Originally published in CommonWealth Magazine on June 18, 2022

Mass. Residents Deserve Inflation Relief

With money available, state should eliminate protectionist laws

by Jon B. Hurst, RAM President

February 26, 2019 by Jon Hurst, RAM President

When it comes to health care in Massachusetts, there’s good news and bad news. The good news? The state recently announced that individuals who buy health care through the Health Connector, our health care exchange, pay the second lowest premiums in the country. The bad news? According to the Massachusetts Health Policy Commission, small businesses and their employees in the state have the second highest premiums in the country.

At first blush, the disparity doesn’t make a lot of sense. After all, Massachusetts has some of the highest health care costs in the nation. But the reason for the discrepancy is straightforward enough: Small businesses are effectively subsidizing individual health care premiums in Massachusetts. Employees of small businesses are required to pay more than their fair share so individuals can pay far less.

And it’s about to get worse. Next year, small businesses in Massachusetts with 50 or fewer employees will receive no pricing adjustment for purchasing health care in bulk for their employees, their lower administrative costs, or the fact that their employees are actuarially a better risk compared to individuals. And to go along with those unaffordable premiums, most of these employees will be forced into high deductible plans, joining the nearly 60 percent small-business level already seen, which requires sharing more of the cost with their employer compared with government and big-business work settings.

January 2, 2019 by Jon Hurst, President

As we celebrate the New Year and look optimistically at the future, many small business owners are facing 2019 with fear for their profitability, given new state payroll mandates on wages and paid leave.

Effective January 1, small businesses saw the increased mandated payroll costs of a $1 minimum wage hike.  This increase is on top of a $3 increase which was just fully implemented two years ago, and is the first step of a $4 increase over 5 years.  Together, the $7 hike over 9 years represents an 88% increase over a period of time in which the cumulative inflation rate is unlikely to exceed 20%. But it isn’t just the wages of new employees, it’s the compression effect of higher wages right up the ladder, along with the mandated Social Security, Unemployment Insurance (UI) and workers compensation premiums that come with it.  And on July 1, those payroll taxes will also include a new state family and medical leave tax on employers and employees alike.

In the day and age of the smartphone, you can’t just raise prices to cover these new costs and expect consumers to still pay you for your goods and services when they can buy anywhere.   So to balance out the new mandated payroll costs, Beacon Hill should do the following in 2019 to ease costs:

1. Fix the Small Business Health Insurance Crisis.  Massachusetts has the second lowest individual premiums, yet the second highest small business premiums in the country.  At the same time large employers pay far less for far better coverage than do small employers.  That is shockingly unacceptable, and is due to discrimination under the law and in the markets. 
2. Close the Loopholes In The UI System.   Massachusetts is ranked 50^th by the Tax Foundation for unemployment insurance systems.  In short, employers and employees alike abuse the system due to an inadequate eligibility system.
3. Prevent Local Ordinances Affecting Consumer Choices.  Many states by law prevent local ordinances affecting interstate commerce, but MA does not.  So a patchwork on tobacco sales, plastic bag usage, water bottle sales, etc., has emerged across the state due to organized special interest group efforts before 351 cities and towns.  These affect local stores, but unfortunately not the new Internet competition.  For consumer choice and small business competitive reasons, require statewide standards for consumer product sales. 
4. Pass a Teen Wage.  Thirty-nine states have them.  Let’s make sure 14-17 year olds have the learning and earning opportunities they need, and small businesses have the incentives to hire them.

September 24, 2018  by Jon Hurst, President

Recently, the Massachusetts Center for Health Information and Analysis (CHIA) presented their 2018 Annual Report. The report was widely reported in the press for showing much slower overall growth in healthcare spending: 1.6% vs. the state’s 3.1% benchmark, and recent 4 year average of 3.6% increases. Yet, totally missed by the press and general public was how the increased costs were disparately distributed among a wide variety of consumers. Dissecting how the overall healthcare “pie” is divided is extremely important for small businesses, as important questions remain whether costs are being fairly distributed across all classes of purchasers.

Commercial, fully-insured premiums increased 4.9%, yet within that market, small businesses saw an increase of 6.9%. Subsidized individuals in the Connector saw a 3.0% increase, unsubsidized individuals saw a 3.8% increase, large groups saw a 4.1% increase, and the state Group Insurance Commission (the GIC; the buying group for state & local employees) saw a 4.4% increase. Meanwhile the state’s Medicaid program saw a drop of -0.2%.

But just looking at the disturbing and unequal premium trends isn’t enough, you also need to look at cost sharing and high deductible plans as you compare the fairness of the markets. Besides seeing a far higher than average premium increase than individuals and large groups, small businesses and their employees saw a greater increase in cost sharing and high deductible plan growth than other market sectors. While 28.2% of the commercial market are now in high deductible plans, 57.5% of small businesses are in that cost sharing space, while the state’s taxpayer funded GIC is at 0%.

January 26, 2017 by Jon B. Hurst, President

ObamaCare (ACA) is under the microscope for repeal and replacement this year in Washington DC.  And here in Boston, yet another state commission on healthcare provider prices is grappling with the fact that in the 11 years since we passed RomneyCare, our healthcare costs have annually increased about 4 times the rate of inflation.  Unfortunately for Main Street, those increases haven’t been spread equally either—small businesses and their employees have seen far higher premium increases than those experienced by big business or big government programs. 

Despite a good economy, these are troubling times in Massachusetts due to the interwoven healthcare cost issues affecting employers, consumers and taxpayers.   

