The Codcast: Sudders talks health care

What’s it like to be in charge of nearly half the state budget?

“Extraordinarily humbling,” said Marylou Sudders. But don’t confuse humbling with cautious indecision or lack of tenacity.

Gov. Charlie Baker’s health and human services secretary has a reputation for strong leadership and a social worker’s commitment to the enormous range of state programs she oversees, led by the Medicaid program that delivers health care coverage to 1.8 million state residents. Sudders said she is on board for a second Baker term, and highlighted some of the priorities she’ll focus on, including another stab at reining in Medicaid drug costs, an initiative to preserve access to community hospitals, and continued work to ensure access to mental health services.

Sudders said the state has built up a lot of protections against any rollback of the Affordable Care Act, but called herself a “worrier” who nonetheless closely tracks developments outside the state — prescient words on Friday afternoon, only hours before a federal judge in Texas struck down the entire federal law.

Sudders touched on those topics and more in the inaugural episode of “Health or Consequences,” a new health policy-focused entry to the Codcast line-up being helmed by John McDonough, a one-time Massachusetts legislator who now teaches at the Harvard Chan School of Public Health, and Paul Hattis of Tufts University’s School of Medicine.

Sudders expressed satisfaction with added conditions placed on the merger of Beth Israel Deaconess Medical Center and Lahey Health, but said there is a need for careful monitoring of the fact that the state health care landscape will now be dominated by two enormous players — the new Beth Israel Lahey network and Partners Health Care. “There’s no question we now have a duopoly,” she said. “I think we now have this obligation to measure the impact of what does it mean to have two strong systems in terms of trying to constrain prices.”

Sudders called a small decrease in opioid overdose deaths “a slight trend in the right direction,” but said it is hardly grounds for “a victory lap.” What she was willing to celebrate was a move, after decades of talk, to have women who are civilly committed because of addiction issues no longer held at Framingham State Prison but instead treated at “an extraordinarily strong program” at Taunton State Hospital. She also touted plans, starting in September 2019, for all county houses of correction to provide medication-assisted treatment and behavioral health services to inmates suffering from addiction issues.

She said the administration was “really disappointed” in the feds denial in June of a proposed to exclude certain specialty drugs from Medicaid coverage, where drug costs have ballooned by $1 billion over five years. “You will see next year another MassHealth pharmacy reform, 1) that guarantees access, 2) goes for direct negotiations with manufacturers, and 3) has strong consumer protections,” she said.

Sudders also said the administration will be unveiling a proposal to strengthen access to community hospitals. “This coming year, as we revisit health reform in the Commonwealth, we need to ensure that people have access to the community hospitals. I can’t tell you what that’s going to look like at this moment, but stay tuned and have me back,” she told McDonough and Hattis.

She said things have gone smoothly for the transition of 850,000 MassHealth recipients into one of 17 “accountable care organizations,” a new payment and care delivery system designed to have patients’ primary care provider coordinate the full range of their health care needs.

“Six months in, we don’t hear a lot of noise,” Sudders said of the ACO effort, which some had feared could destabilize lots of patients’ established routines.

McDonough and Hattis pressed her for details of coming initiatives, but the most concrete news Sudders would offer is that she will be staying on for Baker’s second term.

The job comes with tremendous clout in state government, but Sudders said she’s always equally mindful of its limitations.

“Even with all of those resources, you realize you cannot resolve every human condition and problem that comes to you,” she said. “But what you can do is treat every issue and person that comes to you or becomes known to you with dignity and respect. That’s sort of what drives me. I take it with a seriousness I think you would want me to.”

