Gov. Charlie Baker is eyeing another go at health care reform legislation, two years after he filed a bill that sought to focus on primary and behavioral health care and boost spending in those areas.
"We're going to go back at this one," he told the New England Council on Tuesday. "If you really want to solve this issue, you have to be willing to think outside the box about how to get over the fact that Medicare just doesn't, in my opinion, do the right thing for these services, and because Medicare is the platform that all payment systems in the U.S. are based on, you've got to get outside that if you really want to make significant investments in primary care and behavioral health and addiction."
Baker said Medicare payments undervalue services like behavioral health, addiction treatment, primary care and gerontology, leading to underfunding. The bill he filed in October 2019, one of many bills sidelined by the arrival of COVID-19, would have required new investments in those areas from providers and insurers.
"Now we have bigger challenges in that space than we had before the pandemic, and I can tell you this, we're going to put a bill before the Legislature at some point, probably January-ish," Baker said. "Maybe this fall, but it's probably more like January."
Baker did did sign a health care law at the end of last session, but that law was focused on telehealth, coverage for COVID-19 testing and treatment, the scope of practice for advanced practice nurses and optometrists, surprise billing for out-of-network patient visits, and enhanced Medicaid reimbursements for community hospitals.
Baker's comments come after Senate President Karen Spilka identified mental health parity legislation as one of the items on her fall agenda and House Speaker Ronald Mariano said he'll be looking to pursue "a number of different health care issues."
Public bodies including the Health Policy Commission and Massachusetts Health Connector have recently flagged the rising costs of care facing Massachusetts consumers, and the HPC on Wednesday plans to release an annual cost trends report containing policy reform recommendations.
During his virtual speech to the New England Council, Baker also discussed issues around COVID-19 vaccination and reiterated his call for the Legislature to quickly put federal relief dollars to use on housing, climate infrastructure and workforce development.
With about 76 percent of the population fully vaccinated, Baker said, Massachusetts has the second-highest vaccination rate in the country, behind only Vermont.
"The governor of Vermont, by the way, Phil Scott, has made clear to me that even though he has a smaller state, which I've pointed out to him on a number of occasions, his people are farther apart, so it's been an interesting argument between the two of us," Baker said.
He said that people in New England have, for the most part, wanted to get vaccinated. To reach hesitant communities — including some populations of people of color and immigrants, residents of rural areas and people with concerns about the speed at which COVID-19 vaccines were developed — Baker said the state has tried to work with community, faith, health care and business leaders with trusted reputations among those groups.
Baker, who has imposed a vaccine mandate for the state's executive branch workforce, said data around the shots' efficacy is "pretty compelling," pointing to lower case counts, hospitalization rates and death rates in New England states with higher vaccination rates.
"Typically the folks who get hospitalized who are unvaccinated tend to be a lot sicker than the folks who have been vaccinated, and I wish there was a really simple, easy way to help everybody understand this," he said.
The governor said that social media contains a "tremendous amount" of both accurate and inaccurate information, and said there have been instances when "government leaders, health care leaders, all of us, have not done a good job of describing what's actually been happening."
He described this summer's COVID-19 outbreak in Provincetown as one such instance, where a cluster of more than 1,000 cases was identified among mostly vaccinated people after a rainy holiday weekend drove crowds inside.
"This led to some real headlines across the country and in this region that said, sort of 'OMG, all these people went to this big weekend in Provincetown and they were all vaccinated and there were a lot of cases that came out of it,' " Baker said.
He said that while some interpreted that news as a sign vaccines don't work, "the story is actually a lot different than that."
Baker said seven of the people who contracted COVID-19 were hospitalized and one man in his 70s undergoing chemotherapy died, and that those numbers and the overall case count would have been much higher without the vaccines. He said the shots "did exactly what they were supposed to do."
One of the biggest challenges government has faced throughout the pandemic has been "trying to get not only the message right, but also the narrative arc of the message over the long term right," Baker said.
Baker described questions around booster shots as "a good example of an issue that's been all over the place in the media, through no fault of the media."
"There's just been a lot of chatter about it for the better part of the month with respect to where the feds think we should be with this going forward," he said.
Federal health officials in August announced plans to make booster shots available to all American adults who have already receive both doses of a Pfizer or Moderna vaccine, starting the week of Sept. 20. But as that date approaches, it's unclear when and for whom booster doses will ultimately be authorized, with a Food and Drug Administration panel planning to meet Friday to discuss the Pfizer vaccine data.
Preparing to immunize kids younger than 12, when they become eligible for vaccines, is another issue on Baker's radar.
"Most of us had heard from the feds several months ago that it would be 2022 before there was any real traction on this," he said. "There's been some talk recently that it might happen a lot sooner than that. That obviously will be something that we'll have to figure out how to handle, if it does turn out to be a lot sooner than that, with our colleagues in the health care and public health world, to make sure that we have an infrastructure in place that can do both boosters and potentially younger kids at the same time if that's where we land."
White House press secretary Jen Psaki said Friday that President Biden has not received a booster shot. "We'll wait until it's widely available, which we expect to be soon," she said, according to a transcript.