Local small businesses, employees and consumers have seen their premiums rise far faster than their sales and family incomes.  RAM members have reported average annual premium increases of 12% each year over the past decade.  Likewise, state government has seen their costs for subsidized commercial and Medicaid plans under ObamaCare rise as well, as a significant number of consumers have made the ACA incented, financial decision to take the very generous, low cost, taxpayer subsidized options through the Connector. 

AUG. 2, 2016 • BY JON HURST
As is often the case, the recently concluded formal session of the Legislature featured some wins—mostly in the defeat of costly employer measures—but some losses, primarily the continuation of existing discriminatory policies, which either result in lower sales, or higher costs for local sellers.

One important win was the passage of a measure to keep the state’s innovative Small Business Health Insurance Cooperatives operating and serving employers of 50 and under. RAM operates one of the existing three co-ops in the state, and thanks the Legislature--in particular the House of Representatives--for recognizing the costly, discriminatory and unfair application of health insurance rates under federal ACA rules. In the Economic Development bill passed Sunday, an important section sponsored by Representative Kate Hogan (D-Stow) allows for new financial incentives to use wellness and provider transparency tools through small business cooperatives. In reaction to double digit premium increases for small employers following the passage of “RomneyCare,” the Legislature in 2010 authorized group purchasing through non-profit cooperatives with upfront premium discounts. Yet, those savings are evaporating under preemptive ACA requirements on state rate setting. The ACA required phase out of state rating factors, means no upfront premium flexibility remains to award employees for using wellness programs, or to shop around for the low cost, high quality healthcare providers—common practices for large employers. The new state legislation moves upfront premium incentives to the end of the insurance contract period in the form of rebates, which remains legal under federal rules. The section also encourages the Baker Administration to seek an Innovation Waiver from the federal government under the ACA to seek more flexibility and fairness for Massachusetts small businesses and their employees. Without rate flexibility and consumer financial incentives, small business health insurance premiums are more accurately labeled healthcare taxes.

Health insurance is a mandate which disproportionately disadvantages those who work for small businesses; and the cooperatives reform will help create more fairness. However, RAM is disappointed over the loss of two vital initiatives designed to ease other government imposed competitive discrimination, as they relate to the sales tax and to Blue Law restrictions.

For only the second time in the last twelve years, no Sales Tax Holiday was authorized for this August, meaning local sellers and our economy will lose hundreds of millions in sales to internet and New Hampshire competitors which enjoy 365 days a year of tax free sales. Those two days recover a remarkable amount of tax sensitive sales from consumers looking for a reason to invest their dollars locally. With accelerating mobile commerce growth—much of it untaxed—the 6.25% sales tax disparity is threatening the very future of our Main Streets and retail jobs in the Commonwealth. Government is picking winners and losers in the marketplace, and our losers are our local stores and employers.

JUL. 7, 2016 • BY JON HURST

Ask any small business owner what they need to be successful, to compete with big companies, to thrive alongside the new “innovation economy,” and to compete with smartphone sellers and they will likely tell you two things – higher sales and lower costs. And that is what RAM is pushing for in order to really help Main Street under the Economic Development bill making its way through the Legislature.

The following three issues are the best ways for state government to deliver on those higher sales and lower costs for our Main Street employers.

A 2016 Sales Tax Holiday

The Sales Tax Holiday (STH) has become an important event on the Massachusetts retail calendar and recognizes that consumer spending represents 70% of our economy. The key question is where do our consumers spend their money—locally, or in Silicon Valley or in NH? The Sales Tax Holiday is pro-consumer, pro-Main Street, and pro-retail employee. Consumers love it, and our Main Streets need it. Results have shown that during the STH weekend MA picks up hundreds of millions of impulse buys and recovered vital sales that would normally go to non-taxed locations in New Hampshire or online.

MAR. 31, 2016 • BY JON HURST

They said it would get rid of the free riders, require personal responsibility, and therefore prevent unfair cost shifts. They said it would mean lower costs as the newly insured would stop using high cost and unnecessary emergency rooms and instead go to the proper setting for the proper care. They said it would help our local hospitals by better managing federal Medicaid money, which in turn would help stop unfair cross subsidies from commercial payers to providers covering government funded patients. They said it would create more competition, choices, defined contribution options and lower costs for small businesses and their employees through a state exchange.

And so on April 12, 2006 Chapter 58, or “RomneyCare” was signed into law; to be essentially copied—but also in too many ways to be preempted by the ACA (ObamaCare) four years later.

It is important on this 10 year anniversary to look at the political promises of both RomneyCare, and then the national version ObamaCare, and to determine the outcomes. In truth, none of the above promises have been achieved; but rather the consequences have created huge cost increases for small businesses, while enriching the largest providers and pharma companies. And looking back at the big money interests behind the efforts on both Beacon Hill and Capitol Hill, are we really surprised?

MAY. 27, 2015 • BY RYAN KEARNEY

RAM is pleased with the announcement by Blue Cross Blue Shield of Massachusetts (BCBSMA) that it will be increasing the financial incentives offered as part of its wellness program—Healthy Actions. The incentive program now provides businesses the opportunity to receive a reward amount of up to 7.5% of paid premium (up from 5%) based on the wellness participation of their covered employees. The program also provides a financial incentive of up to $300 a year to covered employees that successfully complete the program.

This news is particularly positive for members of the RAM Health Insurance Cooperative (RAMHIC) which beginning April 1, 2015 has included Healthy Actions in all BCBSMA plans offered through the cooperative. When combined, the Healthy Actions rewards and the RAMHIC upfront discount of 2%, result in a potential savings of 9.5% on health insurance premiums for qualifying small businesses.

For a copy of the press release announcing this program please click here. Members interested in learning more about the RAMHIC may contact Larry Mulrey at 617-523-1900.