Baker Files Wide-Ranging Health Care Bill
STATE HOUSE, BOSTON, OCT. 18, 2018.....Health care providers and insurers would be required to boost their spending on addiction services, behavioral health, primary care, and geriatric services by 30 percent over the next three years under a sweeping health care bill that Gov. Charlie Baker filed Friday afternoon.
The governor's bill, which also seeks to help "distressed" community hospitals and community health centers, marks the first volley in what is likely to be a months-long effort on Beacon Hill to overhaul the state's health care laws after last session's attempts collapsed at the end of formal legislative business.
"We can no longer undervalue primary and behavioral health care. Our system should reward organizations that invest in a comprehensive set of physical and behavioral health services and that's why today we're proposing to flip the script," Baker, the former CEO of Harvard Pilgrim Health Care, said. "This legislation is designed to create positive financial incentives for health care providers and payers to rethink their service delivery and investment decisions and aims to invest in the behavioral health, addiction treatment and recovery, primary care, and geriatric services that are underfunded by today's payment models and incorporate these services more directly into care delivery strategies."
Less than 15 percent of total medical expenses in Massachusetts are currently spent on primary care and outpatient behavioral health services combined, Baker said, and his bill would establish statewide spending targets for primary and behavioral health care at 30 percent above the calendar year 2019 spending, which the governor said would be "all within the parameters of the state's overall health care spending benchmark.
"The way to think about this legislation is what we tried to do here was build on the health care cost containment legislation that was passed several years ago, that creates sort of a ceiling on year-over-year increases in health care costs. But from our point of view, the big problem we have right now is the way we choose to spend the dollars that are underneath that ceiling," Baker said.
Total spending on health care in Massachusetts accelerated faster in 2018 than in recent years, rising 3.1 percent to $60.9 billion, a Center for Health Information and Analysis annual report released earlier this month found.
Health and Human Services Secretary MaryLou Sudders said investing in primary care and behavioral health will increase access, particularly for early identification and treatment, and will help drive down consumer health care costs. The legislation, a copy of which was not provided to the media at the governor's press conference, would also encourage behavioral health care providers to accept insurance by requiring insurers, including MassHealth, to use a standardized credentialing form so providers only need to complete one application.
Sudders said half of all licensed behavioral health care providers do not accept insurance right now. "Finding a practitioner that accepts one's insurance is one of the biggest issues that I hear about," she said.
The bill (HD 4547) also attempts to address hidden consumer costs by placing prohibitions on facility fees and surprise billing for any unplanned emergency service provided by an out-of-network provider at an in-network facility, and to hold drug companies accountable for "unjustified" price hikes.
Baker said his bill would hold the commercial market to the same standard that Massachusetts recently adopted for MassHealth drug prices by granting the Center for Health Information and Analysis the authority to directly refer high-cost and recently-approved drugs that cost more than $50,000 per person per year to the Health Policy Commission for a review.
"These efforts will help put more money back into people's pockets, increase transparency and give consumers the knowledge they need to make the best decisions for themselves and their families," Baker said.
The Baker administration also announced that it had approved $15 million to be deposited into the Health Safety Net Trust Fund to support care provided to uninsured and underinsured patients by acute care hospitals and community health centers.
Stabilizing community hospitals and limiting the growth of consumer health costs were central tenets of the bills passed last session by the House and Senate. Scrambling to wrap up other major bills, the two branches were unable to craft a compromise bill by the end of July 2018, with House Majority Leader Ronald Mariano saying at the time, "We were just too far apart philosophically to a come to a resolution that fit our agenda."
On Friday, Baker said that his latest bill incorporates many of the elements he liked -- and on which House and Senate negotiators agreed -- from last sessions' legislative proposals.
"There were a lot of elements of both those bills that were pretty common ground, and many of them are reflected in the way we've proposed a number of the elements in this bill," he said. "I do think, based on the conversations I've had with leaders in both the House and the Senate, that people want to do a health care bill in this session. I think we believe that we should do a health care bill in this session. Many of these issues are things people have talked about wanting to get done for many years."
Baker, who has seen his health care reforms rejected by the Legislature in recent sessions, said he plans "to work very hard on this" as it wends its way through the Legislature.
Lora Pellegrini, president, and CEO of the Massachusetts Association of Health Plans said her organization is pleased that the bill Baker announced: "targets areas that drive up medical spending, including important provisions to address the rising cost of prescription drugs and increased transparency to better understand how pharmaceutical manufacturers set drug prices."
The national Pharmaceutical Research and Manufacturers of America was less enthused by the governor's plan.
"We are deeply disappointed that Governor Baker is attempting, once again, to implement dangerous price controls that would have a devastating impact on patients. The biopharmaceutical industry is committed to working with legislators to ensure patients have access to medications, that the industry has the ability to continue their efforts to develop new treatments and cures and to lower health care costs in a commonsense way," Tiffany Haverly, a PhRMA spokesperson, said. "While conversations about affordability are important, arbitrarily capping prices will never be the answer."
Massachusetts Biotechnology Council President Robert Coughlin said what Baker put forward Friday "misses the mark by not including any proposals that would directly control skyrocketing health insurance premiums and patient out-of-pocket costs."
Tim Foley, executive vice president at 1199SEIU United Healthcare Workers East, said the legislation "is a good first start as Massachusetts works to make healthcare more affordable and accessible for patients."
"Healthcare workers have a critical role to play in this debate and they've outlined several key priorities that should be included in any final legislation," he said. "This includes more funding for the community hospitals and health centers that need it most and addressing current healthcare workforce challenges. This can be done by banning mandatory overtime for all hospital workers and ensuring that those delivering healthcare is at the center of any reforms."
Partners HealthCare, the largest health system in the state, said it wants to review the bill but embraces many of its concepts and looks forward to addressing other aspects of the system as the Legislature digs in.
"The Governor has clearly put forth several thoughtful proposals particularly with respect to added investments that will make behavioral health and primary care more accessible," Partners said. "The bill will also allow for better utilization of technology and telehealth services and encourage wider adoption of value-based health care, which can slow cost growth."