Go big or go home — or so the saying goes. And in his fifth year as governor, Charlie Baker decided to go big, with an ambitious proposal to tame health care costs.
How much of the enormous (170-plus pages) omnibus bill he recently unveiled makes it through the legislative meat grinder is anyone’s guess. There is enough here for lawmakers — and lobbyists — to gnaw on for months, and some parts that definitely need some work.
But with health care costs continuing to burden families and businesses alike, it’s worth the effort. The bill can make a real difference not just in bending the cost curve on health care but also in bending the services curve — putting the emphasis on primary care and behavioral health, which have remained the poor relations of this health care-rich community for too long.
Several of the proposals in Baker’s bill are not new. Some items legislators have been considering since last year’s abortive attempt to pass a health care bill are in freestanding bills already filed this year. There seems to be agreement, for example, that it’s time to address “surprise billing” and limit the use of hospital facility fees. Those are the charges that show up when a health care provider turns out to be out of network, much to the surprise of a patient who ended up in the emergency room. Ending the practice is overdue.
In another welcome reform, the bill would also require provider directories actually to mean what they say — to connect patients to services and clinicians that exist and will accept their insurance, not the “ghost networks” that too often make it impossible to access care, particularly mental health care. Again, similar bills were filed to make such changes this year one passed the House and Senate in July and is now in conference committee.
The governor’s bill also aims to increase access to telemedicine for consumers by establishing a regulatory framework for those services and requiring insurers to cover them “if the same service is covered” for an in-office visit.
An especially ambitious part of Baker’s bill is an effort to reshape the delivery of services by requiring an increase in spending by hospitals and insurers of 30 percent over the next three years for primary care and behavioral health — without increasing overall spending. One astonishing fact stands out in our current system — today less than 15 percent of total medical expenses are spent on primary care and behavioral health combined, Baker said.
So, if the measure passes, health care facilities are going to have to think twice about investing capital funds in the newest MRI equipment or orthopedic center and investing more in primary care physicians, geriatric specialists, or mental health clinicians.
Which brings us to one of Baker’s other big ideas: fixing a mental health system where 50 percent of practitioners will not accept insurance — not MassHealth, not Medicare, not even private insurance. Even though the Commonwealth currently ranks number one in mental health providers available by population (1 for every 180 residents), actually seeing one is out of reach for too many residents.
Provisions in the bill to require one universal credentialing form to be used by all insurers would cut down on paperwork for behavioral health providers — something the Legislature should embrace. Anticipated rate increases (by establishing a “bottom line” for certain services) and a fairer rate system of billing for clinicians in training are also aimed at encouraging more clinicians to join the marketplace.
Some of the most controversial parts of the bill involve the governor’s attempt to control drug costs, which both the administration and legislative leaders seem to agree is a major driver of overall health care costs. One provision would extend more extensive state oversight to drugs that cost more than $50,000 per person per year — even if bought through the private market. A similar provision was added to the state budget this year but only for drugs purchased under the state’s MassHealth system. This seems a natural extension — although even that was subject to extensive lobbying by the drug industry, which remains unhappy with any attempt at price regulations.
That would, of course, make them totally apoplectic about the Baker effort to subject all drugs to a price cap of no more than inflation plus 2 percent. Call it the “Epi-Pen provision,” after the drug manufacturer everyone loves to hate. No other state has tried it — and, indeed, price caps could be a bridge too far: Lawmakers ought to subject the idea to careful scrutiny to make sure it’s not too blunt an instrument.
The very length and breadth of the bill will make it difficult for lawmakers to get their arms around, as House Speaker Robert DeLeo has indicated. He wasn’t unfriendly to many of its ideas, but noted that it will probably have to be dissected by several committees. Senate President Karen Spilka also seems supportive but favors a piece-by-piece approach.
The governor, a one-time CEO of one of the state’s largest insurers, seems an unlikely health care revolutionary. But who better to tackle an industry that even in this health care mecca — or perhaps especially in this health care mecca — cries out for a change in attitude and a reordering of how it cares for patients.
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For the Record. An earlier version of this editorial cited measures filed in the Legislature this year to require health insurers to fix inaccurate provider directories. It should have said, and has been updated to reflect, that the legislation passed both the House and Senate and is now in conference committee.