Merrill Matthews, Jr.
Merrill Matthews Jr., Ph.D., is a resident scholar with the Institute for Policy Innovation. He is a public policy analyst specializing in health care, Social Security, welfare and Internet issues, and is the author of numerous studies in health policy, as well as other public policy issues. He is past president of the Health Economics Roundtable for the National Association for Business Economics, the largest trade association of business economists, and health policy advisor for the American Legislative Exchange Council, a bipartisan association of state legislators.
Dr. Matthews serves as the medical ethicist for the University of Texas Southwestern Medical Center’s Institutional Review Board for Human Experimentation, and has contributed chapters to two recently published books: Physician Assisted Suicide: Expanding the Debate (Routledge, 1998) and The 21st Century Health Care Leader (Josey-Bass, 1998).
He is a “Brain Trust” columnist for Investor’s Business Daily and has been published in numerous journals and newspapers, including The Wall Street Journal, Barron’s, USA Today and The Washington Times. He is the political analyst for USA Radio Network and an occasional commentator for National Public Radio.
Dr. Matthews received his Ph.D. in Philosophy and Humanities from the University of Texas at Dallas.
Tuesday, July 1, 2008Health Insurance PoolsBy Merrill Matthews, Jr.One public-policy challenge is to find a way to provide coverage to the uninsurable without destroying the individual health insurance market. High-risk pools are one way, as I discussed in a recent op-ed published by the Washington Times.
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Thursday, June 19, 2008Last One in the Pool ... May Not Make Any DifferenceBy Merrill Matthews, Jr.Categories: TennesseeIn Tennessee, Gov. Phil Bredesen (D) has signed into law a bill (S.B. 4014) to allow small employers to form cooperatives to negotiate for group health insurance. Several state legislatures have considered plans in recent years to form similar business cooperatives in an effort to reduce the costs of small group coverage, but this is one of only a few such measures that has garnered sufficient political support to become law.One key reason may be the Nashville-based National Federation of Independent Business (NFIB), which has more than 10,000 statewide members and reportedly pulled out all the stops for the bill. The cooperatives must meet several requirements, including having at least 1,000 eligible employees or at least 10 participating employers. The groups must hold open-enrollment periods at least once a year. Companies are eligible for this voluntary program if they have between two and 50 employees. The NFIB argues that the Tennessee plan puts the state on "the cutting edge of health care reform for small businesses" by allowing employers in large market-based pools to negotiate coverages that have greater rate predictability and stability. Health carriers counter that they are already rating small group premiums based on very large combined blocks of insureds. While I wish them well, count me skeptical. The notion of "if the government could only make a big enough pool, everyone could have affordable health insurance" has almost become "conventional wisdom." There is a lot of experience with trying to establish such pools, with most of them failing to live up to expectations. The new law will take effect in January and may jumpstart efforts elsewhere to provide for such arrangements.
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Wednesday, June 18, 2008From a Private Good to a Public Good to a Public BadBy Merrill Matthews, Jr.Categories: Insurance RegulationJust last week I was commenting to someone how long it had been since I had heard anything from Families USA, the pro-government run health care group that likes to call itself a "consumer" organization."Could it be," I asked, "that they had decided to find something useful to do with their lives?" Apparently not. Families USA has just released a study that can find nothing right with the individual health insurance market. It's filled with breathless concerns about evil health insurance practices. For example, according to the study, "Failing Grades: State Consumer Protections in the Individual Health Insurance Market":
With these kinds of "consumer protections," who needs enemies? The language is deceptive and insidious and never points out that these practices go on all the time -- in life insurance and other types of insurance. What Families USA really opposes is standard underwriting. The organization wants the individual market to work like the group market. And if and when it succeeds in achieving that goal -- and it is having a fair amount of success in the states, as legislators propose legislation creating "groups of one" -- it will then try to get the group market to work like Medicare. Other types of individual insurance operate the same as health insurance. Life insurance, for example, can deny people who apply with a significant, or terminal, medical condition. If life insurers accept an applicant, they can charge more for older people or those with medical conditions that might affect their life expectancy. And life insurers can revoke a policy within the two-year "contestability period" just as health insurers can. Since groups like Families USA aren't screaming about unfair life insurance practices, the organization must not be opposed to those actions in principle -- just where health insurance is concerned. The fact is they don't want a market in health care, and they don't want consumer choice. They see health care as a public good that should be provided and paid for by the government (i.e., taxpayers). All of their criticisms are simply window dressing to help them achieve their goal of universal coverage in a government-controlled system. In doing so, they will turn this "public good" into a public bad.
