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Speaker Mariano says health care regulation needs updates

Wants to expand Health Policy Commission powers, revamp board

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IT”S BEEN A DECADE since the Legislature revamped the way the state regulates health care, passing legislation establishing the Health Policy Commission and instituting a cost control benchmark.

House Speaker Ron Mariano, one of the architects of the 2012 law, said on The Codcast that much has changed over the last 10 years and the law needs some updating.  

“In the 10 years, we’re looking at a vastly different landscape with different cost factors, different drivers that we didn’t anticipate in 2012,” Mariano told hosts Paul Hattis of the Lown Institute and John McDonough of Harvard’s T.H. Chan School of Public Health said. 

The Health Policy Commission, for example, was given authority to review hospital mergers and acquisitions, but it had no direct oversight of Mass General Brigham’s recent proposal to expand by adding three ambulatory care centers in Westborough, Westwood, and Woburn.  

The review of that expansion fell to the Department of Public Health through its determination of need process, which relies heavily on an analysis of the expansion’s impact by a firm hired by the applicant. 

The Department of Public Health ultimately blocked Mass General Brigham’s ambulatory care expansions, but Mariano says that was a combination of luck and public outcry. In the future, Mariano said, the Health Policy Commission should have the authority to review any expansion that could affect the industry’s cost structure. 

“We can’t rely on the result of an analysis hired by the proponent of the project,” he said. 

Mariano said the Health Policy Commission’s cost benchmark worked well initially, but lawmakers failed to anticipate several new developments, including the rise of very expensive medications and the advent of pharmacy benefit managers. 

“All of these things came into the marketplace after we had been up and running for years and we never ever changed the law to account for that,” he said. 

“At the end of 10 years, it is probably time to reassess what we’re asking the HPC to do and how we’re asking them to do it,” Mariano said. “And I do think it is time to maybe take a look at the commission also.” 

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About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

Echoing comments made by his former legislative colleague Steve Walsh, who is now the president and CEO of the Massachusetts Health and Hospital Association, Mariano said it may be time for the commission’s board to change — from a group of volunteers to full-time paid directors. 

“They may not have the time necessary that we need to commit to resolve some of the issues we’re going to be faced with,” Mariano said. “It’s something I’ve been thinking about for a while. It may be time to step in and reassess.” 

Mariano also said:

  • The House is working on a behavioral health bill with a focus on 5- to 18-year-olds who were essentially removed from school and forced into isolation by COVID. He said the House bill will complement the.bill already passed by the Senate in addressing the lack of behavioral health beds.
  • He didn’t seem to think much of Gov. Charlie Baker’s bid to shift health care spending toward primary and behavioral health care, primarily because the legislation has no answer for institutions that fail to do that.

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