Interview with Employer Coalition President Eileen McAnenny

Eileen McAnenny, the driving force behind the Employer Coalition on Health in Massachusetts shares her journey from a typical Irish Catholic home in Somerville (before it was fashionable) to a leader in healthcare policy and cost management. 

Discover how her roots and influential figures like Tip O'Neill and the Kennedys shaped her passion for public service, leading to a law career and roles at the Bank of New England, the Joint Committee on Taxation, and beyond. Eileen's insights on employer engagement in healthcare costs and her work with the Massachusetts Taxpayers Foundation illuminate the challenges and opportunities in controlling this major business expense.

As healthcare costs in Massachusetts continue to balloon, smaller businesses are feeling the pinch more than ever. 

This episode delves into the complexities of managing healthcare costs, especially in a state where large healthcare employers wield significant political influence. We explore the role of employer coalitions in bringing balance to the conversation, representing the needs of those tasked with purchasing healthcare, and striving for sustainability against the backdrop of inflation and workforce shortages. Eileen's experience at Fidelity and her focus on employer-related policy issues provide a compelling narrative on the interplay between businesses and healthcare providers. 

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links: 

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Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. 

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:00 - David Williams
Employers foot the bill for ever-rising costs in healthcare, but they're surprisingly passive in their approach to dealing with key suppliers like hospitals and drug companies, and never mind state legislatures. But what happens when employers pay closer attention to healthcare? Can they make a difference in the common good and for their own bottom lines? Hi everyone, I'm David Williams, president of Strategy Consulting Firm Health Business Group and host of the Health Biz Podcast, a weekly show where I interview top healthcare leaders about their lives and careers. My guest today is Eileen McEnany, leader of the newly launched Employer Coalition on Health in Massachusetts, with an emphasis on controlling runaway healthcare costs. If you like this show, please subscribe and leave a review. Eileen, welcome to the Health Biz Podcast. 

0:00:55 - Eileen McAnenny
Thanks, david, happy to be here. 

0:00:58 - David Williams
Well, we're going to talk about what employers can do, but before that, let's talk about some of your background. I would love to hear a little bit about your childhood, any childhood influences that have stuck with you throughout your career. 

0:01:12 - Eileen McAnenny
Sure. So I grew up in Somerville, massachusetts, long before it was fashionable. I am the youngest of four children and my dad was a fireman. My mom was a stay-at-home mother until least eighth grade and I would describe our family as the typical Irish Catholic Boston Union family of you know the 60s and 70s. And you asked for an influence. Certainly Tiponia, which you saw that I interned for him. Yeah, influence, certainly Tip O'Neill, which you saw that I interned for him. 

0:01:49 - David Williams
But I loved reading about John F Kennedy and Jackie Kennedy was my idol when I was young, that sounds good and I saw you went to Tufts and then I think maybe you had a year at Catholic University and you interned for Tip O'Neill at that time. 

0:02:00 - Eileen McAnenny
I did. I made my own Tufts and Washington program by transferring to Catholic University and I did intern for Tip O'Neill when he was the Speaker of the House and that fulfilled kind of a lifelong dream. Or at least it began just working in and around public policy. 

0:02:19 - David Williams
That's good. You know, I think both Tip O'Neill and Teddy Kennedy are just amazing assets for the country, but also for Massachusetts in particular, and they always made sure that we got at least our fair share of resources. I guess I would say and then some. Fair enough. And what about law school? Why did you go to law school? 

0:02:37 - Eileen McAnenny
Well, you know, I guess I was pretty naive. If you asked me in college what I wanted to be when I grew up, I would have told you a United States senator, until I learned that it was the most exclusive men's club in the world. But I just always was interested in law, public policy, that type of thing, and so I went to law school expecting to have a career in the policy realm. To have a career in the policy realm. 

0:03:04 - David Williams
Good, well, I saw you know as I was looking through your LinkedIn. I know some of your background, but not all of it. I saw you were at Bank of New England and then the Joint Committee on Taxation in the Massachusetts legislature, and then, I think, when we first met, which is probably when you were at Associated Industries of Massachusetts, what was your journey like along that path? 

0:03:24 - Eileen McAnenny
Sure Well. So I worked at Bank of New England in their marketing department actually, but always with an eye towards law school, and I went to law school at night while I was at Bank of New England. And then my first job I worked for a really small law firm but I had a friend who worked up on Beacon Hill and I had applied for a job as a legislative aide. A research director went to visit my friend, she put me in touch with someone who recommended me, and one thing led to another and I started working for Marion Walsh when she was the Senate chair of what was then the Joint Committee on Taxation, and I worked there for a little shy of four years, worked on a lot of interesting tax policy issues. It was a very active time for the committee, so it was a great experience. 

