Key lawmakers like Baker health care priorities

KEY BEACON HILL lawmakers said on Monday they were supportive of Gov. Charlie Baker’s bid to tilt health care more toward behavioral and primary care, but they worried that the $1.4 billion spending mandate over three years would result in higher health care spending.

At a hearing of the Legislature’s Health Care Financing Committee, Baker and Marylou Sudders, his secretary of health and human services, pushed for passage of legislation that would require health care providers to boost spending by 30 percent over three years on primary care, behavioral health, substance abuse treatment, and geriatric care.

The bill requires providers to boost their spending in those areas while still remaining within the health care cost benchmark established by the Health Policy Commission. But several members of the committee said they were concerned about the potential for a rapid runup in health care spending.

“We do have a benchmark,” said Sen. Cindy Friedman of Arlington, the Senate chair of the committee. “But we’re not really doing a great job of it.”

Baker said the reorientation of the health care system (see his testimony here) would result in savings as patients are treated on an ongoing rather than an emergency basis. He noted many patients seeking mental health services are currently ending up waiting in hospital emergency rooms for beds to open.

“I wouldn’t call the system upside down, but I would call it misdirected,” he said.

Rep. John Lawn Jr. of Watertown, the House chair of the committee, raised another concern — that primary care and behavioral health providers would be unable to find the workers they need to provide the additional services.

Baker and Sudders said workers would probably not materialize overnight, but they said passage of the legislation would make a statement about what the state prioritizes and over time draw more workers to the industry.

Baker’s legislation includes a number of other provision, including a section giving 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.

Friedman said she supports many elements of the governor’s bill but also cautioned that the Legislature has a lot left to do between now and the end of the session on July 31. She asked the governor what elements of the bill he would prioritize if the Legislature had to pick and choose.

Baker said he would prioritize greater spending on primary care and behavioral health. “If we don’t do this, there’s not a lot else that’s going to get us to where we need to go,” he said.

Sudders said she would prioritize measures to rein in pharmaceutical spending and end surprise billing. Baker also said reducing pharmaceutical spending is a high priority, if for nothing else than to learn what part of the supply chain (manufacturers or pharmacy benefit managers) is the cause.

“They all blame each other for the rising cost of prescription drugs,” Baker said.