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Boston Globe
17-07-2025
- Politics
- Boston Globe
Despite ahead-of-schedule closing of hotel shelters, Healey admin still says emergency shelter system can't meet demand
Healey's housing secretary, Ed Augustus, wrote in The extended declaration lasts until Nov. 9, and proclaims that because of the strain on the program, the shelter system must keep operating under a number of restrictions the administration began to put in place in the deepest throes of the emergency. The declaration, which is required under rules set out by the Legislature in a 2023 spending bill, can be extended again if Augustus determines it necessary. Amid that bureaucratic change, Healey's office said her emergency declaration from August 2023 still stands. The number of families in emergency shelter has fallen to Advertisement Meanwhile, the ongoing state of emergency means the administration, which has issued at least four contracts In a statement, a spokesperson for Healey said the governor imposed reforms that 'successfully reduced caseloads and costs,' and that 'it is essential that we continue these reforms so that the system does not experience another unsustainable surge and to protect taxpayer dollars.' 'Governor Healey inherited a shelter system that was not equipped to handle the surge in demand Massachusetts experienced these past few years,' the spokesperson, Karissa Hand, said. She said Healey's administration is actively evaluating 'whether the Governor's emergency declaration should remain in place.' Massachusetts experienced a rush of immigrants into the state beginning in the Since Healey took office in January 2023, officials drastically expanded the state's emergency shelter system to house thousands of homeless and migrant families For decades, homeless families have been guaranteed a roof over their heads under Advertisement As costs mounted over the last two years, Healey and legislators repeatedly added new requirements to dial back eligibility, including requiring homeless families to prove lawful immigration status, show they have lived in Massachusetts for at least six months, and undergo In 2023 Augustus, the housing secretary, The state's most recent data show fewer than 3,500 families in the system currently — half of the number there were at the emergency's peak. Mary Connaughton, chief operating officer for the Boston-based think tank Pioneer Institute, said 'calling this ongoing crisis an emergency is not only puzzling, it's costly.' Connaughton said the emergency declaration remaining in place has given cover for the administration to abide by 'weak internal rules,' and pointed out, as an example, a Healey officials and shelter operators rejected conclusions that her office broke the law in using no-bid contracts, and criticized the audit. Advertisement 'As we have seen, the emergency label has become license for weak internal procedures and faulty procurements,' she said. Healey, who is running for re-election in 2026, has drawn criticism of her handling of the shelter system by her GOP opponents. Mike Kennealy, a housing and economic development secretary under Baker, said the crisis 'has become a never-ending emergency' and that the latest extension 'only proves it's not going away.' He said as governor, he would create a 'loophole-free' residency requirement for the emergency shelter system. 'More than two years in, we're still in this situation because the state government lacked either the will or the ability to address the root cause from the start,' Kennealy said. 'Now, it's spiraled out of control.' Former MBTA executive Brian Shortsleeve, who is also running in the GOP primary, said Healey 'wants to use the crisis she created to continue to exercise extraordinary power with little transparency or oversight.' 'The real state of emergency is Maura Healey's out of control spending that is breaking the backs of taxpayers who are fed up with paying for billions in migrant benefits with no accountability,' he said. 'Beacon Hill needs a total overhaul, and that starts with firing the Housing Secretary followed by firing Maura Healey.' Some advocates say the current state of emergency and the related cap at 4,000 families also puts undue pressure on homeless families. Kelly Turley, associate director of the Massachusetts Coalition for the Homeless, said the current limits on the shelter system have created a cycle where people are leaving and re-entering the system instead of finding permanent housing they can afford. 'When the state of emergency was first declared, we weren't sure what powers it would give the state,' Turley said. 'Families are being timed out of shelter before they are able to secure long-term housing. The landscape has changed since August 2023 since the state of emergency was first declared.' Advertisement Matt Stout of the Globe staff contributed to this report. Samantha J. Gross can be reached at
Business Wire
25-06-2025
- Health
- Business Wire
Study Finds Trump's Most Favored Nation Drug Proposal Could Still Raise Out-of-Pocket Costs Without PBM Reform
