Politics

What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

The Ancient Rome Angle On Mass. Health Reform, Circa 2012

The emperor Diocletian (fmschmitt.com)

Boston Globe columnist Jeff Jacoby is often too caveman-ish for my taste, but he certainly gets erudition points today for comparing Gov. Deval Patrick to the third-century Roman emperor Diocletian.

In a column headlined “On health care, state doesn’t know best,” he describes Diocletian’s “famous” (I guess to everyone but me) “Edict on Prices.” It “established price ceilings for a wide range of goods and services,” and it totally backfired, leading to hoarding, black-marketeering, speculation and a general economic worsening. Now to the proposals afoot to contain rising health costs in Massachusetts:

These bills aren’t written in Latin and they don’t impose the death penalty, but their core principle is not much different from Diocletian’s: The state knows best. What fraction of the local economy should health care consume? How fast should medical spending rise? On what business model should provider networks be organized? How should hospital and doctors fees be calculated? Where should consumers get information on quality and cost of care? When are a provider’s high rates justified? What penalty should it bear when they aren’t? In the world these plans envision, decision after decision comes not through the voluntary interplay of doctors, patients, hospitals, and insurers, but from government agents who impose them from above.

And his conclusion: “Price controls invariably make economic problems worse. It was true in Diocletian’s Rome. It’s no less true in Deval Patrick’s Massachusetts.”

There are already some thoughtful comments, both agreeing and disagreeing, below the column on the Globe’s site here. Including: Continue reading →

FILED UNDER: Medicine/Science, Politics, health reform 2012, mahealthcosts

May 15, 2012 | 3:56 PM | By Rachel Zimmerman

Live: MA Senate Debates Health Care Cost Bill

As we speak, a debate on S.2260, the Senate’s health care cost bill, is underway. You can watch it live here.

But get comfortable: staffers report there are 265 filed amendments to consider.

Lawmakers weigh in on the Senate health care cost bill

Update at 4:53: The Senate voted 15-22 rejecting amendment #125 that sought to trigger a single-payer health care system.

FILED UNDER: Insurance, Money, Personal Health, Politics, health costs, Mass. Senate

May 9, 2012 | 1:00 AM | By Rachel Zimmerman

Mass. Senate Health Cost Bill: Mostly ‘Darn Similar’ To House Plan

By Rachel Zimmerman and Carey Goldberg

The Massachusetts Senate today released its version of a sweeping plan to control health care costs. And guess what? It’s pretty close to the sweeping plan the House released last week. Both emphasize preventive care and wellness. Both place a specific cap on the growth of health spending linked to the growth of the state economy. And both envision shifting more care into systems that put doctors on a budget instead of paying per procedure.

In the details, the Senate plan may be slightly more business-friendly: There’s no “luxury tax” on pricey hospitals that fail to justify their high costs, and there are more references to “market-based” solutions as opposed to government interventions.

The Senate’s cap on health spending is also slightly less restrictive. (Until 2015 it’s set to be equal to the projected growth of the gross state product plus 0.5%. From 2016 to 2026 it’s equal to the projected growth in the state’s GSP and from 2027 and beyond, it’s the GSP plus 1.0%. The house plan proposes GSP minus 0.5% beginning in three years.)

The House and Senate health cost plans ‘look pretty darn similar to me.’ – MIT economist Jonathan Gruber

Other new elements: The Senate bill‘s prevention and wellness provision is backed by $100 million in funding over five years. And it establishes a new certification process for “Beacon ACOs,” the most effective accountable care organizations. These “beacons” would get preference in state health-care contracting.

The Boston Globe’s Liz Kowalczyk sums up the House-Senate difference in flavor: “The Senate bill appears to allow doctors and hospitals more leeway to find their own solutions, while the House appears to want more oversight.”

Still, the degree of common ground is notable. Electronic health records become inescapable in a few years. The price of specific medical tests and treatments should soon be transparent to any consumer who checks a Website or makes a phone call. If your doctor makes an error, you may well receive a direct and prompt apology under new medical malpractice provisions in both bills. State agencies overseeing health care are reorganized.

We asked a few local experts for their first impressions.

Jonathan Gruber, the MIT economist who served as an advisor on the state’s 2006 health insurance reform law as well as the national Affordable Care Act, emailed that the two bills “look pretty darn similar to me.” Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, health reform 2012, mahealthcosts, reform 2012

May 7, 2012 | 5:06 PM | By Carey Goldberg

Judy Foreman: Blue Cross Painkiller Policy Risks Hurting Patients

Health columnist Judy Foreman

The state’s largest insurer has just unveiled a plan aimed at stemming abuse of painkillers, a major national problem. The Boston Globe writes about the new policy here, and today’s Radio Boston show focused on it as well, featuring Dr. Lynda Young, Mass. Medical Society president, and Dr. John Fallon, chief physician executive at Blue Cross Blue Shield.

Syndicated columnist Judy Foreman, author of an upcoming book about chronic pain — “A Nation in Pain: Healing Our Biggest Health Problem” – comments:

By Judy Foreman
Guest Blogger

It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it.

