Speaker Mariano says health care regulation needs updates

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.” 

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.






State falling short: Dwaign Tindal of Alternatives for Community and Environment and Roseann Bongiovanni of GreenRoots say the state is not living up to its environmental justice responsibilities. Read more.

Climate-friendly cremations: Matthew Stephens, the president and CEO of Mount Auburn Cemetery, says state laws need to be tweaked to allow climate-friendly cremations and burials. Read more.

Get serious: Steve Walsh, president of the Massachusetts Health & Hospital Association, says it’s time to treat gun violence as the public health threat it is and respond as aggressively as the country did with COVID. Read more.





Traffic and car ownership have soared over the last decade in Lawrence, creating hassles for drivers. (Eagle-Tribune)

While Boston was booming, it was losing its population of families with children, a trend with horrible consequences for the civic fabric that must be stopped, writes Will Austin. (Boston Globe)

In the tiny town of Savoy, many positions on commissions and boards are vacant, preventing them from tackling business. “It would be wonderful if residents would choose to be more involved in their town,” said Town Clerk Valerie Reiner. (Berkshire Eagle)

A Berkshire Eagle editorial praises the Board of Health for coming to its senses and canceling plans to engage in legal action with Verizon over a cell phone tower that some residents had complained made them sick.


Two new cases of monkeypox are diagnosed in Massachusetts. (MassLive)

Steward Health Care is paying $4.7 million to settle kickback allegations. (Boston Globe)


Senate negotiators reached agreement over the weekend on a bipartisan plan for a narrow set of new gun control measures. (New York Times

Dozens of members of a group called Patriot Front were arrested in Idaho for allegedly plotting to disrupt a pride event. (New York Times)


The super PAC that worked on behalf of Andrea Campbell when she ran for mayor is sitting out the attorney general’s race, potentially defusing a major point of contention in the race. Quentin Palfrey has urged Campbell to pledge not to accept super PAC funds. (Dorchester Reporter)

Probation officer Alfred Barbalunga plans to challenge incumbent Berkshire County Sheriff Thomas Bowler. (Berkshire Eagle


Mayor Michelle Wu says consistency in leadership is what’s needed for the Boston Public Schools and warns that fixes to what ails the district will take time. (Boston Herald)


An open house for potential bidders for the long-shuttered Mohawk Theater in North Adams attracts little interest. (Berkshire Eagle)


More than eight months after an escalator at the MBTA’s Back Bay Station malfunctioned and injured a number of people, it remains out of service. (Boston Globe


Only a small number of guns – eight last year – have been seized under the state’s new red flag law, that lets a judge take a gun of someone who poses a danger to themselves or others. (Salem News)


Axios Boston publishes its first daily newsletter. The lead story is an interview with Gov. Baker about his priorities for the end of the legislative session, Baker’s last before leaving office.