Baker’s Dozen – Food for thought in the gubernatorial campaign, part 2

Our assignment today, fellow students, is to look beyond gubernatorial candidates’ touting of what they’ve done (which all may be laudable) and explore their recommendations of where we go from here. So let’s look at the rest of Republican Charlie Baker’s “Baker’s Dozen” proposals, released earlier this week.

6. Reform Medicaid – He estimates between $175M to $250M in savings. Baker mentions moving Medicaid into managed care plans. Ed King tried this, proposing to give Medicaid recipients one point of entry into the health care system through their primary care providers. Advocates protested that this would be creating an inequitable two-tier system, with a more restrictive access for Medicaid recipients than everyone else. When Mike Dukakis returned to the State House in 1982 and named the late Manny Carballo his human services secretary, the executive branch stopped managed care for Medicaid recipients dead in its tracks. But now that there’s a broader appreciation of the problems with runaway fee-for-service, it’s time to revisit the possibilities of managed care for the Medicaid population.

7. Require proof of legal residency for state benefits – Baker projects between $10M to $25M in savings but pushed everyone’s hot buttons when asserting that even a homeless shelter or other emergency services should require that proof of legal residency before extending a helping hand. Open mouth; insert foot. He has since backtracked from that. There’s an argument to be made for more uniformity in requirements across state agencies, but he has muddled this discussion by painting in overly broad strokes and playing to Arizona-like anti-immigrant hostility.

8. Conduct forensic financial analysis for benefits eligibility – Between $10M to $20M in savings. Baker wants to do a “lifestyle analysis” – looking at credit card bills, recreation activities, auto loans, grocery bills – to see if a person getting public services is spending more than he or she is declaring in income to be eligible for assistance. If spending does exceed declare income, then something smells bad and warrants attention. But I admit that the notion of doing a “lifestyle analysis” to confirm eligibility is a little creepy. Could buying Grey Poupon rather than the store brand cause someone to be dropped from welfare?

9. Eliminate costly duplication of services for Medicaid and Medicare – Between $50M to $70M in savings – Apparently there are more than 100,000 dual eligible seniors who could, if they chose, participate in the so-called Senior Care Options Plan, a managed care approach that provides all the benefits of MassHealth plus Medicare. Elders would have to use Senior Care network providers like doctors and pharmacists, but they’d get additional benefits, for example, dental, vision, hearing, senior day care, medical transportation. I’d like to know how Baker specifically would increase participation in the program and how he computes the savings.

10. Bring welfare reform in line with federal standards, - between $50 m and $75 m in savings, largely by imposing stricter work requirements. Most everyone nods affirmatively, but, given the large number of unemployed in today’s economy and the scarcity of jobs, how Baker would do this is anybody’s guess. And what about the offsetting costs of job training and day care services needed to support welfare recipients in the work world?

11. Offer incentives to state agencies to collect state revenues – Between $15M to $25M in savings – That is, let them keep more of the fees they collect to incentivize their diligence in collecting what is owed to the state. Democrat-turned-Independent quasi Republican Tim Cahill, Mr. Incentivizer, should like that one! But if they get to keep 10% more of the fees collected will that mean a reduced budget the next year?

12. Charge inmates room and board – Between $10M to $40M in savings – to offset the costs of incarceration. For those who can’t pay, add it up and forgive them for good behavior upon their release. I suppose having to pay room and board is a lesson in the realities of life for inmates, supposed to help them when they are released, but can someone tell me where they’ll get the scratch? Is this to be a jail tax for their “not guilty” families? Will time be added to the sentences of those who fail to pay? If some pay for their room and board and others are free riders, is that fair?

13. Restructure overly generous public employee retiree benefits– Between $50M to $100M in savings, according to Baker. Similar to pension reform, the state must also reform the “other post-employment benefits” provided to state employees. The state is facing a $15 billion unfunded liability due to the overly generous benefits – namely health benefits – provided to state employees upon retirement. Baker would increase eligibility from 10 years of service to 15. What’s wrong with this? Hey, most of us don’t even get retiree health benefits.

Baker would also increase the eligibility age for retiree health benefits from age 55 to age 60. Why not? This isn’t Greece. Don’t the rest of us have to wait for Medicare until the age of 65? And he’d require state employees, who now contribute a measly 15 percent towards their health insurance premiums upon retirement, to pay more. (He’d have a tiered system depending on how many years they worked.) Again, those of us in the private sector contribute a heck of a lot more toward our coverage.

I really want readers to weigh in on Baker’s dozen, almost as much as I want the Governor to tell us where he is on each of these proposals.

- Please let me know your thoughts in the comments section below.