–MICHAEL JONAS


BEACON HILL

The Baker administration is exploring a carbon fee on auto fuels along with as many as 15 other states. (CommonWealth) A commission charged with exploring the future of transportation recommends massive vehicle electrification, the carbon fee, and possibly the use of tolls to reduce congestion. (CommonWealth)

The state income tax rate is set to drop slightly in January. (Eagle-Tribune)

Hillary Chabot says the state’s fix-it governor has failed to fix nagging tech problems facing state government, including “antiquated payroll and accounting systems.” (Boston Herald)

MUNICIPAL MATTERS

More than a dozen new restaurants have opened in Quincy Center since 2015, a “restaurant renaissance” there. (Patriot Ledger)

A Fall River city councilor is pushing for the city to again adopt a two-week amnesty program around Christmas from it’s pay-as-you-throw trash collection system. (Herald News)

“Plan for the worst, hope for the best,” says Leicester’s police chief, offering advice to other communities preparing for the opening of pot shops. (Boston Herald) Some early problems are popping up, including a 10-year-old child left in a car in a parking lot while an adult took a shuttle bus to the Leicester pot store. (Boston Herald)

WASHINGTON/NATIONAL/INTERNATIONAL

A report prepared for a Senate committee says Russia engaged in a sweeping social media effort to tilt to the 2016 election toward Donald Trump and worked even harder to support him once he was elected. (Washington Post)

MIT economist Jonathan Gruber, one of the architects of the Affordable Housing Act, decries a Texas federal court ruling invalidating the law, calling the ruling “ridiculous,” but worrying that the Supreme Court could tilt out of the mainstream and uphold it. (Boston Globe)

Sen. Elizabeth Warren tells graduates at Morgan State University, a historically black college in Baltimore, that the system is rigged, and is especially so for minority communities. (New York Times)

ELECTIONS

New early voting measures could have Californians casting ballots in the 2020 presidential primary contests before the traditional first presidential preferences from the Iowa caucuses. (Boston Globe) Secretary of State Bill Galvin wants Massachusetts to get in on the early voting action in the 2020 primaries. (Boston Globe)

BUSINESS/ECONOMY

Since some people don’t like the name WooSox, the Red Sox farm team is reaching out to fans for other ideas and so far has received 237 possible names for the team from about 1,000 fans. (MassLive)

EDUCATION

Lane Glenn, the president of Northern Essex Community College, says Massachusetts doesn’t really have a public college system because no school gets more than 50 percent of its money from the state. (CommonWealth)

Yana Minchenko, who teaches at the Urban Science Academy in West Roxbury, questions why the school is being closed. (CommonWealth)

The New York Times digs into the sexual harassment allegations against star Harvard economist Roland Fryer that have led the university to bar him from the Education Innovation Lab he founded while an investigation is completed.

TRANSPORTATION

Transportation Secretary Stephanie Pollack’s decision to replace Luis Ramirez with Steven Poftak as MBTA general manager reflects a change in philosophy. (WGBH)

ENERGY/ENVIRONMENT

Paul Levy, a former chair of the Department of Public Utilities, questions whether all the subsidies for solar power in Massachusetts have paid off. (CommonWealth)

A former employee of Columbia Gas said the company was cutting corners and reducing expenses, putting safety in jeopardy before the natural gas fires and explosions that rocked the Merrimack Valley. (NBC10)

Sen. Ed Markey, in a Globe op-ed, says November’s blue wave of Democratic wins also represented a green wave that will push back against the Trump administration on climate change policies.

Three firms, including Vineyard Wind, pay record amounts for federal ocean leases, sending a strong signal that the offshore wind industry sees promise and profits ahead. (CommonWealth)

A Globe editorial urges embrace of hydroelectricity from Quebec and denounces an unholy alliance of environmentalists and fossil fuel interests that has opposed importing more hydropower to the state.

A Framingham couple gets Eversource to pay for repairs to a gas meter installation that allowed water to seep into their basement. (MetroWest Daily News)

CRIMINAL JUSTICE/COURTS

Massachusetts is the only state that lets citizens seek criminal complaints that are vetted and can be resolved in secret court sessions. (Boston Globe)

Eric Goldscheider says Benjamin LaGuer, struggling with liver cancer and likely to live only a few more months, deserves a compassionate release. (CommonWealth)

Food at the Bristol County Jail, where inmates protested the fare this summer, isn’t very appetizing or healthy. (South Coast Today)

MEDIA

Boston Globe union members are not happy with a new contract proposal — or with the company’s hiring of a well-known anti-union law firm to handle negotiations. (Boston Herald)

PASSINGS

Amy Anthony, a major figure in affordable housing development in Massachusetts and beyond, died at age 74. (Boston Globe)