It depends. They already do work together, the model just needs to evolve. How? By respecting the boundary between government and the private market — and the application of private sector management principles, the government can work with the private sector to insure the uninsured and lower cost.

In 2006, Massachusetts enacted health care reform similar to the Affordable Care Act. Today, Massachusetts insures almost 98% of its residents, leading the nation on that measure. On the other hand, it also leads the nation in health care costs — 36% higher per capita than any state in the country.

When the law was passed, the business and broker communities partnered with regional health plans (four of top 10 in the country) to implement it and increase the percentage of employer-sponsored insured (which it did). Negative impacts of the law were identified along the way and changes were made by listening to and working collaboratively with the private market. In many cases, employers and brokers stepped forward to hold government accountable when it ignored the boundaries, i.e., “Connector Scope Creep” — and at times, it looked like the government and the private market could work together.

A wrong turn

Then, along came the ACA and its negative impact to MA. Rather than grant Massachusetts a waiver from the ACA because it had already achieved the goal of insuring the uninsured, the new federal ACA requirements broke a fully-functioning website un-insuring the insured and replaced it with inferior technology. Today, the Massachusetts private market is holding our state government accountable to solve the adverse impact of the ACA and it is safe to say, that is one of the reasons Republican Charlie Baker was elected as its next governor.

Baker is a seasoned health care executive who ran the nation’s No.1 health plan — and he has vowed to partner with the private market to seek a waiver from the ACA and focus on controlling cost by making the health care market transparent. Baker respects the private market.

On a federal level, has a new CEO who understands the importance of and how to partner with the private market. Kevin Counihan was a health care executive with Tufts Health Plan and the chief marketing officer for the Massachusetts Healthcare Connector. He was also the executive director for the Connecticut State Exchange — which by all accounts has become a model for other state-based exchanges to emulate across the country. Why? Because, it was designed to partner with the private market and forge relationships with employers and brokers. Counihan respects the private market.

Can the government and the private market work together on health care reform? The answer is it depends on who’s leading and how they lead. If the government partners with the private market, listens to and embraces feedback, respects the boundary lines and can approach ACA implementation with a collaborative rather than authoritative mindset, magical things can happen.

Gaunya is principal at Borislow Insurance and an EBA advisory board member. He can be reached at

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