0:04:16 - David Williams
Very good and AIM. 

0:04:20 - Eileen McAnenny
So that was kind of the natural, I guess, progression. Having worked on tax issues for several years, I got to know Rick Lord, who was the head lobbyist of Associated Industries of Massachusetts at the time. He then became the president, but they were looking for a lobbyist and so approached me and the time was right and I went to work for them and focused on tax policy issues, as I had when I worked, you know, for the legislature, but then on healthcare policy and that kind of began my journey into health policy. 

0:04:56 - David Williams
Got it, and that's when I got to know AIM a little bit, and Rick when we were working on that. And then I see a stint at Fidelity you're working on that. 

0:05:09 - Eileen McAnenny
And then I see a stint at Fidelity. Yes, so I've been at AIM for 13 years or so, thought it might be time for a change and there was an opportunity to go in-house working on public policy at Fidelity and I worked on issues that were of importance to them as an employer. So, again, things like tax, healthcare, unemployment, employment law issues any of those things that affected them as an employer. 

0:05:31 - David Williams
Got it. And then the Massachusetts Taxpayers Foundation, and I'll ask you about that and I'll ask you is it fair to describe Massachusetts, sometimes described as taxachusetts, maybe just because the name goes together? Is that fair, fair? Or what is the Taxpayers Foundation for? 

0:05:47 - Eileen McAnenny
I think it was fair at one time. I don't think it's fair as much these days, because a lot of work was done in the 90s to get Massachusetts more in line with other states. We were an outlier for a long time. I think our overall taxes tend to be in the middle of the pack, but it doesn't mean there aren't some particular taxes that stand out. The estate tax is certainly one of them. For businesses, we have a surtax on S corporations, we have a tax on non-income as part of the corporate excise, so there are places where an outlier is short yeah, yeah, got it. 

0:06:30 - David Williams
And about the Pioneer Institute. That's where you've been most recently, up until and including launching this Employer Coalition on Health. What is the Pioneer Institute and what's your role there? 

0:06:40 - Eileen McAnenny
So I'm a senior fellow of economic opportunity and Pioneer really supports free markets, open and transparent government, immigrant entrepreneurship, educational choice and a whole host of other things. 

0:06:57 - David Williams
Got it All right. Well, let's talk about this brand new Employer Coalition on Health, and when I say brand new, we've been talking about it for a while, but I think it's just officially being launched very, very recently. 

0:07:09 - Eileen McAnenny
And I want to start off by asking about what role have employers historically played in health care bill chapter 58, as it's often called, and then some of the subsequent pieces of legislation, one of them being chapter 224, which was all about cost containment. So the employer voice was really important to any of the kind of milestones we've made in health care coverage and access and quality in the past 20 years. But in recent years I think that voice has been muted. 

0:07:59 - David Williams
Got it so back at the time of these various chapters which among maybe commonly called that, but not necessarily among the average resident or casual viewer, but this Romneycare, which was the basis of Obamacare. And it's interesting, of course, that Obamacare became just a famous, you know, democratic versus Republican issue, but Governor Romney was certainly not a Democrat, and could you talk a little bit more about how things came together and why? You know why this Chapter 58 occurred under Republican gubernatorial administration. 

0:08:41 - Eileen McAnenny
Absolutely, and what I will say is so, Romneycare as you refer to it and I refer to it as Chapter 58, we'll just call it Massachusetts Landmark Healthcare Reform but it was able to come about because Massachusetts was in a place. 

We were far ahead of the nation as a whole on a number of fronts. We had great coverage, we spent a lot of money on healthcare covering people who are uninsured, and we also reimbursed hospitals for the free care they provided. We had a number of provisions and insurance laws that made the coverage robust, and so I think when Governor Romney took office, he said how can we spend the significant amount of money that we're currently spending on health care in a better way? And so his thought was, rather than compensate hospitals after the fact when they provided care to the uninsured often in the emergency room and often in a much more serious condition than if someone had had insurance and got preventative care what he decided to do was say let's make sure everyone has coverage, let's make sure everyone has coverage, and that required some new costs for employers, certainly for individuals, for the Commonwealth, but the notion was to better utilize the healthcare spend to provide preventative care and in the long run, it would make people healthier and save money to the system. That was the idea. 

