Good health reforms for Massachusetts — and one big disagreement
A FRAMEWORK FOR TELEMEDICINE, price transparency for pharmaceuticals, better online information about provider networks, consumer protection against surprise billing: None of those wonky health care reforms arouse much passion, but provisions included in both House and Senate health bills would help patients by introducing them to Massachusetts.
And as negotiators from the conference committee continue to meet on Beacon Hill, hashing out the minor differences between the language in the two bills that covers those reforms seems easily achievable. Indeed, if those policies were all the bill covered, negotiators would probably have a much simpler task.
The major obstacle to consensus, though, appears to be the part of both bills that has also hogged the most attention: the fundamentally different ways both pieces of legislation seek to assist the state’s struggling community hospitals.
There is a possible pathway to a compromise on community hospitals, too — but time is short, the disagreements are deep, and neither the House nor the Senate bill would be adequate on its own. If the negotiators can’t bridge their differences before the end of the legislative session, they shouldn’t let the reforms contained in the bills become a casualty.
The telemedicine provisions, for instance, would foster use of technology to reach underserved populations; imagine a doctor or dentist consultation on an iPad. Telemedicine is considered especially promising in rural areas.
The final legislation should also require accurate, user-friendly online directories, making it easier for patients to search for providers in their networks.
Lawmakers also have the chance to crack down on surprise billing. When a patient goes to a hospital for a procedure she thinks is covered in network, but it turns out the anesthesiologist was out of network, the resulting bill can be an unpleasant shock. By requiring advance warning, the Legislature can help patients avoid surprise charges.
Both bills, particularly the Senate’s, also call for greater transparency from pharmaceutical companies, so regulators and the public can understand how companies set their prices. While there have been signs of moderation in overall health care cost increases, prescription drug prices climbed 6.1 percent from 2015 to 2016, according to the Health Policy Commission.
In none of those areas do the differences between House and Senate look irreconcilable.
The more contentious plans, to help community hospitals, stem from a widely recognized inequity: The hospitals that treat the state’s poorest communities also tend to receive the lowest payments from insurers. Holyoke Medical Center, Cambridge Health Alliance, Brockton Hospital, and similar providers have been imploring the Legislature to establish a “minimum wage” so they can remain viable.
The House proposes to raid health plan reserves and the coffers of top-paid hospitals like Partners, and then divide up the proceeds to the neediest hospitals.
The Senate bill would set a rate floor, meaning that insurers would need to pay at least 90 percent of the state average reimbursement. Right now, hospitals like Lawrence General receive as little as 75 percent.
What both approaches have in common is that they’d raise overall health care costs, which already place a big burden on patients and businesses. The House disguises the cost by targeting insurance company reserves, but that’s not a free pot of money: The insurers will need to rebuild those reserves, an expense ultimately paid in premiums. The Senate bill pays lip service to bringing costs down at the top, but its effect would also be inflationary.
If the conference committee took the Senate approach and added tougher cost controls — perhaps in the form of a cap, or the sort of freeze that Governor Baker unsuccessfully proposed last year — that could be the basis for a bill that helps the community hospitals while protecting the public. Boosting the low payments to community hospitals is the easy part of addressing price variation, but the problem shouldn’t be tackled piecemeal.
And if the negotiators can’t reach an agreement on the vexing cost question? A comprehensive effort in the future would be warranted and, in the meantime, there may be other short-term ways to help community hospitals (the state’s recent unexpected boost in tax receipts, for instance). But if the negotiators hit an impasse, that shouldn’t keep the rest of the Legislature’s work from the governor’s desk.