Wednesday July 25, 2012

With less than a week left in the legislative session, a year and a half of work on state health care reform is hanging in the balance. What ever is or isn't crafted by July 31, it ap pears as if Berkshire County's lack of clout will cost it.

The House bill is more aggressive than is the Senate's in several ways, including narrowing the gap between what insurers pay to Boston hospitals and what they pay to the three Berkshire hospitals. As state Representative William "Smitty" Pigna telli, a Lenox Democrat, told The Eagle last week, there must be a leveling of the playing field on payments that will help critical access hospitals in rural areas like the Berkshires which serve people in a wide geographic radius. This payment gap, Mr. Pignatelli observed, contributes to the shortage of primary care physicians in the Berkshires that has grown from serious to critical in the past year or two.

The Massachusetts Hospital Associ ation, aligned with the big Boston hospitals, is lobbying against lowering of insurer payments, however, and their clout on Beacon Hill is far more considerable than that of the Berkshire hospitals. In response to Attorney General Martha Coakley's assertion that the influence of these major hospitals is a key contributor to rising health care costs, the big hospitals say they have renegotiated insurance contracts to lower fees, but there is no indication that this is any more than a minor fix.

Both the House and Senate bills would limit increases in medical spending to the rate of growth of the state's economy, which would ordinarily be around 3 percent. The House measure includes tough er enforcement provisions to ensure these limits. Earlier this month, Governor Deval Patrick pointed out in a meeting at The Eagle that health care spending is now less than one percent of the state budget, but this is not an argument against the caps. If the state economy improves, as we all hope it will, health care spending will assuredly increase with it.

There are so many national forces at play when it comes to health care that it is difficult to execute reform at a state level, but there are measures Beacon Hill can enact. One would be to address some of the unfair disadvantages Berkshire hospitals face in trying to stay afloat financially.