Our Opinion: State must be bold on health care issue

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Last week, the state Senate unveiled legislation addressing a variety of deficiencies in Massachusetts' health care system. Many of these provisions will require further vetting, and there is no guarantee than any will make it through the lawmaking process on Beacon Hill, but it is an admirably ambitious effort to improve the health care system at a time when Washington, D.C. can only focus on making it worse.

Health care spending in Massachusetts rose 4.8 percent from 2015 to 2016, hitting $59 billion, according to the state Center for Health Information Analysis (CHIA). On Friday came the harsh news that the state will insurance rates up to 24 percent for as many as 80,000 residents who buy the most popular plans on the Massachusetts Health Connector in response to President Trump's promise to pull federal payments that subsidize coverage for this plans. Middle income residents are projected to be hit the hardest.

A significant problem facing the state is that MassHealth, which was designed to provide health insurance for those who do not get it through an employer, is overburdened by people who can join insurance plans at work but enroll in MassHealth because it is cheaper. The Senate bill adds an option enabling employers to buy MassHealth plans for some employees rather than go to a private insurer, which would not add costs to employers while boosting revenue for MassHealth. It's a bold idea, the details of which will need considerable exploration, but regardless of its ultimate fate, the dilemma of MassHealth as victim of its own success has to be resolved.

The CHIA report found that the growing expense of prescription drugs is a primary driver of increased health care costs, and the Senate bill attempts to address this by subjecting pharmaceutical companies to the oversight of both CHIA and the Health Policy Commission, two agencies created in 2012 by a state health care cost control law. Drug makers would be required to provide pricing information and the rationale behind increases to the two groups. The pharmaceutical industry carries considerable weight on Beacon Hill so this provision may drop by the wayside in the course of the sausage-making process.

The different reimbursement rates paid to hospitals by insurers, which works to the benefit of big eastern hospitals and to the detriment of smaller community hospitals like Berkshire Medical Center in the western and central parts of the state, is a longstanding problem that the Senate bill takes on, at least in part. While the bill establishes a target reimbursement rate for all hospitals, it doesn't set a hard floor or ceiling on how much a hospital, large or small, can be paid.

"I want commercial [insurers] to stop paying me on my ZIP code and start paying me on my quality," declared Winfield S. Brown, chief executive of Heywood Hospital in Gardner, at a State House press conference Tuesday, the day the bill was revealed. A reasonable request, but the Massachusetts Health & Hospital Association, which while representing all state health systems has done little to resolve the funding disparity among them, warned Tuesday in a statement of unspecified "unintended consequences" of the legislation.

The bill creates a certification process for mid-level dental therapists, which would increase dental care access to people, including those in the Berkshires, who go without it in part because many dentists don't accept underfunded MassHealth. Many ultimately end up in emergency rooms, where care is more expensive. The Massachusetts Dental Society acknowledges the reality of the problem and supports an effort to create a new position with higher qualifying standards than are in the Senate bill. However, the additional schooling required could mean that a problem that needs addressing as soon as possible would not be taken on for years.

The House is cool to the Senate bill, with budget chief Jeffrey Sanchez warning in The Boston Globe that uncertainty around health care at the national level makes this a bad time for a new state health care bill. Unfortunately, as long as President Trump and a Republican Congress create that uncertainty with their attempts to destroy the Affordable Care Act (ACA), there won't be an ideal time to act. The state can't afford to wait for stability in Washington before it addresses its health care challenges.

The Senate bill, the product of a year of work that included exploration of what other states have done to address their own health care situations, will be the subject of a hearing Monday on Beacon Hill. This is one step in a process, but Senate leaders made the point Tuesday that it was a Senate bill that led to the creation of the health reform law known as Romneycare, which in turn was in part the basis for the ACA, or Obamacare. Beacon Hill shouldn't be reluctant to be bold when taking on the state's health care issues. Indeed, it can't afford not to be.


























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