BOSTON--(BUSINESS WIRE)--Out-of-pocket drug costs for seniors may rise under President Trump's Most Favored Nation (MFN) proposal if policymakers do not address the role of pharmacy benefit managers (PBMs), according to a brief released today by the Pioneer Institute. Smith and Popovian's brief hypothesize that under the Inflation Reduction Act (IRA), PBMs faced lost revenue due to federal price controls, leading them to shift costs to patients. According to Pioneer Institute's IRA Tool, out-of-pocket costs rose by 32 p Share The MFN proposal aims to link U.S. drug prices to the lowest prices in developed countries. However, if rebate contracting remains in place, lower drug prices could still translate into higher out-of-pocket costs for seniors, who may be forced to skip medications to avoid the financial burden. 'We can say with confidence that pharmacy benefit managers are profiting substantially from rebates, fees, and concessions tied to popular medications commonly prescribed to seniors,' said Dr. Bill Smith, co-author of the brief with Dr. Robert Popovian. 'These rebate payments can reach into the billions each year, creating strong incentives for PBMs to maintain the current system, even though many seniors on Medicare cannot afford the rising out-of-pocket costs. Policymakers must address this imbalance and ensure drug pricing works for patients, not just middlemen.' Under the current U.S. pharmaceutical market, PBMs negotiate deals with drug manufacturers promising better coverage in exchange for rebates, various concessions, and fees. To fulfill these contracts, PBMs may increase patients' out-of-pocket costs or impose extra paperwork to steer patients toward certain drugs. While generous rebates can sometimes reduce costs and administrative burdens, the system also incentivizes PBMs to favor higher-priced drugs that offer larger rebates, resulting in higher overall patient costs. This rebate system is largely unregulated and operates behind the scenes. PBMs argue rebates help lower overall drug costs and keep insurance premiums down. However, the lack of transparency creates incentives that don't always benefit patients. Smith and Popovian's brief hypothesize that under the Inflation Reduction Act (IRA), PBMs faced lost revenue due to federal price controls, leading them to shift costs to patients. According to Pioneer Institute's IRA Tool, out-of-pocket costs rose by 32 percent on average for nine commonly prescribed drugs, with seven seeing significant increases. 'Simply put, for the drugs with prices lowered by federal controls, seniors ended up paying more out-of-pocket,' said Dr. Popovian. 'If drug prices fall under the President's new policy but the flawed rebate system remains, patients will still struggle to afford their medications, and well-intentioned policies will backfire.' This warning follows last month's launch by Pioneer, a public tool to monitor the real impact of federal drug price controls under the IRA. The Medicare Drug Access Tracker focuses on Medicare patients served by the four largest PBMs, which cover 87 percent of the market, tracking whether price controls improve affordability over time. Pioneer's initial analysis found out-of-pocket costs increased for seven of nine drugs studied. Key findings include an average cost increase from $74.51 to $98.42 and individual drug cost hikes ranging from $10.56 to $316.81. The public can access the tool at and the full study at Dr. William S. Smith is Senior Fellow & Director of Pioneer Life Sciences Initiative. Dr. Smith has 25 years of experience in government and in corporate roles. His career includes senior staff positions for the Republican House leadership on Capitol Hill, the White House Office of National Drug Control Policy, and the Massachusetts Governor's office where he served under Governors Weld and Cellucci. He spent ten years at Pfizer Inc as Vice President of Public Affairs and Policy where he was responsible for Pfizer's corporate strategies for the U.S. policy environment. He later served as a consultant to major pharmaceutical, biotechnology and medical device companies. Dr. Smith earned his PhD in political science with distinction at The Catholic University of America. Dr. Robert Popovian is the Founder of the strategic consulting firm Conquest Advisors. He also serves as Chief Science Policy Officer at the Global Healthy Living Foundation, Senior Healthy Policy Fellow at the Progressive Policy Institute, and Visiting Health Policy Fellow at the Pioneer Institute. He previously served as Vice President, U.S. Government Relations at Pfizer. One of the country's foremost experts on every significant facet of biopharmaceuticals and the healthcare industry, he is a recognized authority on health economics, policy, government relations, medical affairs, and strategic planning. To learn more about Dr. Popovian please click here. Pioneer empowers Americans with choices and opportunities to live freely and thrive. Working with state policymakers, we use expert research, educational initiatives, legal action and coalition-building to advance human potential in four critical areas: K-12 Education, Health, Economic Opportunity, and American Civic Values.
Boston Globe
18-06-2025
- Business
- Boston Globe
Healey opened the door to tweaking the ‘millionaires tax.' Now what?
