Lawmakers: Baker’s health care bill a good start

Boosts spending on primary care, behavioral health by 30%

LAST SESSION, Beacon Hill’s big three – the governor, the House speaker, and the Senate president — each had fundamentally different ideas about how to reform the state’s health care system, and attempts at compromise sputtered and failed.

Now, Gov. Charlie Baker is taking another go at changing the health care marketplace, and he’s getting some early buy-in from House Speaker Robert DeLeo and Senate President Karen Spilka, which may have something to do with the fact that the governor’s sweeping health care proposal borrows extensively from provisions that have passed either the House or Senate but stopped short of becoming law.

After a closed-door meeting with top lawmakers from the House and Senate on Monday, there was some good-natured ribbing between DeLeo and Baker about the scale of the project.

“I think there’s going to be a long-term process,” DeLeo said. “I mean, obviously, it’s a lengthy bill that the governor has provided.”

“It’s only a hundred pages long,” Baker interjected.

“I think it’s more like a novel,” DeLeo countered, in stride.

The jocularity appears to signal more camaraderie on health care this time around.

DeLeo went on to say he appreciated how the governor had incorporated some of the ideas that the House has previously advanced, and he thinks “it’s the beginning of what’s going to be a long and, hopefully, I feel a productive discussion, but I think it’s a good start.”

That would be a departure from last session when the governor’s cost-saving proposal for MassHealth was swiftly rejected by lawmakers who then failed to agree on their own health care legislation before the end of the session.

In his filing letter, the governor focused on how his bill attempts to shift the system’s emphasis from technological advancements to hands-on care, but other provisions in the 160-section, 179-page bill would alter other key aspects of health care, especially on the issue of pharmaceutical pricing.

The annual state budget that was signed into law authorizes MassHealth to negotiate prices with pharmaceutical companies, and it includes some accountability measures intended to encourage fairer pricing by drug manufacturers. The governor’s proposal extends similar accountability measures to the commercial insurance marketplace, according to Health and Human Services Secretary Marylou Sudders, who said it would also create some regulatory oversight on pharmacy benefits managers, who act as brokers between the drug-makers and insurers. Additionally, the bill would require the pharmaceutical industry to participate in the annual discussion of health care cost trends convened by the Health Policy Commission, and it would require pharmacists to disclose the cheapest option to customers, Sudders said.

The Massachusetts Biotechnology Council, which represents the pharmaceutical industry, swiftly condemned the governor’s approach, casting blame on the insurance industry for rising costs.

“The administration’s proposal misses the mark by not including any proposals that would directly control skyrocketing health insurance premiums and patient out-of-pocket costs,” said MassBio President Bob Coughlin in a statement.

The big ticket item in the governor’s bill does not directly address the issue of costs to consumers, but Sudders said she thinks that in the long-run it would make the system run more efficiently. Baker proposes requiring providers and insurers, including MassHealth, the state’s Medicaid program, to increase spending on behavioral health and primary care by 30 percent over the course of three years.

That increase in spending on primary care and behavioral health should occur within the existing goals for limiting the growth in overall health care costs, according to Sudders and others, who said it would shift the priorities for the big players in the marketplace.

The medical industry’s success at treating chronic illness with innovative therapies has overshadowed the more labor-intensive work of caring for people with chronic illnesses and addiction issues, Baker wrote in his filing letter.

The required increase in spending would result in easier access to primary care and behavioral health interventions, which over time should bring costs down by relieving emergency departments from the burden of handling behavioral health crises, Sudders said.

That approach struck a positive chord with Spilka, who has a degree in social work and has been employed as a social worker.

“I’m excited about looking at some of the behavioral health aspects of it, and increasing parity in behavioral health,” said Spilka.

Senate Ways and Means Chairman Michael Rodrigues was even more enthusiastic about the governor’s bill, although he deferred to Sen. Cindy Friedman, the co-chairwoman of the Committee on Health Care Financing, on the specifics.

“I like most of it,” Rodrigues said. “The bill addresses a lot of the areas that we’ve addressed in the past.”

House Ways and Means Chairman Aaron Michlewitz was more circumspect, indicating that he and others appreciated the inclusion of provisions that the Legislature advanced last session but he would need more time to review it.

Massachusetts Association of Health Plans President Lora Pellegrini had only positive things to say about the bill, saying it “targets areas that drive up medical spending, including important provisions to address the rising cost of prescription drugs and increased transparency to better understand how pharmaceutical manufacturers set drug prices.

“The Governor’s bill also reins in the ongoing practice of surprise billing, establishes clear standards for urgent care centers, and puts an end to unfair facility fees. These practices cost consumers and employers millions of dollars in additional spending each year,” Pellegrini said.

Steve Walsh, the president of the Massachusetts Health and Hospital Association who helped draft the big overhaul to the health care system in 2012, called the bill a “tremendous opportunity” to adapt to the needs of the changing population, which Baker said is increasingly beset by chronic disease.

The debate in Massachusetts occurs in the shadow of a more brash national debate over the future of health care that has split the Democrats running for president between those who want government to supplant the role of health insurers and their more centrist rivals who argue in favor of smaller changes that build upon the existing structure of Obamacare.