Mass. Senate bill aims to rein in health costs, study single-payer
The bill sets a target for reducing hospital re-admissions, imposes new oversight on the pharmaceutical industry, and calls for a study of the costs of shifting to a single-payer system. It aims to cut down on unexpected consumer costs like out-of-network charges and facility fees, and to increase access to telemedicine and mobile integrated health, which involves paramedics performing non-emergency services.
"The bill is really about the consumers and doing everything we can to make health care affordable to consumers," said Sen. James Welch, who led the working group that wrote the bill.
"Everyone deserves access to high quality health care at a fair price," said state Sen. Adam Hinds, D-Pittsfield, in a prepared statement. "Massachusetts has always been a leader when it comes to health care, and this legislation is the next step in our efforts to protect and empower consumers, encourage innovative health care and ensure access and affordability."
Hinds said, "Our goal is to achieve long-term cost savings for the state, without sacrificing our unwavering commitment to high quality coverage for all."
While senators frequently tout their bipartisan work, Democrats were unable to attract any Republican votes for their bill, which passed on a party line vote with the chamber's six Republicans dissenting and objecting to solutions they said rely on more bureaucracy.
Gov. Charlie Baker on Thursday said the bill "doesn't save the state any money" and the Senate was "not trying to chase reforms that are going to make" MassHealth more affordable, one of the goals that punctuated the health care debate earlier this year.
"What they're doing are chasing a variety of initiatives they believe will make the system better," Baker told reporters.
Senate Ways and Means Chairwoman Karen Spilka, who has said the bill could yield $114 million in savings from MassHealth reforms and $475 million to $525 million from its commercial market reforms by 2020, said after the bill passed that she was "very surprised" and "dumbfounded" by Baker's characterization.
"I understand the governor's concerns," Welch said. "He comes from the health care industry, comes from the insurance industry, and I'm sure obviously still has relationships in the health care industry that would make him concerned or that members of the health care industry might be concerned about. But I think the way we approached this bill is really to focus on the consumer."
Debate began on Wednesday, and behind-the-scenes discussions both days involved negotiations around contentious measures proposing to automatically enroll MassHealth-eligible consumers participating in the home care program into Senior Care Options, a managed care program that covers services normally paid for through Medicare and MassHealth, with no co-pays. Senior advocacy groups opposed the plan.
Hinds' amendment, based on pending legislation he has sponsored with Rep. Paul Mark, D- Peru, allows volunteer ambulance services in rural communities to transport a patient receiving care at the nonparamedic level of basic life support to staff the ambulance with one EMT and one first responder.
Updating this requirement to meet the needs and staffing realities of small rural volunteer ambulance departments is a major priority for many towns in Hinds' Western Massachusetts district, which includes all of the Berkshires. The senator worked with many local stakeholders, including Rural Commonwealth, volunteer ambulance services, municipal officials, hospital administrators and the Department of Public Health to finalize the amendment language, which was passed unanimously.
"This is a critical policy update for rural communities," Hinds said. "It is also a glaring example of how state laws, often passed and implemented with the best intentions, do not always apply fairly across the state. Small, rural towns often have difficulty mobilizing two EMTs in time to help someone in dire need of medical attention. My amendment allows them to move more efficiently, respond to calls more effectively, and hopefully, when implemented, will save lives."
Some of the most heated moments in the two days of debate came as Republicans tried unsuccessfully to beat back an element of the bill they dubbed the "name and shame" list — an annual public report identifying the 50 Massachusetts employers with the highest number of employees "who receive medical assistance, medical benefits or assistance through the Health Safety Net Trust Fund."
Tarr said the amendment was an attempt to shame people into changing their behavior, while Sen. John Keenan of Quincy said it was a way to gather data to understand how many people with access to employer-sponsored insurance are enrolling in MassHealth, and which employers are not providing coverage that's accessible to their workers.
In a back-and-forth with Keenan, Tarr said the bill tries to "somehow avoid directly the problem" of increased enrollment and subsequent higher costs at MassHealth. He called the bill "incredibly cumbersome" and repeatedly said it defaults to bureaucracy instead of direct action to try to control costs.
Before passing the bill, senators agreed to modify the way it attempts to shrink the gap between rates paid to the most expensive, larger hospitals and lower-paid community hospitals.
"We view that this is a market failure, and we're asking the market to correct itself, and if it is unable to do so, then and only then would you turn to government regulation," Senate President Stanley Rosenberg said.
The bill would raise rates for lower-paid hospitals to 90 percent of the statewide average for the previous year, and set a target rate of growth for total hospital spending.
While senators stopped short of imposing a rate cap at the upper level, they adopted a Sen. Jamie Eldridge amendment specifying that efforts to meet the target "do not directly contribute to increased consumer health care costs."
The Senate overwhelmingly endorsed studying how the costs of a single-payer health care model would compare to the state's current health care spending, which the Center for Health Information and Analysis tallied at $59 billion in 2016.
On a 35-3 vote, the Senate adopted an amendment calling for state officials to measure health spending against the estimated costs of providing health care to all residents through a single-payer system. If the single-payer projections prove to be less costly, the Health Policy Commission would need to submit "a proposed single payer health care implementation plan" to the Legislature for potential action.
Sen. Julian Cyr, of Truro, the amendment's sponsor, compared the current health care system to "one of those rubber band balls you get at Staples," pointing to interconnected pieces that would be difficult to unwind without an extensive plan. He stressed the amendment would not commit the state to pursuing single-payer but said it would "keep all doors open."
Tarr voiced concerns about the possible cost of a single-payer system, saying by some estimates it could double the state's health expenditures, but ultimately voted for the amendment. Republican Sens. Vinny deMacedo, Ryan Fattman and Donald Humason voted against, and Sen. Richard Ross, a Wrentham Republican, voted present.
In 2012, a similar single-payer benchmark proposal failed 15-22 in the Senate.
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