It is an accepted fact that health reform will succeed only with focused attention on cost control. All stakeholders seem to agree that we will not be able to afford universal coverage unless health care costs are brought under control, and there are many worthwhile ideas about how best to meet this goal. Unfortunately, there are just as many, if not more, ideas that would increase costs.
When it comes to coverage, Massachusetts’ health insurers are heavily regulated. The rules were established with the best of intentions, but each new rule adds to the cost of coverage, either by requiring coverage for specified services or by making it more difficult for health plans to manage care.
The Health Reform Act recognized the impact of such requirements on the cost of coverage. It imposed, for instance, a moratorium on new mandated benefits until the Division of Health Care Finance and Policy completed a study of the cost impact of existing mandates. The Division has not yet released this important report.
Against this backdrop, it is surprising that some of health reform’s staunchest allies are supporting laws that would expand benefits further. Ironically, many of these same stakeholders advocate for more waivers from the individual mandate on the grounds that no affordable coverage options exist for moderate-income individuals. We cannot have this both ways. An individual mandate premised on the availability of affordable products needs to give health insurers the ability to sell affordable products. Otherwise, our goal of universal coverage is an illusion.
We will not bring costs under control by adding new costs to the system. While this is not a cure-all for controlling health care costs, it would be a good starting point.
Bruce Bullen
COO, Harvard Pilgrim Health Care
On the surface, the call for a full moratorium on any new insurance mandate is simple and exudes common sense. But, as the two recently released Commonwealth reports attest, it is not mandates that are the driver in escalating insurance premiums and health care costs. As an employer with 700 staff and family members covered, we have experienced double-digit increases. Our medical expense utilization trend reports detail year after year, that the most costly inpatient expense is surgery; mental health and substance abuse is second to last. And on the outpatient side, radiology diagnostic is $14.62 pmpm as compared to mental health and substance abuse at 43 cents. Treatment of mental illness and substance abuse is not the escalator in insurance costs. In this swirling debate about costs, the discussion shouldn’t be focussed disproportionately on proposed mandates. HB4423 (the full mental health parity bill) should pass now. It is not about abandoning fiscal responsibility; it is about ending the longstanding discrimination by insurance and the health care industry.