Mass. Senate Healthcare Reform, CSRs, and more...

Mass. Senate Proposes Massive Healthcare Reform Bill

Senate leaders unveiled a 159-section, 101-page healthcare reform bill on Tuesday that addresses behavioral health, provider price variation, readmissions, the scope of practice for various health professions, and telemedicine – among a host of other reforms.

On Monday, Oct. 23, a newly appointed Special Senate Committee on Health Care Cost Containment & Reform will hold a public hearing on the legislation. It is expected that the legislation will be reported to the Senate Ways & Means Committee after Monday’s public hearing, and the Senate is expected to vote on a final bill before November 15.

Hospital leaders from across the state participated in an MHA-convened conference call on Thursday to hear MHA’s initial overview and explanation of the proposed legislation’s elements.

MHA President & CEO Lynn Nicholas, FACHE, said of the legislation, “MHA commends Senate President Rosenberg and the rest of our state senators for keeping their focus on reducing the cost of healthcare in the commonwealth and for advancing steps meant to enhance patient access to healthcare services. We look forward to engaging with Senate leaders to ensure that such provisions are enacted in a manner that achieves true progress in these vital areas.” Nicholas added that the complexity of several parts of the bill merited “further vetting in order to prevent unintended consequences that could run counter to the goals set out by the Senate.”

At first glance, the bill’s recognition of the importance of expanding access to telemedicine takes important steps to address a long-standing MHA goal. Another important beneficial provision if enacted is the establishment of an aligned measure set for the state and health insurers to use in contracting with healthcare providers.  Requiring all carriers to use the aligned quality measure set will make it much easier for consumers to make meaningful quality comparisons and for providers to focus on quality improvements among a narrower set of options. Standardized quality measures from insurers will also create a more level playing field when placing providers into tiers since all carriers will be using the same set of measures.

Notable for their absence from the bill are a series of MassHealth reforms that Governor Baker proposed earlier this year. Specifically the governor’s plan to move 140,000 people from MassHealth to commercial insurance did not make the cut in the Senate’s bill; instead the Senate calls for further analysis of the governor’s Medicaid waiver proposal.

Dithering on CSRs Results in Premium Spike

A key Senate Republican, Lamar Alexander (R-Tenn.) worked this week to show President Donald Trump that the bill Alexander crafted with Democrat Patty Murray (D-Wash.) helps consumers – not insurers – by funding cost-sharing reductions (CSR).

Trump recently cancelled the monthly CSR payments to insurers which help lower-income people afford co-pays and deductibles on health plans they buy through insurance exchanges. In cancelling the payments, the president called on Congress to resolve the issue – which is what the bipartisan Alexander-Murray bill attempts to do.  After the bill was rolled out on Tuesday, the president offered his tentative support, followed by his criticism of the plan, followed by Alexander’s effort to get Trump on board.

The uncertainty has a clear and quantifiable downside – insurance premiums will spike upward in 2018. The Massachusetts exchange, the Connector, had been waiting to determine which set of rates it would use for 2018 open enrollment which begins November 1 – either ones that assume the CSRs or rates that did not. As it prepared to communicate to enrollees on the 2018 health plan options, the Connector was forced this week to assume there will be no CSRs given the White House and Congressional inaction.

On Thursday, Governor Charlie Baker wrote to the entire Massachusetts Congressional delegation informing them that because of the inability to fund the cost-sharing reductions, insurance premiums through plans on the Connector will rise by 18% above the expected 8% – a 26% total increase on average.

“Some members will be protected from these increases because they will receive offsetting premium tax credits,” Baker wrote. “As you know, this means the failure to fund the CSRs will actually cost the federal government more because of the increase in spending on premium tax credit subsidies. However, up to 80,000 members are not eligible for premium tax credits and will face the full impact of these premium increases.”

Baker also noted the cessation of CSRs creates a $28 million unfunded liability for insurance carriers through the end of calendar year 2017.

Schwartz Center Dinner – Thurs., Nov. 16

Tickets are now available for the annual Kenneth B. Schwartz Compassionate Healthcare Dinner on Thursday, November 16, with the reception beginning at 5 p.m. and the dinner and award ceremony at 7 p.m. Gov. Baker is the guest speaker. The five finalists for this year’s award are: Rana Awdish, M.D. of the Henry Ford Hospital in Detroit; Jonathan Bartels, R.N. of the University of Virginia Health System in Charlottesville, Virginia; Victor Fagan, LPN, of the VA Pittsburgh Healthcare System in Pittsburgh; Terrie Inder, M.D., of Brigham and Women’s Hospital, Boston; Lynne McAtee-Harris, R.N., of Boulder Community Health in Boulder, Colorado; and Alan Rosenthal, M.D. of Cleveland Clinic Children’s in Cleveland, Ohio.  Register for the dinner by clicking here.

Is The Price Right? The Emergence of Pricing Transparency

Friday, November 3; 8:30 a.m. – 12:15 p.m.
MHA Conference Center, Burlington, Mass.

Pricing transparency has been Massachusetts law since Ch. 224 passed in 2012, requiring healthcare providers to give consumers the costs of admissions, office visits, or procedures within two business days of a request. The law also requires that insurance companies provide their members with price information in real time, including the member’s out-of-pocket costs and an online cost estimator tool. Consumer awareness of this law has been low, but is expected to increase sharply in coming months as the state’s Center for Health Information Analysis launches a cost transparency website and patients with high deductibles seek more affordable options for care. Is your organization ready to respond? Join us at this conference where we’ll take a look at the latest trends in healthcare pricing transparency and consumer engagement, and help answer questions like: What is working well?  What are the challenges” And how can organizations be sure they are putting their best foot forward in providing accurate and meaningful information to consumers?  Learn more information, including registration details, here.

John LoDico, Editor