GUESTS: Mike Minogue, former chairman, president, and CEO of Abiomed and Republican candidate for governor of Massachusetts
MIKE MINOGUE, THE REPUBLICAN mega-donor and candidate for governor, said this week he supports the concept of a legislative push to raise the share of health insurance spending on primary care — but worries that the state could find itself scrambling to funnel more and more money into the health care space unless costs can be controlled.
Minogue, who spent 19 years as CEO of Abiomed, the Danvers-based heart pump company, joined hosts John McDonough of the Harvard T.H. Chan School of Public Health and Paul Hattis of the Lown Institute on this month’s Health or Consequences podcast. (Gov. Maura Healey’s office did not respond to the show’s invitation to appear.)
A primary care taskforce and the state Senate have endorsed requiring insurers to raise primary care spending from roughly 7 to 8 percent of premiums today to 15 percent over several years. Minogue questioned whether the mandate would simply shift money from one part of the health care system to another without addressing underlying costs.
“Instead of a problem solved, you take a piece of pie from someone and give it to someone else,” he said. “I haven’t seen that work in health care. The way I like it is, let’s get rid of some of the waste and fraud.”
Minogue, who has rolled out a “Patients First” campaign platform, pointed to pharmacy benefit managers as one target, arguing that PBMs have financial incentives to keep patients on brand-name drugs rather than cheaper generics, costing the state hundreds of millions of dollars.
On the Trump administration’s so-called One Big Beautiful Bill Act’s Medicaid cuts — which the Congressional Budget Office projects will cause 326,000 low-income Massachusetts residents to lose coverage and cost the state $2 billion a year in federal revenue — Minogue said he opposes anyone losing health care. His proposed response focused largely on administrative fixes: a 1-800 number and multilingual website to help Medicaid enrollees navigate new work requirements before they lose coverage.
McDonough noted that about 7,500 documented legal immigrants were set to lose MassHealth, the state’s Medicaid coverage, on October 1. Trump administration restrictions on visas could make closing physicians and nurses staffing shortage more difficult, he said.
Minogue did not address the MassHealth population directly, and said the state could “have incentives for people to stay here.”
He mentioned Temporary Protected Status as a lawful way for people to be in the country. The Trump administration has been aggressively rolling back TPS status for many of the countries that support the health care workforce.
Minogue noted that mental health needs are a significant strain on the system, touting work by the Michael & Renee Minogue Foundation on homelessness and addiction services.
“We are not ready for the mental health crisis,” he said. “And I look at the mental health crisis as a health care issue, because what a lot of people do for care is they go to that emergency room. That emergency room is the most expensive, least compassionate, and efficient way to treat them.”
On the Health Policy Commission, the independent state agency focused on health care affordability, Minogue declined to propose specific changes.
“Well, I haven’t been on the inside,” he said, but “what I would say is that the results are the results. We have the most expensive [commercial] health care in America. We have the longest [emergency room] wait times on record since we’ve been tracking in the Boston ERs.” Those sorts of realities, he said, mean “we need to do something different.”
He said he would seek a shared savings model agreement with federal health officials, where the state establishes a benchmark budget and works to manage care more efficiently. If the state spends below that agreed-upon baseline, the resulting “savings” are split between the federal government and the state. Minogue said he would push to keep 80 percent of any savings generated.
When Hattis pressed him on hospital market consolidation, which state data has consistently linked to higher prices, Minogue said he would push large systems to expand into communities through surgery centers and clinics, reducing pressure on Boston hospitals.
Minogue also addressed the state’s individual health insurance mandate, the mechanism that has helped keep Massachusetts’s uninsurance rate at 2 to 3 percent, the lowest in the country, for 20 years. He said he wouldn’t commit to supporting or opposing it without more study.
“In concept I agree with it — that people should pay something for health insurance,” he said. “The problem is who pays and makes up the difference. There’s a reason we’re the most expensive health care in the country.”
On the episode, McDonough, Hattis, and Minogue discuss primary care spending mandates (7:30), the Medicaid cliff (13:00), hospital consolidation (20:00), and the Massachusetts individual mandate (26:30).
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