But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15– day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications.

There’s no question that a few physicians prescribe too many opioids and a few patients scam their doctors for more. But the far larger problem is under-treatment of the pain of 100 million Americans, some of whom appropriately need opioid medications.

Blue Cross’ new policy, while it may stem from legitimate, benign motivation, could end up making the lives of pain patients more difficult than they already are. Blue Cross is concerned about “doctor-shopping,” that is, patients going from doctor to doctor to get drugs in order to abuse them. But the truth is that many legitimate pain patients go from doctor to doctor not to abuse drugs but to find someone who understands and can treat their pain. Continue reading →

FILED UNDER: Medicine/Science, Politics, pain

May 7, 2012 | 10:26 AM | By Carey Goldberg

Reactions To House Health Reform Plan: Confusion, Cheers, Concerns

Times like this separate the true health reform wonks from the wannabes. Did you spend your weekend poring through H.4070, An Act relative to Health Care Quality Improvement and Cost Reduction Act of 2012, which was finally unveiled Friday afternoon? For the hard core, this was a health cost weekend: No time for lilacs or Little League, what the heck does this thing say and what does it mean? (Here’s our initial summary.)

Though many of the bill’s proposals were long expected, reaction tended to be muted on Friday because everyone needed a chance to digest. Now, the considered analyses are beginning to roll in, and we aim to make CommonHealth their home, much as it was during the debate around the state’s 2006 health reform. The Senate is expected to weigh in with its own bill on Wednesday, and then comes the great sorting-out. Here’s a very early sampling of today’s opinion harvest, and we plan to update this post today as others come in.

Forbes:
Massachusetts moves toward health care price controls; Is America next?

Goodness, ‘The Apothecary‘ blogger Avik Roy — a member of Mitt Romney’s health care advisory council, according to his Forbes profile — re-posts a bit more of CommonHealth’s bill summary than is usual blogging practice. But he does make some interesting points, including a prediction that the proposal to impose a surcharge on high-cost hospitals will backfire badly. He writes:

The beauty of government-controlled relative pricing is that it creates an incentive for everyone to raise prices. There are two ways for a high-cost provider (say, Partners HealthCare) to get their prices within the 20-percent band: (1) lower their prices; (2) get everyone else to raise their prices.

Thanks to the transparency provisions of the bill (and transparent prices are, in general, a good thing), low-cost providers will know what their peers are charging. They will therefore have the ability to raise their prices considerably.

For example, let’s say Mass General charges $32,000 for a coronary angioplasty, whereas the state median is $21,000, driven in part by low-cost Tufts, which is charging $16,000. Now that Tufts knows that MGH is charging $32,000, Tufts knows that it can charge, say, $25,000 per procedure, and still gain favorable status from insurers, without incurring the new “luxury tax.” Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, mahealthcosts

May 4, 2012 | 2:34 PM | By Rachel Zimmerman

A New Approach To Cutting MA’s Health Costs: Throw Spaghetti

(401k/flickr)

By Rachel Zimmerman and Carey Goldberg

When Massachusetts passed sweeping health insurance reform in 2006, a crucial piece was missing from the landmark legislation: how to control rising medical costs.

Today, state lawmakers unveiled an ambitious new proposal to do just that, including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state’s most expensive hospitals if they can’t justify their prices.

MIT economics professor Jonathan Gruber, an architect of the state’s 2006 health law and an advisor to President Barack Obama on the national Affordable Care Act calls the new House proposal “aggressive, broad and visionary.”

“This is an incredibly hard problem,” said Gruber, speaking on WBUR’s Radio Boston today. “What I like about this…is that it’s really taking the spaghetti approach to cost control; let’s throw a bunch of things against the wall and see what sticks. They’re doing a bunch of different things all of which might work.”

So, what does it mean for patients?

Rep. Steve Walsh, the House chair of the joint Committee on Health Care Financing, said the plan would save $160 billion over 15 years. As far as savings for patients, Walsh said: “The first thing I’d tell [a patient] is five years from now, her family plan is going to be $2,000 cheaper than it is today.” Walsh said businesses would also find their health costs cut significantly.

House Speaker Robert DeLeo added: “With this bill, I think everyone’s gotten a little something they want and everyone’s gotten a little something they don’t want. So that’s what this legislation is all about, but at the end of the day, most importantly what it’s going to provide is some real health care cost containment. That’s what the bill is all about.”

One of the greatest challenges, he said, was to contain costs while not undermining a key industry in the state, with 1 in 7 jobs here linked to health care. Clearly some folks will be disappointed that the plan didn’t go far enough. Gov. Deval Patrick introduced legislation in February 2011 that would have allowed greater government oversight of contracts between insurers and health care providers and moved more medical groups into global payment systems that put doctors and medical groups on a budget.

But DeLeo also made the point that once again, the state is in the forefront of health reform. “I look at this as Massachusetts being a leader once again in terms of what’s going on in the health care field in the country.”

Here are some details of the House bill, officially the Health Care Quality Improvement and Cost Reduction Act of 2012, presented today by lawmakers. The state Senate is expected to introduce its own version of the plan next week.

