When it was official that Charlie Baker would return to state government as Governor, I went into a PTSD state of fear and anger.
Not many people realize it but he was both Health and Human Services and Administration and Finance Secretary under then Gov. Bill Weld throughout the 1990s. These were rough years for people with disabilities and poor people in general. Back then, as he is doing now, Baker pounced on Medicaid and started cutting and sometimes gutting programs that had a negative effect on the lives of people with disabilities and elders.
He was successful in bringing together a coalition of community organizations that wanted to close outdated and unwanted psychiatric hospitals statewide and build a system of community services and supports so that people with psychiatric disabilities could live in the community and receive services locally. This is something that the disability and provider communities wanted for decades, so after lengthy negotiations with HHS Secretary Charlie Baker, advocates agreed to support the plan provided that funding would be made available for the community side of the equation. That didn't happen and today we have one of the highest rates of homeless mentally ill people in the country.
Another shelling was when Baker attempted to remove the "optional" Medicaid Personal Care Assistance program that provided thousands of people with significant physical disabilities who live in the community with funding for attendant care. This program had been working successfully since its inception in 1974 but, it too, didn't escape the chopping block. In a surprise reaction after many warnings, the disability community occupied Nurses Hall in the Statehouse and turned it into a "Nursing Home" to symbolize what would happen if the program was cut as proposed. It was occupied for 28 days around-the-clock before Gov. Weld finally relented the plan.
In 1996 Sec. Baker decided that there was money to be saved in reducing and combining state agencies and chose the Massachusetts Rehabilitation Commission, Massachusetts Commission for Deaf and Hard of Hearing and the Massachusetts Commission for the Blind. Once again, the disability community pulled together and fought off the attack by establishing a consortium of different disability groups to stop it in the legislature.
There were other attacks on other groups and they generally tended to be poor and perceived as relatively powerless. When they banded together, however, they collectively had quite a bit of power and managed to survive the carnage, but with heavy losses.
We shouldn't be surprised one bit that today Gov. Charlie Baker is picking up where he left off -- he's attacking MassHealth in the name of "sustainability." Although his chosen bureaucrats vehemently argue that better services can be found with less money, people with disabilities have always come out on the short end of the stick as evidenced by the Governor’s past performance. He is in the process of "re-engineering" MassHealth in a way that hasn't been witnessed in 20 years. Which, by the way, was when he was last in state government.
He's launching a managed care empire that builds off of his history and experience as CEO of Harvard Pilgrim Health Plan. The new plan shifts costs from a fee-for-service model to a managed care organization structure. Similar to private health plans, uniform rates for medical and long-term services and supports would be established and large providers, or Accountable Care Organizations, would oversee hospitals, community care clinics and long-term services and supports entities in the delivery of healthcare. The Baker administration is presently in negotiation with the Centers for Medicaid and Medicare Services for a $1.5 billion planning and implementation grant under the Affordable Care Act.
Again, people with disabilities are challenging the Administration, just as we were in the 90s. Based on experience, we know that back room deals and empty promises will only leave us in worse condition than we were when we started. We can't afford to be duped this time around into believing that the motive in the healthcare restructuring is to "improve efficiency and provide for better health outcomes." Interesting theory but, it's all about the money!
Now, he's decided not to pay Personal Care Assistants overtime. If you don't know what a PCA is or does, it may sound like a reasonable, albeit callous, cost savings measure for a growing program. Don't pay overtime, save money and everything will work itself out. It's all in the details, just like when the psychiatric hospitals were closed in the 90s under then Secretary Baker and community services and supports were part of the deal that didn't materialize.
Over 300 people with disabilities, PCAs and others rallied at the Statehouse on September 20 in opposition of this decision that will destabilize the program and force people with disabilities to receive less personal assistance because their, already delicate system, will be slowly eroded and eventually destroyed. Because of no overtime, good, qualified, reliable PCAs will leave the field and it will get harder and harder to piece a support system together for everyone who uses this program that has functioned perfectly well over the decades.
We won't get fooled again.
