Gov. Charlie Baker plans to take another shot at health-care reform legislation, two years after he filed a bill focused on boosting spending on primary and behavioral health care.
“We’re going to go back at this one,” he told the New England Council Tuesday.
Baker said Medicare payments undervalue services like behavioral health, addiction treatment, primary care and gerontology, leading to underfunding.
According to the State House News Service, the bill Baker filed in October 2019, one of many sidelined by the arrival of COVID-19, would have required new investments in those areas from providers and insurers.
Baker’s first crack at this legislation compelled hospitals, physician groups and insurers to disclose how much they currently spend on primary care and behavioral health. By 2023, spending in those two areas would need to increase by 30% — without exceeding the annual health-care cost cap.
This additional financial commitment would be offset by higher insurer reimbursements for these services. It’s estimated that Massachusetts spends only about 11% to 15% of its health-care dollars on primary care and mental health.
Providers or insurers that didn’t comply would face a review by state regulators
Baker’s initiative would have aligned Massachusetts closer to other industrialized nations, which spend far less on health care but enjoy higher life expectancies than the U.S.
That’s because these countries put far more emphasis on primary care than we do. Their gate-keeper physicians often can dispense pre-emptive solutions that can preclude the need for more sophisticated — and costly – procedures later.
The result of this imbalance results in the vast majority of health-care resources in this country going to hospital services, specialty care and prescription drugs.
The governor’s bill also followed the lead at the federal level to replace the fee-for-service-model — quantity of billed care instead of quality — with one that rewards positive patient outcomes, not volume.
These proposed redistribution of resources didn’t receive a warm reception from with many Boston hospitals and others used to imparting high-tech medical solutions; they called these state-mandated steps unrealistic.
Baker told the New England Council his bill, which he said he’d probably file by January, couldn’t be more timely.
“Now we have bigger challenges in that space than we had before the pandemic …”
The News Service indicated that Baker’s comments dovetail with those of Senate President Karen Spilka and House Speaker Ronald Mariano, who both identified mental health and health care in general as top legislative priorities.
Public bodies, including the Health Policy Commission and Massachusetts Health Connector, have recently flagged the rising costs facing Massachusetts consumers.
Last week, the Health Connector approved several plan offerings for 2022, with rising costs that some board members said were unsustainable.
The plans feature an average 6.9% premium increase for the 85,138 members whose medical coverage isn’t subsidized or who receive Advance Premium Tax Credits.
With member aging factored in, the 6.9% rate increase for unsubsidized non-group members becomes about an 8.5% jump.
Nancy Turnbull, who formerly worked at the state’s Division of Insurance and the Harvard School of Public Health, noted that next year’s average premium increases are “twice, if not more” than the current 3.1% health-care cost cap benchmark.
On Wednesday, the Policy Commission recommended several steps in response to these continually rising costs.
Approved unanimously, they include price caps for the most expensive providers, greater scrutiny around hospital outpatient and ambulatory care expansions, and new affordability standards for health plans.
The recommendations are part of the HPC’s annual cost trends report, which explores the 4.3% growth in the state’s total health-care spending from 2018 to 2019.
We don’t know whether Baker’s refiled bill will exactly mirror his previous effort, but mandating adherence to cost caps and the allocation of sufficient resources for historically underfunded and undervalued sectors like primary care and mental health should be its main thrust.