0:10:13 - David Williams
Remember we had the I think the uncompensated care pool you may be referring to, where the money was being spent, but it was the idea of bringing everybody into the system, have coverage and then see if the market could work better. I recall, after Chapter 58 was enacted and there were some other states, like California, that were looking at doing something similar, and you look and you say you know there's a difference, because we already had here in Massachusetts, a high level of coverage and it was just a relatively small gap to bridge and the equivalent of Chapter 58 wasn't achievable nationwide, certainly, and there may be a couple of other states where it could have been done. And so I think one of the things that happened with the Affordable Care Act is that it ends up needing a lot of new resources. So it's not just maybe Rob McKeer is a model for Obamacare, but it wasn't the same thing that the money's already in the system. Let's make it more, let's just make it more effective. And so employers rallied around. That, I think, is what you're saying. 

0:11:09 - Eileen McAnenny
Well, they did right because they contributed to the uncompensated care pool, you know, indirectly, certainly in the cost of care at hospitals and through insurance premiums. And so they thought that that made sense. And you know, you have to remember, employers provide health care coverage as a benefit. Their health insurance is the biggest benefit they provide typically. Their health insurance is the biggest benefit they provide typically. And so they wanted to make sure that the coverage that their employees were receiving was good and that everyone had decent care. And so, I mean, I think people came together. It made sense from an economic standpoint, it made sense from a social welfare standpoint and it made sense because of where Massachusetts was standpoint. And it made sense because of where Massachusetts was, like you say, it was a smaller step to achieve that than it was for the nation as a whole. For sure. 

0:12:01 - David Williams
So what's happened with the healthcare system in Massachusetts since that time? So the idea was there was enough money in the system, we'll reallocate it. That's been a while since then. I know the costs have gone up, the budget is strained and there's new noises around and about. But what occurred after that, between Chapter 58 and now? 

0:12:23 - Eileen McAnenny
Well, a whole bunch of things, and so, first of all, I'll just go back to, you know, take it back up a level and say the whole promise of healthcare reform was that we would improve access, we would improve cost and we would improve quality, often referred to as the three legs of the stool in healthcare and so we improved access, right with Romney Cara, chapter 58. 

I think quality has always been one of the strong suits of the Massachusetts health care system, certainly relative to other places, and so the unfinished business was cost containment, and that's what employers were promised. It's what they expected is the next phase of health care reform, and it's still elusive at this point. And so that's why I think this employer coalition on health is needed, but it's also because, right now, massachusetts has an affordability and a competitiveness problem. We're losing people, we're losing young people, and housing cost is certainly part of the equation, but so is the cost of health care, among other things. And so I think it's really important that we keep our eye on that health care affordability ball, because it's super important to individuals, it's important to businesses and actually it's important to taxpayers, because they pick up the tab for a lot of the health care costs too. 

0:13:55 - David Williams
So, eileen, in the Chapter 58 days, I think one of the things that was a change that occurred then was that there had been for quite a while the discussion of, well, we have to get cost under control before we can deal with coverage. And there was just a change that said, ok, look, we've been trying that for a while, it hasn't worked. You had groups like Health Care for All and change that said, ok, look, we've been trying that for a while, it hasn't worked. You had groups like Healthcare for All and others that said, look, you never get it, you won't get it under control, let's do it the other way. And that was part of the logic that by having everybody in the system you can help to bring costs under control. 

And, as you said, that is not really what happens. So you've got folks in the system Costs, folks in the system costs have not been under control. Maybe they were under control for a little while, but not so much since. So where you're talking about the need for the employer coalition now, but where did the employers go? I mean, they were around for Chapter 58. They've certainly been paying the bills since, but you haven't heard about such an organized employer community as it relates to these sort of healthcare cost issues. As you say they were promised. 

0:14:57 - Eileen McAnenny
Well, so there is a chapter in between kind of where we are now in Chapter 58, and that is the creation of a couple of state agencies that were focused on health care costs. So one was the Health Policy Commission and the other was the Center for Health Information and Analysis, and they were part of that Chapter 224 that I referenced. But the notion was let's gather all the information, let's understand what's driving cost, let's have data to inform how we move forward in our cost control efforts, and so those agencies were created. They've existed for about 12 years now and they did have some initial success. One of the things that the Health Policy Commission did was set an annual cost benchmark, and the notion was healthcare should not increase. The total healthcare spend in Massachusetts should not increase by more than a certain percentage, and it was either 3.1 or 3.6%. 

