection.
Here’s the topic: Two thoughtful web articles on MA health reform appeared last week, from the left and right. Both are worth reading. The articles illustrate the curious political alignment around chapter 58. From the beginning, the law had support from both the moderate left and the moderate right, but for completely different reasons, coupled with strong opposition from the far right and the far left, also for different reasons.
In the left corner, American Prospect blogger Ezra Klein reviews what he sees as a “Limited Health-Care Success in Massachussetts.” And in the right-hand corner, Greg D’Angelo and Edmund F. Haislmaier of the Heritage Foundation post a web memo, “Health Care Reform in Massachusetts: Medicaid Waiver Renewal Will Set a Precedent.”
Klein’s article defends health reform for making progress towards its goal – covering the uninsured. It’s not comprehensive health reform, he argues, since it doesn’t deal with quality and cost issues.
Klein refutes the popular notion that the problem is cost overruns, the “Big Dig” analogy that Commonwealth Care spending is exceeding the original budget. Klein quotes Connector Board member Jon Gruber taking this head on:
There are more uninsured people in Massachusetts than experts originally thought, and the response has been more enthusiastic than expected. Some of the plan’s opponents have used this to blast the plan as a typical case of inefficient government. “They make it sound like the Big Dig,” complains Jon Gruber, an MIT economist heavily involved in the plan’s creation. “It’s not. We’re covering the uninsured and it turns out there’s a lot of the uninsured. If you were doing the Big Dig and it turned out the tunnel was six times as long, you wouldn’t be surprised it cost six times as much.”
Medical cost growth is the issue, but Klein accepts the logic that drove us to focus on expanding coverage first:
This is, at least in the abstract, the political logic of focusing on access first: Expanding access creates pressures that force the system to figure out how to control costs. There’s evidence this is beginning to happen in Massachusetts. The legislature is beginning to consider cost-control measures. “We call it health care reform 2,” says [Connector ED Jon] Kingsdale. If they fail, the Massachusetts plan will go down in history as an interesting, well-intentioned, but ultimately inadequate experiment. But if their commitment to coverage leads it to stare down costs, it can look forward to the day when everyone looks at the plan and sees the same thing: a success.
Klein’s assessments corrects the harsh further-left and error-filled critiques the American Prospect published in April by Marcia Angel (opposing the mandate as harsh and arguing that only single-payer reforms are worthwhile), and in January by co-editor Robert Kuttner (ditto).
Coming from the the other side, Ed Haislmaier worked with the Romney administration in formulating the original mandate ideas and the “exchange,” which became the Connector. The Heritage Foundation analysts take issue with their more right-wing critics at the Wall Street Journal and agree with Klein that cost overruns due to more uninsured than expected are not a fundamental problem.
They focus on the ongoing waiver negotiations, and urge the feds to maintain the strict waiver conditions that limit growth in spending, particularly funds used to support safety net institutions making the transition to increased coverage. They advise the federal government to continue in place the “sub-cap” that limits federal reimbursements for a portion of the health reform plan. This gets into waiver arcana that’s too complicated to explain here. However, state officials (and HCFA) would emphatically disagree. The Commonwealth’s application pledges to live within the overall budget neutrality limit, without the artificial sub-cap limit imposed in the current waiver. Further restricting spending via a subcap could severely limit the state’s flexibility to maximize coverage.
Like the blind men and the elephant, where people stand on chapter 58 often depends on where they sit. As the national health reform debates heat up, we need to focus on making sure the national stories honestly reflect the facts on the ground.
Brian Rosman
There is no uniform legal definition of a “resident” in Massachusetts. In many circumstances, it means a person who lives in the Commonwealth, with an intention to remain indefinitely. This would exclude a person who plans to live here only for a set period of time.
Tax regulations define resident as follows.
“Resident” or “inhabitant”, (1) any natural person domiciled in the commonwealth, or (2) any natural person who is not domiciled in the commonwealth but who maintains a permanent place of abode in the commonwealth and spends in the aggregate more than one hundred and eighty-three days of the taxable year in the commonwealth, including days spent partially in and partially out of the commonwealth. For purposes of clause (2), a day spent in the commonwealth while on active duty in the armed forces of the United States shall not be counted as a day in the commonwealth. The word “non-resident” shall mean any natural person who is not a resident or inhabitant.
So, the answer may depend on why you are asking–does the question relate to the meaning of a “resident” for tax purposes, or for some other reason?
Ed Haislmaier,
What’s a resident?
If an answer is not possible, can it be politely said so, rather than a rude deletion of the question?
As you blather more people needlessly suffer and many die
Because you are propping up a profit-driven corporate-controlled healthcare system
Shame