Moore Eyes Health Care Bill by March, Mariano Touts Short-term Plans

February 8, 2012
State House News Service

By Kyle Cheney

STATE HOUSE, BOSTON, FEB. 8, 2012 - A major refashioning of the Massachusetts health care system aimed at incentivizing high quality health care and eliminating duplicative procedures could be presented to the House in a month, a lawmaker leading negotiations on the proposal said Wednesday.

Sen. Richard Moore (D-Uxbridge), co-chair of the Legislature’s Health Care Financing Committee, said he hopes to strike a deal with his House counterpart Rep. Steven Walsh (D-Lynn) by March, but he said that in the absence of an agreement, the Senate would likely advance a bill on its own.

“I don’t think the Senate’s prepared to wait forever,” he said.

The long-awaited proposal carries substantial economic and political ramifications for Massachusetts and its elected leaders. Gov. Deval Patrick has repeatedly pleaded with lawmakers to send him a health care system reform bill quickly, calling it a moral and fiscal imperative. But the Legislature has repeatedly rebuffed him, reviewing his bill for a year and warning hasty action on the proposal could destabilize an industry that ranks as the top employer in Massachusetts and processes tens of billions of dollars a year.

The proposal could also bear on President Barack Obama’s reelection prospects. The president, with the aid of Patrick as a campaign surrogate, will be forced this year to defend the national health care law he signed in 2010, an effort he has described as based on Massachusetts’s model, but one that critics say has failed to tackle soaring health care costs. An effort by Massachusetts to redesign its payment system, which proponents say could cut into ever-growing health care costs, has been cast by supporters as a precursor to potential cost-cutting efforts on the federal level.

House Majority Leader Ronald Mariano told the News Service Wednesday that he’s confident lawmakers will come to terms on a health care cost control bill this year but that he’s not as assured that Patrick will like the outcome.

“The problem becomes what’s going to happen with the Executive Branch, although I think he’s really desperate for a bill,” Mariano said. “So I think he’s gonna be kind of happy.”

Patrick has made no secret that he’s girding for the Legislature to send him a health care bill, demanding in his State of the Commonwealth address last month that they act before budget deliberations begin in April, and he’s pointed to polls showing that Massachusetts residents want government intervention to curtail health care costs. But lawmakers insist they’ll work at their own pace to craft a proposal.

The proposals under consideration by the Legislature would, in part, embrace a system that essentially puts groups of health care providers on a patient-by-patient budget and provide incentives for doctors and hospitals to work within that budget. Supporters of the so-called global payment system say it would emphasize healthy outcomes for patients and diminish the “fee-for-service” system in which providers are reimbursed for every service they provide, rather than for keeping patients healthy, reducing errors and minimizing unnecessary hospitalizations. Others have suggested lawmakers must also tackle major disparities in the prices charged by hospitals around the state for similar services, a dynamic Attorney General Martha Coakley has attributed, in part, to the market clout wielded by powerful hospital networks.

Mariano urged his colleagues at a hearing Wednesday to back a bill he filed that he described as a short-term fix to financial stresses on the state’s community hospitals – often among the lowest-paid providers in Massachusetts – while a broader payment reform takes effect. His proposal, heard by the Committee on Health Care Financing, would reduce reimbursements for some of the state’s highest cost health care providers and raise them for certain community health centers to help relieve pressure on places like Holyoke Community Hospital, which is operating on three days of cash reserves.

“These are facilities we can’t allow to fail,” said Rep. Walsh.

Although he joked that his bill was based on “communist” principles because “you take from the haves and spread it out amongst the have-nots,” Mariano said his bill would preserve critical low-cost facilities for patients and also support hospitals that are often the economic engines for their communities.

“We can’t afford to see these go, both as a treatment center that’s an alternative to the high prices,” he said in an interview in his State House office. “You can’t be telling people we’re going to tier your health care and give you low-cost alternatives and then let the low-cost alternatives go under. We need to get a predictable revenue stream for these folks.”

Mariano’s comments dovetailed with remarks made earlier by Speaker Robert DeLeo, who said during an address to the House that he expects to “continue to monitor the market disparity between our large providers and those in your neighborhoods that are offering low-cost high-quality care and we will thoughtfully implement the most appropriate mechanisms for balancing out the system.” Mariano said the speaker’s remarks were informed by his bill, which he expects will be considered by Moore and Walsh as they negotiate a broader payment reform proposal.

“I would expect it’ll be folded into the bigger piece. I think it, in some ways, it goes at cross-purposes to what Stevie and Dick are trying to do. They’re trying to provide some long-term incentives for the marketplace to move. This is not a long-term incentive. It’s a short-term fix,” he said, noting however, “They both recognize the fact that something has to be done.”

Mariano’s bill won plaudits from the Massachusetts Association of Health Plans, which praised it for proposing “temporary statutory restrictions on how much prices may vary for comparable services to improve market function until these efforts can correct the market distortions.”

Health Care for All, which advocates for consumers, also supported the bill. “State government must have the authority to require reasonable prices,” said the group’s executive director, Amy Whitcomb Slemmer.

Mariano and Moore were both members of the conference committee that crafted the 2006 health care reform law that has helped, by some estimates, 98 percent of Massachusetts residents to obtain health insurance, the highest coverage rate in the country. Although that bill was touted as a measure to bring down costs by limiting preventable emergency room visits, costs have continued to rise at a rapid clip, as they have across the country.

Moore told the News Service that uncertainty over the fate of national health reform – which could be decided by the 2012 presidential and Congressional elections – has had limited impact on efforts to craft a payment reform bill. Both he and Mariano said they didn’t foresee the bill’s late movement in the Legislature’s two-year session as worrisome, contending that a version is likely to pass. Moore predicted passage in May or June.