Pretty much for the past 12 years, community was very actively advocating for a cost benchmark. That was actually taking cost out of the system, making that cost benchmark negative, and the reason is because there was ample evidence and really, by everyone's admission, a lot of the care that was provided was either unnecessary, inappropriate or even potentially harmful, and so the thought was let's kind of get the system efficient. Let's take some of that excess out of the system, and then we'll move forward. Let's make sure the baseline is set appropriately. It never happened, though. It became a cost growth benchmark, and so the notion was to moderate cost growth rather than take cost out of the system. But even given that more lenient bench line or benchmark, if you will we failed to meet it for several years, and so it hasn't had the effect that certainly the employer community was hoping for. 

0:17:16 - David Williams
So what's driving the need to have a totally new group come now, this coalition? 

0:17:21 - Eileen McAnenny
Well, I think there are a couple of things. The cost of health care has really risen in recent years. I think it was year over year from 2021 to 2022, the increase was about 9%. And at the most recent cost trend hearing, where this Health Policy Commission hears from all kinds of experts, some of the insurance company executives said that the trend is even more eye-opening, saying things like 40% increases over the next three years, and I just I think that that is not sustainable given the backdrop of high inflation that we have and a lot of pressure on wages because we have a workforce shortage. So you know, it's kind of a one-two punch and I think these healthcare cost trends that they're unsustainable and we have to do something about it, particularly if we want to retain people and businesses in Massachusetts. 

0:18:17 - David Williams
Got it. You know one of the things that's notable when I think about employers, of course, partly because there's so much spending on health care, a lot of the employment is in health care and therefore a lot of the employers. So if you look around at who some of the big employers are, you've got, you know, the state government, universities we have a lot of. We have companies, but there's a lot of hospitals, there's drug companies, which of course is a lot of what powers the Massachusetts economy. But I think one of the challenges of a typical chamber of commerce or, you know, employer group is that a lot of it is the insiders who may not be quite as they still care about the cost actually for health insurance for their own employees. Ironically, even hospitals and physician groups complain sometimes to the cost of health insurance. But it makes it a little difficult. Is this group focused more on the non-healthcare part of our economy such as it is? 

0:19:16 - Eileen McAnenny
So you're exactly right. 

You know that I think healthcare big healthcare are large employers in Massachusetts and they tend to be some of the largest members of a lot of chambers of commerce. 

I live in Melrose and I'm sure Melrose-Wakefield is the largest employer in the city, and so they have some sway, certainly on the local chambers and other business organizations. 

And so often what happens is if there is some kind of controversial health care issue or you know some kind of proposal that would take cost out of the system, then those chambers or business organizations often can't reach a consensus and so they remain neutral, they don't take a position. But the problem is, you know, some of the stakeholders in healthcare, like the Mass Hospital Association, like the Mass Medical Society, like Mass Bio and Pharma and a whole bunch of other kind of trade associations, are strictly focused on it from their stakeholders' point of view, and so the employer perspective is either missing or, as I said, muted. And so the purpose of this employer coalition on healthcare is to amplify the purchaser perspective, and I'm certainly not going to say that someone in the healthcare realm can't be a member, but the people that are involved would have to be the actual benefit managers or the person responsible for purchasing healthcare, because that will be the primary focus of our organization. 

0:20:54 - David Williams
Got it, and so who are you finding as the main backers? Who's most enthusiastic about backing this new coalition? 

0:21:03 - Eileen McAnenny
Well, so I mean there are several business trade associations, and they tend to represent smaller businesses, because I think smaller businesses are feeling the pinch of healthcare costs more than anyone else. 

They have fewer tools. If you're a large company, like Fidelity or State Street, you can self-insure and so you have a little more control over the benefits that you offer and how you manage them, whereas if you're a small business, you are purchasing in the fully insured commercial market and they tend to pay the highest cost because they have mandated benefits that apply only to them. You know, often people don't realize when the legislature enacts a new benefit that has to be covered, it only affects small businesses because self-insured aren't subject to it. So that's one aspect, and just the other is they're a smaller group. They can't spread the risk over a large population. But the big issue is they cross-subsidize a lot of the public payers like MassHealth, the Medicaid program in Massachusetts, or Medicare, because they don't pay the full cost of care and so providers tend to make up the difference on the commercially insured. So they're really getting hammered. 

0:22:28 - David Williams
So you've got, if we compare it back to the days of the uncompensated care pool. So they are paying high insurance. Maybe there's no directly uncompensated but there's maybe an undercompensated care pool that they're paying into in a sense. And of course, you know it's the taxes too that pay for Medicaid and pay for Medicare. So they are paying those taxes anyway for the direct support of the program, plus kind of additional subsidy. I guess I would add to that also. 

