MA State Legislature Remains Committed to Health Care Reform Legislation

HILL'S BIG THREE POINT TO ANOTHER RUN AT HEALTH CARE OVERHAUL
By Colin A. Young
STATE HOUSE NEWS SERVICE

BOSTON, OCT. 16, 2018.....After picking up the pieces from a failed attempt at the end of formal legislative business to agree on a health care bill, the Massachusetts Legislature is gearing up to take another crack at stabilizing community hospitals and limiting the growth of consumer health costs.

House Speaker Robert DeLeo, speaking Tuesday morning at the Health Policy Commission's annual cost trends hearing, said "no one is more disappointed than am I" about the collapse in July of negotiations between the House and Senate on a health care bill, but he said the House's work on that legislation will serve as a good starting point for the upcoming session.

"Because of that work, the valued input from the health care community and our commitment to the people of the commonwealth, we will not give up. This coming legislative session, the House will try again," he said. "Despite our success at slowing spending growth, we know that patients are still forgoing care due to costs. Our community hospitals and our health centers are still struggling to survive."

The Senate passed a health care policy bill last November but the House did not follow suit until June due to, among other things, the death of Rep. Peter Kocot who was authoring the House's bill. With about a month before formal business was to end, the House agreed to a bill that would have used $337 million in new assessments to stabilize community hospitals.

The two branches were unable to reach an agreement by the end of July on a compromise bill, with House Majority Leader Ronald Mariano saying at the time, "We were just too far apart philosophically to a come to a resolution that fit our agenda." DeLeo also said Tuesday he hopes to start work on the next health care bill "as early as possible" so the House does not again run out of time.

It was the latest attempt at an overhaul of health care laws as lawmakers try to hold on to the insurance access gains achieved since Gov. Mitt Romney signed a universal access law in 2006. Since then, costs have continued to grow -- per capita, health care spending in 2017 was $8,907 according to the Center for Health Information and Analysis -- and the state's massive MassHealth program has grown to consume about 40 percent of all state spending.

The House's bill sought to address pharmaceutical spending, telemedicine, out-of-network billing, transparency in the health care system and provider price variation. DeLeo said Tuesday that the House is "still committed to addressing the same issues" but that the next bill may not follow all the same contours as the last.

"With much of the research and study that was done during the last session, that obviously will be helpful to us as we start," DeLeo said. "But I think in addition, since we were not successful, I think it is incumbent upon us to also take a fresh look at some of the things maybe we should have last time or just to improve what we already have."

He added, "Bottom line, I think you'll see a combination of both."

Senate President Karen Spilka, who did not attend Tuesday's HPC hearing, said over the summer that the Senate would "regroup and start again and plan on getting" a health care bill, education funding reform bill and others done.

"Massachusetts has always been a leader when it comes to healthcare, and the Senate will continue our efforts to protect and empower consumers, encourage innovative healthcare and ensure access and affordability," she said in a statement Tuesday. "We look forward to doing this work next session."

Gov. Charlie Baker made the need for reforms to the state's health care laws part of his own address to the HPC's cost trends hearing on Tuesday morning, saying his administration stands ready to work with lawmakers and others to reach an agreement.

"While ultimately the Legislature was unable to come to a consensus on a final health care bill this past session -- and believe me, there's a tremendous amount of time, effort, energy, conversation, discussion, and reams and reams and reams of trees that were sacrificed in that whole effort by everybody -- the need to address the growing cost of health care and especially the impact on the state budget and on our residents remains," he said.

Asked afterward whether he thinks the House and Senate should pick up where they left off in July or start from scratch when the new sessions starts in January, Baker said that decision belongs to the legislature but highlighted the parts of the bills he liked.

"I think the desire to do some things with respect to practice parameters for certain participants on the provider side was a very good step in the right direction, we supported virtually all of the elements of that that were included in that discussion," the governor said. "And coming up with strategies to deal with many of the issues community hospitals face ... is absolutely the right place to go."

The stumbling block the next go-round, the governor predicted, will be finding common ground on a way to stabilize the finances of community hospitals. The House's bill in July included $247.5 million in assessments on insurers and $90 million in assessments on the largest hospitals as a centerpiece, which were vigorously opposed by the industry. The Senate tried to address community hospital struggles with a rate floor for hospital payments from insurers at 90 percent of the statewide average.

"I think the big challenge, for them and frankly for us too, will be figuring out what the mechanism is to deal with it," Baker said. "That seemed to me to be, more than anything, where they had trouble coming to terms last year."

Asked whether the House will continue to pursue its assessments to help stabilize community hospitals, DeLeo said he doesn't yet know "how we're going to get there."

"All I do know is that obviously I think we have a situation, we are mindful of the role community hospitals and health centers play in our health care system and the importance they play, not only providing health care but in terms of cost," the speaker said. "How we can get there to see that they can survive and flourish is going to be one of the important issues for us."

DeLeo on Tuesday also highlighted another issue that he expects to make part of the House's next health care legislation, an issue that was left unaddressed by the failed bill earlier this year.

"We also acknowledge, by the way, that there are areas worthy of examination that we did not address, particularly MassHealth," he said. "While this program is arguably one of, if not the most, important safety net program that we have in Massachusetts, we need to be responsible in how we spend those dollars."

After giving his prepared remarks, DeLeo again mentioned the need to take action to rein in MassHealth while speaking with reporters. In the summer 2017, Baker offered the Legislature a package of reforms aimed at controlling costs at MassHealth and lawmakers rejected his plan in favor of developing their own approach.

"We can readily see the figures, we can readily see the percentage of the budget which continues to grow and makes our budgeting very difficult, so I think that has to be part and parcel of the process of putting together legislation," the speaker said.

While MassHealth reforms fell by the wayside, Baker and the Legislature agreed to assessments on employers in 2017 to help pay for the program. The assessments on employers with six or more employees are designed to run through 2018 and 2019 and to generate a total of $400 million.

As he wrapped up his presentation to the HPC on Tuesday, DeLeo sounded a semi-optimistic tone about the House's chances of getting a health care bill across home plate next session.

"If the Red Sox can do it, so can we," he said before adding, "Maybe I shouldn't put it that way, I don't know. We'll see what happens in the next couple of games."

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10/16/2018