1. Oversight: A new, quasi-governmental agency called the Division of Health Care Cost and Quality would oversee the transition to the new payment and delivery system with a board including consumer, government and industry representatives.

2. Cost-Cutting: To curb the increase in medical spending, the plan establishes a cap for health-care spending linked to the local economy, the Gross State Product, minus one-half a percent.

3. Leveling The Field: The state could impose a 10 percent “luxury tax” on pricey hospitals that charge more than 20 percent of the state median price for a given service without being able to justify that higher price. (Two earlier reports by Attorney General Martha Coakley found that certain hospitals exploited their market clout and charged higher prices without offering better quality care.) Hospitals would pay this penalty into a “distressed hospital” fund for institutions that serve a high proportion of poor and vulnerable patients. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, cost, hospitals, mass. health reform, payments reform, reform 2012

May 3, 2012 | 3:27 PM | By Rachel Zimmerman

Breaking Report: House To Release Health Payment Reform Bill Friday

This just in from Michael Norton at State House News Service:

Stepping in front of a planned announcement from state senators, House leaders late Thursday said they’ll unveil a long-awaited health care payment reform and cost control bill on Friday.

According to House Speaker Robert DeLeo’s office, the bill will be unveiled during a 2:30 p.m. press conference in Nurses Hall with Health Care Financing Committee Co-chairman Rep. Steven Walsh (D-Lynn) and other members of the committee.

Senate President Therese Murray said last week the Senate planned to debate its version of Gov. Deval Patrick’s payment reform bill, filed in February 2011, in mid- May, after the bill emerged from the Senate Ways and Means Committee. This week, Murray said the Senate bill would be released next week.

Rumors began circulating on Beacon Hill Wednesday that a House health care bill might emerge on Friday, before the Senate bill. Until Thursday afternoon, House aides either declined to respond or declined comment when asked to confirm those plans or whether committee members were voting on bill. Continue reading →

FILED UNDER: Insurance, Politics, cost, mass. health reform

May 3, 2012 | 9:16 AM | By Rachel Zimmerman

The Wonk Olympics: Sweeping New Health Cost-Cutting Plan Coming

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state's universal health law at Faneuil Hall in Boston. (AP File)

In health policy circles, it’s as big as the Olympics, with major players, major maneuvering and all eyes watching. It’s a sweeping new plan to control health care costs through radical changes in how doctors are paid and other measures that will be soon be unveiled by state lawmakers in the next chapter of health reform, reports WBUR’s Martha Bebinger. Here’s a bit of her preview:

The House and Senate are expected to build on movements that are already under way: global payments, electronic health records and the increased focus on primary care. The House point person on health care, Steven Walsh, has outlined his proposals in meetings with dozens of groups.

Legislators are considering some controversial moves.

The Senate has talked about taxing insurance company profits. One House leader has a proposal to close the gap in payments to rich and poor hospitals. There’s a vigorous debate about how aggressive the state should be in trying to hold down health care costs. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, cost, global payments, mass. health reform

May 1, 2012 | 11:39 AM | By Rachel Zimmerman

Feds Grant $33M To Community Health Centers In Mass.

Health and Human Services Secretary Kathleen Sebelius today announced $33,716,628 in grants awarded to community health centers around the state for renovation and new construction projects under the new health care law, the Affordable Care Act. The agency noted that “these awards will help them serve approximately 42,539 new patients,” according to estimates from the grantees.

From HHS:

The announcement made today is for awards from two capital programs for community health centers. One will provide approximately $629 million to 171 existing health centers across the country for longer-term projects to expand their facilities, improve existing services, and serve more patients. This program will expand access to an additional 860,000 patients. The second set of awards will provide approximately $99.3 million to 227 existing health centers to address pressing facility and equipment needs. Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, affordable care act, community health centers

May 1, 2012 | 8:21 AM | By Rachel Zimmerman

Nation Eyes Bay State As Cost-Cutting Health Reform Plan Emerges

(jimmywayne/flickr)

Here’s more evidence that as Massachusetts goes, so goes the nation. The Washington Post reports on details of the soon-to-be-released, highly anticipated Health Reform 2.0 bill, aka, the cost-control plan. Put succinctly by Brian Rosman, of Health Care For All:

“There’s a bit of Bay State pride tied up in this,” said Brian Rosman, research director for the Boston-based advocacy group Health Care for All. “We were the first to figure out universal coverage. Now we want to be the first to crack health-care costs.”

The Post report touches on various aspect of the wide-ranging cost-cutting plan, expected to be out later this month:

The payment-reform law that Massachusetts will soon debate could create new incentives for doctors, hospitals and providers to participate in a payment system that looks a lot like the Alternative Quality Contract.

In February 2011, Gov. Deval L. Patrick (D) introduced legislation that would have moved all Massachusetts health-care providers to value-based payments (arrangements like the Alternative Quality Contract) by June 2015. A new government entity, created by the bill, would facilitate that change, setting various benchmarks and timelines… Continue reading →