Could Marylou Sudders be staying on?

A lot of work left on controlling costs, she says

Editor’s note: After The Codcast went live and this report on it was published, Sudders notified employees that she would be stepping down January 3.

AFTER EIGHT YEARS as secretary of health and human services under Gov. Charlie Baker, could Marylou Sudders be staying on with Gov.-elect Maura Healey?

There has been no announcement, but during the recording of The Codcast last week Sudders sounded like someone who wasn’t necessarily ready to call it quits.

She chatted with Paul Hattis of the Lown Institute and John McDonough of the T.H. Chan School of Public Health, who initially described the conversation with Sudders as an exit interview.

But at the end of the conversation McDonough took a different tack, asking what’s next for her and whether there was any possibility she could be staying on after January 3, either temporarily or permanently. Other news outlets havereported that Healey may be interested in retaining members of the Baker administration in her cabinet.

“I’m here until I’m not,” Sudders said, acknowledging there have been meetings and discussions with Healey and Lt. Gov.-elect Kim Driscoll. “What I can assure you is this transition will be very smooth.”

One reason Sudders may be interested in staying on is to address the cost of health care. As one of the founding members of the Health Policy Commission (initially appointed as a behavioral health expert by former attorney general Martha Coakley and later as Baker’s secretary of health and human services), she has struggled with the cost issue time and time again and now thinks it is time to act.

“It is time for the administration, the Legislature, consumer advocates, and the like to really come back to the table on major health care reform. And it has everything to do with the balance of free market and regulation — price controls, price caps on certain procedures and certain providers,” she said.

“It is time for us to sit at the table for everything from drug pricing to the role of the Health Policy Commission to the structure of the Health Policy Commission, the tools that the commission has, the role of the executive branch,” she said.

Sudders also said existing laws dealing with hospital expansions and elimination of what are considered essential services need to be reviewed. She noted the essential services law, passed in the early 1990s, requires the state to merely hold a hearing when a hospital seeks to shut down a service deemed essential.

“There’s no teeth other than having an essential services hearing,” she said. “Once a hearing is held and a plan is filed, the service can close.”

She said mental health legislation and other reforms passed this legislative session, but Beacon Hill hasn’t addressed the core issues of health care cost, access, quality, and equity.

“We should use this moment and galvanize it and see it,” she said. “To me that is the policy opportunity to come back to the table and address health care costs in the Commonwealth, and I have some strong opinions about it, as you can tell.”

In response to a question, Sudders said the state’s Medicaid program has had some success in reining in the cost of pharmaceuticals, but she said the headwinds against change are strong. In 2008, she said, the median cost of bringing a drug to market was $2,000 per utilizer for 24 drugs. By 2021, the cost had risen to $180,000 per utilizer for 50 new drugs.

“The headwinds are significant and we can provide drugs, as we’ve demonstrated in the Medicaid program, for consumers at much more reasonable cost. In Massachusetts, if nothing else, as part of a comprehensive cost strategy, we need to really take on drug pricing as well as managing the pharmacy benefit managers, the PBMs,” she said.