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Friday, June 6, 2008Minnesota Tones Down Expansion PlansBy Merrill Matthews, Jr.Categories: Insurance Regulation, Medicaid, MinnesotaNo sooner had Governor Tim Pawlenty (R) vetoed HF 3391 -- a health reform bill pushed by the Democratic Farmer Labor Party (DFL) -- then the legislature passed a more moderate proposal expected to gain the governor's signature. SF 3780 included many similar provisions to the vetoed HF 3391, but did not expand government health insurance to 400 percent of federal poverty. The bill does include:
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Friday, June 6, 2008Iowa Creates "Medical Homes"By Merrill Matthews, Jr.Categories: Insurance Regulation, Iowa, SCHIPIowa Gov. Chet Culver (D) has signed HF 2539, the health reform package finally agreed upon by the legislature. Like many other states, Iowa created a commission to study health reform and agreed upon a fairly ambitious agenda, but in the end, more modest reforms passed, including:
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Thursday, June 5, 2008New Hampshire Law on InsuranceBy Merrill Matthews, Jr.Categories: Insurance Regulation, New HampshireIn New Hampshire, all small group carriers with at least 1,000 covered lives will be required to offer a new guaranteed issue standardized wellness benefits plan with the enactment of health care reform legislation (SB 540) earlier this month. The new law grants the state insurance commissioner discretion to formulate benefits, specifying only that they "promote primary care, preventive care and a medical home model." A committee comprised of businesses, consumers and legislators -- but no insurers -- will advise the commissioner on benefit decisions. Policy premiums must not exceed 10 percent of the previous year's median state wage. The plans will be offered to small employers beginning in October 2009.
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Thursday, June 5, 2008Reform Panel Launched in West VirginiaBy Merrill Matthews, Jr.Categories: West VirginiaKey legislators in West Virginia revealed on May 26 that they are undertaking collaborative efforts to fix the state's ailing health care system. The chairmen of the Senate and House health committees have retained Dr. Ken Thorpe, the chairman of the health policy management program at Emory University to provide specific medical reform recommendations. Thorpe, who spearheaded similar efforts for the state of Vermont in 2006 and 2007, will oversee four working groups that will look at health care delivery, administration and paperwork, technology and electronic medical records, and obesity prevention. The end product, Thorpe says, will be a new model for delivering better, less-expensive health care. Legislative leaders believe they have formed a rough consensus around the idea of major changes to the state's health care system, and they hope to file resulting legislation next year. At a press conference, both the AFL-CIO and PhRMA endorsed the process.
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Wednesday, June 4, 2008Will Consumers Union Find a Place for ... Consumers?By Merrill Matthews, Jr.Several years ago I was asked to speak about Medical Savings Accounts (now Health Savings Accounts, or HSAs) as a panelist at an Alliance for Health Reform event. The Alliance is a bi-partisan, congressionally created program charged with looking into health policy issues and reforms.I noticed from the RSVP list that a lot of Consumers Union (CU) people would be there. Now, Consumers Union has, for years, been a proponent of a huge government-run health care system. And a constant critic of any consumer driven health care reform initiatives, like HSAs. So I took time in my speech and directly addressed the CU people. I said that the organization's whole existence is based on the notion that informed consumers can make good decisions. That's what "Consumer Reports" is all about, I said. So why, I wondered, was the organization so convinced that informed patients couldn't make good decisions? Well, I got no answer . . . until now. Consumers Union will launch a hospital ratings service that will evaluate some 3,000 hospitals nationwide. I don't know the specifics, so I won't comment on how good the system will be. But it's exactly what one would expect to happen in a consumer driven health care world. The sad thing is that it took CU -- which has "consumer" in its name, no less -- so many years to do what should have been a natural fit for it all along.
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Tuesday, June 3, 2008California Inflates Loss RatioBy Merrill Matthews, Jr.Categories: California, Insurance RegulationCalifornia Sen. Shelia Keuhl (D), a staunch single-payer proponent, has succeeded in passing SB 1440 through the state senate. The bill would require all health insurers to spend 85 percent of all premiums on patient care. Proponents believe that this will lead to more affordable policies, but high loss ratios can actually lead to less-affordable policies.The problem with artificially high loss ratios is that they undermine competition and encourage health insurers to offer only rich benefit plans. The National Association of Insurance Commissioners has actually proposed a much lower standard, around 55 percent for individual health insurance policies.
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Tuesday, June 3, 2008Hollywood and AARP Combine for Bad ActingBy Merrill Matthews, Jr.Uh-oh. That bastion of bad policy proposals, Hollywood, has decided to get into the health care reform debate. According to USA Today, a bunch of Hollywood-types, including Steven Spielberg-partner Jeffrey Katzenberg, are hooking up with AARP -- which has its own bad actors when it comes to health care reform -- "to bring attention to the need to provide affordable health care." You already know what the message will be. For Hollywood, almost all of our societal ills are a result of greedy corporate CEOs, who will do anything to make -- or save -- a buck. No matter who or how many it hurts. And so we'll be inundated by subtle -- and some not so subtle -- messages that employers should provide expensive, benefit-rich policies. This from the same industry that routinely uses contract labor and increasingly shoots films in foreign lands in order to avoid paying union wages. As for AARP, don't expect any in the media to ask whether -- since AARP makes hundreds of millions of dollars from selling health insurance to its members -- it just might be pushing this effort in order to make more money. Or as a way to push its own policy initiatives. AARP just announced it will spend millions of dollars to fight a proposal to raise Medicare's premiums in order to avoid cutting doctors' reimbursements by 10.6%. The point is that AARP has an agenda. And as far as I can tell, its only real policy recommendation is to give just about everyone, and especially seniors, all the health care they need for little or nothing. Which happens to be filmmaker Michael Moore's only recommendation, and so will likely be Hollywood's only recommendation.
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