Baker renews push for primary, behavioral health care 

GOV. CHARLIE BAKER on Tuesday reintroduced a bill that would require hospitals and insurers to spend more on primary and behavioral health care, an attempt to revamp a medical system that has traditionally favored specialty care. Baker said his bill would result in increased spending of around $1.4 billion in these areas – and less money in other areas.  

“If you put more money into certain kinds of services, you will get more of them,” Baker said at a press conference at Codman Square Health Center in Dorchester. “That’s the way markets work. In this particular case, we have underinvested in primary care, geriatrics, and mental health care, and as a result we have a lot less than what we need, especially in the pandemic.” 

Baker, a Republican who used to work as a health care executive, made a similar proposal in 2019. But the Legislature’s attention was diverted by the COVID-19 pandemic that hit in early 2020. The Legislature did pass, and Baker signed, a health care bill on New Year’s Day in 2021, but it focused primarily on creating a financial framework for the continued use of telehealth, which skyrocketed during the pandemic. 

The Legislature is expected to seriously consider health care legislation this session. Senate President Karen Spilka has prioritized a bill that would expand access to mental health care, and the Senate also passed a bill to create more transparency in the pricing of prescription drugs. House Speaker Ron Mariano prioritized a bill to further regulate hospital expansions, and has also expressed willingness to tackle issues related to behavioral health care.  

The core of Baker’s bill is a provision that would require both health care providers and insurers to increase the amount of money they spend on primary care, geriatric care, mental health treatment, and substance use treatment by 30 percent over three years. Doctors and insurers would have flexibility on how they go about increasing the funding, but they would have to stay within the confines of Massachusetts’s health care cost benchmark, so they could not simply raise spending overall. They could do things like raise the rates paid to these providers, offer more after-hours care, or expand their primary and behavioral health networks. 

For years, lawmakers have agreed that mental and physical health care should be reimbursed equally, but practically, that has not always happened.  

Baker said the root of the problem is the amount insurers pay for different types of services tends to be related to what Medicare pays, and Medicare has traditionally prioritized technology and specialty services over primary and behavioral health care. That is why nationwide, there are more physicians entering the specialties. To incentivize more doctors to work in primary or mental health care and thereby create more access, Baker said, “You have to be willing to fund it.”  

Baker’s bill would use existing structures established through the state’s Health Policy Commission to ensure providers and insurers comply with the new requirements and enhance spending on primary and behavioral health care. The bill would also create a new fund to give more money to providers who provide behavioral health and primary care services to Medicaid recipients. 

Baker said the state has always struggled to provide adequate access to mental health care, and the problem worsened with the pandemic as more people struggled with isolation, depression, anxiety, and other mental health issues. “No one disputes the fact at this point we have very significant issues with respect to behavioral health access,” he said. 

Kate Walsh, president and CEO of Boston Medical Center, speaking at Baker’s press conference, said nationally, emergency rooms have seen a 24 percent increase in mental health-related visits by children ages five to 11, and a 31 percent increase in visits from those ages 12 to 17, during the pandemic. “There are still significant gaps in our ability to meet the primary care and behavioral health needs of the communities we serve,” Walsh said.  Walsh said BMC sees patients who come to Boston from as far as Lawrence or New Bedford to find a behavioral health clinician who accepts MassHealth insurance, the state’s Medicaid program. 

The bill includes several other provisions, many of which lawmakers have considered in other proposals. 

It would give the Health Policy Commission more authority to regulate drug prices by seeking information from drug manufacturers about the pricing of high-cost drugs and imposing penalties for excessive price increases. It would also set a default rate that insurers would pay for out-of-network services, limiting “surprise” billing. 

It removes some administrative hurdles related to inter-state health care licensing and expands the scope of what certain professionals can do.  

Amy Rosenthal, executive director of Health Care For All, a consumer advocacy group, praised the bill for its focus on primary and behavioral health. “We have long known that promoting overall health must include behavioral health care and, too often, we hear from people on our help line who struggle to find a primary care physician or mental health provider who takes their insurance,” Rosenthal said.  

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, which represents insurers, also called the focus on primary and behavioral health important, though she added, “It is essential that these investments are made within the confines of the state’s cost growth benchmark.” 

Rosenthal and Pellegrini both voiced support for requiring pharmaceutical companies to participate in the same Health Policy Commission process aimed at controlling costs that hospitals and insurers already go through. But PhRMA, the pharmaceutical industry lobbying association, criticized Baker for that section of the bill, accusing him of harming an industry that supports 90,000 jobs in Massachusetts. “Governor Baker’s decision to once again propose dangerous price controls on manufacturers threatens access to medicines for patients living in the Commonwealth and has a chilling effect on innovation and development of new therapies,” PhRMA said in a statement. 

MassBio, which represents the Massachusetts life sciences industry, says the bill fails to recognize the role insurers, rather than drug manufacturers play in setting drug prices. The bill, the organization said in a statement, “would have countless unintended consequences for patients with unmet medical needs.”

The Massachusetts Health and Hospital Association, which represents hospitals, issued a statement supporting provisions aimed at boosting the health care workforce, expanding access to telehealth and urgent care, and making prescription drugs more affordable. “The bill also takes necessary steps to implement coverage parity for behavioral health services, which for far too long has been a barrier to expanding treatment access and ensuring timely care for those in need,” the association said. “We look forward to reviewing the bill further and providing detailed feedback as it moves through the legislative process.”