Jim Stergios — executive director of the right-leaning Pioneer Institute that opposed the millionaires tax — was thisclose to issuing a press release praising Healey. Then reality set in. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up The next day the governor — who as a then-candidate supported the Fair Share Amendment ballot initiative that created the millionaires tax — clarified her thoughts, telling Advertisement Now if you were in the audience, as I was, Healey came across as someone who has been getting an earful from business leaders about the impact of the tax — hearing that entrepreneurs might not want to start their businesses here, companies are having a hard time recruiting senior executives, and wealthy individuals are uprooting to Florida, New Hampshire, and other states without income taxes. Advertisement And while Healey did not give a full-throttled rejection of the millionaires tax, she was doing what any good leader should do: Listen, take notes, and review what's not working. 'I'm going to look at ways to lower costs, including what other tax reforms are necessary,' she said. 'I want Massachusetts to be a place where people are attracted to come and grow, and make money and succeed and do well. So I think we need to be open to that, to be open to looking at what we need to do within our existing tax regime that will make us more conducive to that.' Hundreds of attendees gathered both in-person and online for the Globe Tech Innovation Summit in Boston last week. Michael Manning Photography Anyone who has followed the millionaires tax debate knows that, for the business community, this is what counts as a victory, after And during the seven-year push to get the millionaires tax on the ballot, its pros and cons have been well litigated, both in court and in the court of public opinion. Voters approved the tax because they want better schools and a functioning T, and now that billions of dollars in new tax money is flowing, it's hard to see Beacon Hill giving it up. Nothing gives But what the opposition is saying now is that an idea that was conceived before the pandemic feels more ill-conceived today. 'We need to recognize that the millionaires tax was a concept that was put forward in far different economic time,' said Jay Ash, CEO of the Massachusetts Competitive Partnership, whose business group opposed the tax. 'COVID made the world much smaller ... now everyone can operate from anywhere.' Advertisement Employees and companies have choices they may not have a few years ago. Between the high cost of doing business and a I don't see business leaders marching in the streets demanding a repeal of the millionaires tax. They're smarter than that. Rather, they're playing the long game: Here's Had the Massachusetts private sector created 250,000 jobs during that period like North Carolina did, we would have generated an additional $1.3 billion in state income and sales tax revenue, according to Pioneer Institute analysis. John T. C. Lee, CEO of MKS Inc. and chair of the Massachusetts High Technology Council, says he knows a few people who've moved away to avoid the millionaires tax. He's also seen the surtax hurt recruiting, with a couple of job candidates deciding not to work at MKS, an Andover company that supplies equipment and components to computer chip makers. Advertisement 'Whether it's revisiting, repealing, whatever, I think it is worth looking at the data,' said Lee. 'The best thing is that we look at the facts, and the facts steer us towards one direction or another.' The Fair Share Amendment ballot initiative created the millionaires tax. 52 percent of voters approved the tax by a clear margin in 2022. Pat Greenhouse/Globe Staff Data will be key, and so far it's all too early to weigh the benefits of the millionaires tax against the costs, Meanwhile, any effort to repeal the tax would take years, requiring an amendment to the state constitution and votes by two successive Legislatures, followed by a citizen ballot question. And it would clearly draw a fight from powerful labor groups, who outspent the business community the first time around. Another option: lower the base income tax rate for everyone to something below 5 percent. That'd be a tough sell to Beacon Hill because income taxes are the primary source of revenue for the state budget. The bottom line: Repealing the millionaires tax isn't on the table yet, but make no mistake the push to chip away at it has already begun. Shirley Leung is a Business columnist and host of the Globe Opinion podcast 'Say More with Shirley Leung.' Find the podcast on , , and . Follow her on Threads Advertisement Shirley Leung is a Business columnist. She can be reached at
Boston Globe
14-06-2025
- Health
- Boston Globe
Call for Medicaid work requirements is greeted by a chorus of boos
Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up What Archambault does not acknowledge is that Medicaid serves the working poor, which includes low-wage workers who are working multiple part-time jobs that don't provide coverage or positions that fall just below the threshold that would qualify them for coverage by their employer (an all-too-common practice by companies to avoid providing benefits). Advertisement Moreover, some family members who are caregivers might not be able to meet the work requirement. In a June 2 op-ed, Advertisement Finally, this hyperfocus on which low-income people deserve access to subsidized medical care distracts from what should be the primary focus: that our federal leaders are promising 'savings' on the cost of benefits in order to advance massive tax cuts that will benefit the wealthy and increase the national debt. Rosemarie Buxton Haverhill With health care costs skyrocketing, reform is needed — but not this kind My Pioneer Institute colleague, Josh Archambault, is correct that we do need Medicaid reform, but the solutions he offers, an old trope of work-or-volunteer remedies that recall the 'welfare queen' stereotype of 40 years ago, will As Archambault states, the original idea behind national Medicaid was to provide health insurance to seniors and people who are blind or have other disabilities. Over time, however, rapidly escalating health care costs strained the limits of employer-sponsored health insurance, and by 1995 the Since that time, Massachusetts has chosen policies to expand health insurance coverage. Eligibility for Medicaid, known here as MassHealth, has grown to include those who are not only below poverty lines but also those who are at certain levels above poverty rates. This includes nondisabled people and many more children. At the same time, health care prices in Massachusetts have skyrocketed, with Advertisement Barbara Anthony Cambridge The writer is a senior fellow at the Pioneer Institute and former undersecretary of the Massachusetts Office of Consumer Affairs and Business Regulation. National health safety net is frayed enough as it is Josh Archambault's op-ed does nothing to advance an important debate around our national health safety net. The situation is far more complicated than the talking points he offers. An estimated We have seen this before. When Arkansas and Georgia implemented work requirements, most of the people who lost coverage actually met the requirements but got caught up in red tape. We hear from callers every day on We stand with the Massachusetts congressional delegation in pushing back against the unprecedented health care cuts in the House bill. Advertisement Amy Rosenthal Executive director Health Care for All Boston Instead of prodding the 'able-bodied,' strengthen workforce development Josh Archambault's argument that imposing work requirements on 'able-bodied' adults who receive Medicaid will improve health is wrong on several levels. First, multiple evaluations of the Affordable Care Act Medicaid expansion demonstrate improved health overall and improved outcomes for specific populations (for example, reduced deaths from opioid use). The Second, evaluations of the impact of work requirements for welfare recipients have generally shown the initial increased work participation failed to sustain income or reduce poverty over time because of low wages and insufficient work supports. Third, to get Medicaid via disability, people must meet strict Social Security definitions of disability — a high severity bar — and large numbers of people with significant disabilities do not. Many of the 'nondisabled' childless adults on Medicaid have major mental health conditions, substance use disorders, and developmental disorders, including autism, that significantly affect their ability to succeed in the workforce. The population of low-income adults who became eligible for Medicaid through the Affordable Care Act also includes many parents, who too would be subject to paperwork burdens every six months. Work that provides a living wage is a desirable outcome. Rather than imposing burdensome administrative requirements, real reform means strengthening workforce development policies — at all ages — through apprenticeship programs, other training work, coaching, reliable hours and transportation, and other policies that encourage jobs for previously unemployed people. Advertisement Real reform also means strengthening health care prevention and promotion. MassHealth has taken clear leadership in promoting comprehensive primary care by transforming payment systems and providing incentives for team care, including the integration of mental-behavioral health care. Such efforts should be amplified rather than impeded through work requirement efforts. Dr. James M. Perrin Boston Dr. Charles J. Homer Brookline Perrin is a professor emeritus of pediatrics at Harvard Medical School and John C. Robinson Distinguished Chair in Pediatrics at MassGeneral Brigham for Children and former president of the American Academy of Pediatrics. Homer is senior adviser at Economic Mobility Pathways and former deputy assistant secretary, human services policy, at the US Department of Health and Human Services. The less fortunate don't need more hoops to jump through There are a number of sleights of hand in Josh Archambault's call for Medicaid reform, not the least of which is judging a program that pays for access to our medical system by the outcomes provided by that system. But it's his call for government-mandated community engagement as a condition for having your doctor's visit subsidized that is truly gobsmacking. It was not so long ago that such a proposal would be derided by conservatives as government social engineering because, among other things, it's literally that. Does Archambault truly believe that the federal government is capable of creating a meaningful social fabric for the less fortunate among us, or does he think that, as proven time and time again, adding requirements to social safety net benefits will simply discourage recipients from applying, thus reducing the costs of the programs? Saul Tannenbaum Boston
Yahoo
09-05-2025
- Health
