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Charlie Baker eyes a legacy-defining revamp of Mass. health care

Governor Baker wants providers and insurers to raise spending on primary care and behavioral health by 30 percent.
Governor Baker wants providers and insurers to raise spending on primary care and behavioral health by 30 percent.Jessica Rinaldi/Globe Staff/Globe Staff

Governor Charlie Baker has already hit the radio. His aides are briefing lawmakers. And come Monday, his health secretary will meet with hundreds of grass-roots activists.

The one-time health insurance executive has planted himself at the epicenter of a renewed health care debate on Beacon Hill, armed with a litany of ideas about how to retool an industry he knows better than perhaps any other.

His push began last month when he released voluminous legislation that seeks to dramatically bolster primary care, rein in drug costs, and curb surprise medical bills — efforts already generating a combination of applause and pushback.

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It has also quickly added a new front to a well-worn discussion between interest groups, advocates, and legislators that, a year ago, Baker had largely eschewed. Now, Baker, whose résumé also includes a stint as state health and human services secretary, is positioning himself to be a driving voice in a discussion that could shape the trajectory of one of the state’s most important industries — and his legacy.

“It is a chance for him to make a mark,” said Rosemarie Day, a health care consultant who worked for Baker in the 1990s. “He has a reputation of being a thought leader on the health care side, and I don’t think he’d want to back away from that. There’s got to be some personal stake in it, as well as what’s good for the Commonwealth.”

Baker’s 179-page proposal — sometimes wonky, sometimes broad — is headlined by a mandate that providers and insurers increase their spending on primary care and behavioral health by 30 percent over three years, while meeting existing requirements to control their total spending. Baker called this “aggressive but reasonable.”

“I’ve been unhappy about the way the health care system has treated primary care and behavioral health for a really long time,” the governor said in an interview at his State House office last week.

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“I really hope that this bill changes the course of those services. Because I think it’s a really big deal for patients and I think it’s a really big deal for the future of . . . where we should be going in health care delivery.”

The bill also adds teeth to how the state enforces its spending benchmarks, and it would penalize drug companies that raise the price of prescription medicines too sharply, giving state government a stronger role in regulating the health care and pharmaceutical industries.

The legislation attempts to put behavioral health care on similar footing with physical health care as well, including by making it easier for patients to see both types of providers on the same day.

“I view that as righting a wrong,” said Baker, a Republican. “I don’t view that as sort of an overreach.”

His plan is strikingly different from other GOP health care proposals. In Washington, Republicans have focused on rolling back requirements of the Affordable Care Act, which extended insurance coverage to millions of Americans.

Passing a new state law will require months of backroom discussions with legislative leaders, an effort that will heavily feature Baker’s health and human services secretary, Marylou Sudders, while the House and Senate craft their own big health care bills.

Jonathan Gruber, an economist at the Massachusetts Institute of Technology, called Baker’s approach “an interesting mix of clearly feasible and ambitious.”

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On the latter — increasing spending on primary care and curbing prescription drug costs — the details will be important.

“As you get more precise, you make more enemies. There’s always that tension of how specific to get,” said Gruber, who was an adviser on the Affordable Care Act and Massachusetts’s 2006 universal health coverage law.

Baker has already begun an early public push, no easy task when explaining a complex, multi-layered health care proposal.

He and Sudders appeared on WGBH radio for 30 minutes last week to discuss the bill, and Sudders, a former social worker, is expected to appear Monday before the Greater Boston Interfaith Organization, a social justice group that represents churches, synagogues, and mosques, and is advocating for health reform.

Then specifically there’s Baker, who spent a decade running Harvard Pilgrim Health Care, one of the state’s largest insurers. Asked whether he planned to be more involved than with other legislation, Baker paused, looked out his office window, and quietly mulled the question for 10 seconds.

“This is something, certainly, on which I think I have more to contribute,” he said.

So far, Baker’s work in health care has focused on the opioid crisis, the Massachusetts Health Connector, and the state Medicaid program, called MassHealth.

This summer, legislators approved a version of a plan that Baker proposed to control prescription drug spending in MassHealth.

Legislators have sometimes followed Baker’s lead, but not always. For example, they rejected a past idea of changing eligibility rules for MassHealth and moving thousands of people off the public program. But even those that have disagreed with his policies in the past acknowledge his deep understanding of health care.

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“This is the guy that told docs how to prescribe. . . . That was a pretty big deal. And they’re kind of doing the same thing with this one,” said former state representative Jeffrey Sanchez, referring to landmark legislation Baker signed in 2016, which limits initial opioid prescriptions to a seven-day supply.

“The question [with this bill] is: Given who we are in the Commonwealth, given our position in health care locally and globally, how will it be received? And ultimately will the average person feel the impact of such a change?” said Sanchez, now a senior adviser at Rasky Partners, which lobbies on behalf of some health care companies. “One thing I know about Charlie Baker is, when he puts something down, he believes it.”

Baker’s bill drew promising early reviews, but some in the health care industry are starting to push back on pieces of it.

Hospitals are objecting to his strategy for tackling surprise medical bills: the unwelcome charges sent to patients who unknowingly receive care from out-of-network providers. Baker’s bill would establish a default payment rate for out-of-network providers.

And the pharmaceutical industry has harshly criticized the administration’s proposal for controlling drug costs by penalizing companies that raise prices by more than 2 percent a year, above inflation.

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“He’s got the bully pulpit, so I think he’s got to use that,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans. Insurers have largely supported the bill.

“If he believes this is the right approach, he’s got to work hard for it.”

Baker and his aides will also have to negotiate with a Democratic-dominated legislative body that has prioritized health care legislation before its formal session ends July 31.

But House and Senate lawmakers have not set a timeline for releasing their own health care bills, and they are likely to stray from Baker’s approach in at least some areas. Baker said he’d be happy with final legislation that “thematically looks like what we proposed.”

The House and Senate each passed their own versions of health care legislation last session, but talks collapsed in the waning hours, including over differences about how to help struggling community hospitals.

“We may have our different ways of getting to the goal. But I don’t doubt that all of our goals are to reduce cost and increase access,” said Senator Cindy F. Friedman, who is leading that chamber’s efforts. “And there’s nothing in this bill that tells me the administration’s goals are anything different.”

But with roughly nine months until the session closes, some also cautioned that it’s too early to tell where potential hang-ups may loom.

“We don’t even know what’s in the bill and we don’t know what we’re going to embrace,” said state Representative Ronald Mariano, the House majority leader and a lead negotiator last year. “I think there are certain segments of the health care industry that need to be shaken up. And I think there are certain segments that we need to help. So it’s a mixed bag.”

Whatever final legislation emerges, it could affect health care in Massachusetts for years to come, long after Baker leaves office.

“I think he’s going to push very hard,” said Steve Walsh, president of the Massachusetts Health & Hospital Association. “I think he believes deeply in the fundamentals of the bill.”

EDITORIAL: Our thoughts on Baker’s proposal


Matt Stout can be reached at matt.stout@globe.com. Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com.