You know I started off in the intro talking about, you know, hospitals and drug companies as suppliers. If I'm a company and I'm, you know, I'm making boxes then you know one of my big suppliers is selling me paper and I don't hesitate to go out for bid or to, you know, challenge a cost or to actually say, hey, that cost should be going down and not up. But when it comes to health care, I think, both because it's extremely complicated and then also because you're dealing with somebody's health or life, the people are more hands off and even though the cost is just as high probably a box company pays more for health care than they pay for paper People tend to stay away from it and I'm wondering if that's also one of the things with a coalition, especially if you've got uh, smaller businesses that just don't have the ability to have that sort of expertise on board. Is it also just the opportunity to access, you know, folks like yourself that that know what they're talking about and can navigate this complexity? 

0:23:50 - Eileen McAnenny
Yeah, I think there are a few differences between your paper supplier and your healthcare provider In a sense, as you say, insurance companies, and so when you asked about who was supporting this coalition, the other group is insurers, because their customer base are the employers or individuals purchasing the commercial insurance that we talked about. But no one seems to be sympathetic to insurance companies, right? A lot of people blame them for the cost of care, even though their prices reflect the underlying cost of care, and we can talk about that, and so that relationship isn't the same. There isn't that direct discussion, and I think as healthcare gets more expensive, it also gets more complicated. There are several middlemen in between the actual patient or consumer and the purchaser, the employer and the provider, right, and so it just makes it complicated. 

But I think small businesses, by and large, large, are busy running their business, right. They don't have the time, probably, or the inclination to be super knowledgeable about the ins and outs of health care policy or to focus what's happening on Beacon Hill and how some bills could potentially add to their health care cost and how some bills could potentially add to their health care cost. And so that is the purpose of the Employer Coalition on Health to act as a conduit. It's a two-way communication, certainly informing small businesses and purchasers what's happening on Beacon Hill so that they can weigh in, but also understanding what the employer concerns impacts of health care costs are, so we can convey that to lawmakers. 

0:25:59 - David Williams
We talk about some of the challenges within Massachusetts of having employers be active in health care, but also how they have succeeded, at least in the past. As you look around the country, do you see examples of employer coalitions or other similar groups succeeding elsewhere, outside of Boston, outside of Massachusetts? 

0:26:20 - Eileen McAnenny
Yes, a couple come to mind. Certainly, way back in my AIM days, I worked very closely with the purchases group in Minnesota, and they were able to affect healthcare policy and change benefit design and really amplify the voice of employers. I will say, though, the makeup of the employer base in Minnesota was quite different. They had several national companies that were headquartered there, like Target, 3m and a bunch of others, I think General Mills and some more, and so they had a lot of purchasing power. They had a lot of clout. 

Indiana is another example where they recently were very effective and got kind of sweeping reforms passed through the Indiana legislature. They are also different from Massachusetts because they had it's a Republican state, they had a Republican legislature, a Republican governor who were more inclined to listen to the concerns of businesses and more willing to do some of that, and so each state is different. I think in Massachusetts, taking on healthcare cost is particularly challenging, because health care is such a big part of our economy and you know you reduce the cost of health care, that's revenue to someone else, right, and so it is a challenge, but I think the alternative of doing nothing is unacceptable, and so the Employer Coalition on Health is going to give it their best effort. 

0:27:56 - David Williams
Good, all right. Well, I wish you the best success. So let me close off the. Let me close off the way that I normally do it. I want to know whether there's any good books that you've read, either lately or at any point, that you would recommend to our audience. 

0:28:10 - Eileen McAnenny
So I read a great book and I can't even believe. I don't remember the name of it, but it was David Brooks and it's about um, listening, right, but it was one of the best books I ever heard about it's commentary on you know why people don't hear people the impacts of that on individuals, on society. Super good read and, uh, really enjoyed the book. It's David Brooks but, sorry, I don't remember the title. 

0:28:37 - David Williams
Well, I think it's the art of I was just looking at the art of seeing and hearing. 

0:28:44 - Eileen McAnenny
It's the art. That's exactly it. 

0:28:46 - David Williams
Yeah. 

0:28:46 - Eileen McAnenny
Great read. I recommend it. 

0:28:48 - David Williams
Yeah, good, all right, well, excellent. Well, I want to say thank you, eileen, for joining me today on the Health Biz Podcast, and to say that your Employee Coalition on Health from Massachusetts sounds like a great idea. So thank you very much. 

0:29:04 - Eileen McAnenny
Well, thank you, I appreciate it. David. 

0:29:05 - David Williams
Nice to be here to the Health Biz Podcast. With me, David Williams, President of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroup.com.