- Yahoo
Pioneer Institute Launches Tracker Showing Drug Price Controls Are Raising Out-of-Pocket Costs for Medicare Patients
New data tool shows out-of-pocket costs have increased for most drugs targeted by Inflation Reduction Act price controls BOSTON, May 09, 2025--(BUSINESS WIRE)--A new data tool from Pioneer Institute reveals that federal drug price controls—intended to reduce out-of-pocket costs for seniors—are instead making many prescription drugs more expensive for Medicare beneficiaries. The IRA Medicare Drug Access Tracker, developed by Dr. William Smith and Dr. Robert Popovian, monitors the impact of the Inflation Reduction Act's (IRA) drug pricing provisions. Its first analysis shows that among nine commonly prescribed medications which were subject to price setting by the IRA —used to treat conditions like heart failure, diabetes, and blood clotting—seven saw an increase in patient out-of-pocket costs. (The insulin product was not studied since its price was fixed in statute under a separate IRA provision.) "The price controls show that Congress fundamentally doesn't understand the rebate system that underpins the pharmaceutical market," said Dr. William Smith, who built the Tracker with Dr. Robert Popovian. "All the politicians who argued that the IRA law would make drugs more affordable should look at this new data." Under the current system, drug manufacturers pay substantial rebates to pharmacy benefit managers (PBMs) such as Caremark and Optum. These rebates help offset costs but are invisible to patients. When CMS seeks to control prices by lowering a drug's official "list price," as it does with the anti-coagulant Eliquis—bringing the price down from $521 to $231—rebates disappear, likely eliminating hundreds of millions in rebate payments from manufacturers to PBMs. PBMs appear to be compensating for that loss by raising co-pays, co-insurance, and transferring other charges directly to patients. The IRA Medicare Drug Access Tracker focuses on Medicare patients served by the four largest PBMs, which account for 87 percent of the market. The tool is designed to measure whether federal price controls actually improve affordability for seniors by tracking out-of-pocket costs over time. It also follows administrative burdens that PBMs may have imposed on these drugs, which may strain already short-staffed providers, such as requiring them to fill out additional paperwork to secure a prescription (prior authorization) or placing quantity limits on the medications. Such administrative burdens are often used in the industry to discourage demand (demand management). Among the Tracker's key findings: Average out-of-pocket costs for the nine drugs rose 32 percent, from $74.51 to $98.42 Seven of the nine drugs saw individual cost increases ranging from $10.56 to $316.81 One of the two medicines seeing no increase in out-of-pocket costs faced competition from biosimilars that only became available in 2025 "Higher out-of-pocket costs are unlikely to be the only unintended consequence of drug price controls," Dr. Popovian said. "The IRA also creates less incentive for pharmaceutical innovation and increases the possibility that some popular drugs may be excluded from health insurance formularies." This release marks the Tracker's first report. Pioneer Institute will publish additional data later this year, as more drugs fall under the Inflation Reduction Act's price-setting provisions. The public can find the tool at Dr. William S. Smith is Senior Fellow & Director of Pioneer Life Sciences Initiative. Dr. Smith has 25 years of experience in government and in corporate roles. His career includes senior staff positions for the Republican House leadership on Capitol Hill, the White House Office of National Drug Control Policy, and the Massachusetts Governor's office where he served under Governors Weld and Cellucci. He spent ten years at Pfizer Inc as Vice President of Public Affairs and Policy where he was responsible for Pfizer's corporate strategies for the U.S. policy environment. He later served as a consultant to major pharmaceutical, biotechnology and medical device companies. Dr. Smith earned his PhD in political science with distinction at The Catholic University of America. Dr. Robert Popovian is the Founder of the strategic consulting firm Conquest Advisors. He also serves as Chief Science Policy Officer at the Global Healthy Living Foundation, Senior Healthy Policy Fellow at the Progressive Policy Institute, and Visiting Health Policy Fellow at the Pioneer Institute. He previously served as Vice President, U.S. Government Relations at Pfizer. One of the country's foremost experts on every significant facet of biopharmaceuticals and the healthcare industry, he is a recognized authority on health economics, policy, government relations, medical affairs, and strategic planning. To learn more about Dr. Popovian please click here. About Pioneer Institute Pioneer empowers Americans with choices and opportunities to live freely and thrive. Working with state policymakers, we use expert research, educational initiatives, legal action and coalition-building to advance human potential in four critical areas: K-12 Education, Health, Economic Opportunity, and American Civic Values. Please see below the first group of drugs subject that Pioneer is studying. Eliquis Enbrel Entresto Farxiga Imbruvica Januvia Jardiance Stelara Xarelto View source version on Contacts Media Contact: Amie O'Hearn aohearn@ Sign in to access your portfolio
