Could a Health Plan Executive Actually Become Governor? Yes

Les Masterson, for HealthLeaders Media , July 15, 2009

Baker is a leader who took a sputtering health plan in 1999 and built it into one of the most respected insurers in the nation. In fact, U.S. News & World Report and the National Committee for Quality Assurance named Harvard Pilgrim the top commercial health plan in America last year and J.D. Power and Associates ranked Harvard Pilgrim number one in the New England region this year.

Baker also has a decent shot in 2010 because of the state's healthcare reform plan, which has struggled with costs. The chief executive has been outspoken about the current system in his blog, Let's Talk Health Care, calling attention most recently to the merged market, which blended the individual and small group markets. "As a result of the merger," he said, "the premiums paid by small businesses went up, and individual prices went down."

With rising health costs crowding out other programs and state officials raising premiums and cutting benefits to those in the public programs, Baker's experience could be seen by voters as a reason to go Republican. In his blog, Baker also has promoted the ideas of bundling payments for quality and care coordination, closing loopholes in the state's health reform program, and Medicare payment reform. He has also written about his concerns with a possible public insurance option.

Having Baker as governor would place healthcare reform in the state on a different course. One significant change that a Baker administration might make is fixing a loophole that allows individuals to buy insurance for a short amount of time, receive costly healthcare services, and be considered insured so they don't have to pay a fine.

According to Baker, about 40% of Harvard Pilgrim members who had individual insurance were covered for less than five months between April 2008 to March 2009. He added that those same people cost about $2,400 per month, which is about 600% higher than what is expected.

Baker said those costs are being transferred to small businesses and individuals that are purchasing 12 months of health insurance and it is allowing residents to game the system.

He suggested the state change its policy to remove the loophole. "That would be the simplest and easiest way to protect individuals and small businesses who are playing by the rules—and limit the very costly impact of this wrinkle in health care reform."

Electing Baker would not only help insurers in his state, but could also indirectly affect insurers across the country. Healthcare leaders are closely watching the Massachusetts experiment and any successes there will be tried in other states. With his experience in healthcare and government, plus his outsider role, Massachusetts voters might actually take a chance on a CEO of a health insurance plan.

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Les Masterson is an editor for HealthLeaders Media.

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