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On health care law's anniversary, cost
control is clearly next front
By Kyle Cheney April 10, 2008 ... Two years after passage of a landmark state law, universal health care remains an elusive dream for Massachusetts policymakers, with those at the top now wondering whether skyrocketing costs – the bane of state budget writers and consumers alike – will spell the difference between resounding success and frustrating failure. Since April 2006, when Gov. Mitt Romney signed the Chapter 58 health care reform law, 340,000 residents have signed up for insurance in Massachusetts, with 175,000 joining Commonwealth Care, the state’s subsidized insurance for low-income residents. At a celebration of the law’s anniversary Thursday morning, Gov. Deval Patrick characterized health care reform as a “wonderful, wonderful experiment.” But as much as the morning was meant for rejoicing, state leaders peppered their praise with caveats. Senate President Therese Murray decried the “escalating costs that threaten to derail our accomplishments.” Speaker Salvatore DiMasi echoed that sentiment, saying, “Our first priority has to be coming together to rein in costs.” Senate Minority Leader Richard Tisei issued a statement Thursday morning praising the success of health care reform, but calling overall results “mixed.” Pointing to the expected spike in health care costs, Tisei said, “Annual cost increases of this magnitude are unsustainable going forward, not only for the commonwealth but for local businesses. Unless we do something to alleviate the burden on small businesses, the private sector’s ability to continue to provide insurance to its employees will be put at serious risk. And unless we get a handle on costs, the health care bill could end up bankrupting the state.” Their warnings came as the Commonwealth Health Insurance Connector Authority, the board charged with implementing major portions of the health care law, approved a 12.1 percent spike in costs of Commonwealth Care plans. The Connector also approved a 10 percent increase in premiums for insured residents who make between 150 percent and 500 percent of the federal poverty level. The premium increases would not apply to individuals with incomes less than $15,613 and families with incomes of under $26,413. The month of March saw a slight dip in enrollment in Commonwealth Care to 174,595 from a high of 176,000 as of March 1. The state expects an additional 50,000 enrollees to sign up for subsidized insurance in fiscal 2009, bringing the total to 225,000, a daunting challenge for fiscal planners and taxpayers. The governor allocated $869 million in his budget for subsidized health insurance but prognosticators have already warned that expenses could rise to as much as $1 billion. Financing the differential hinges in part on a tax increase package, up for debate in the House today, that would raise the price of a pack of cigarettes by $1. House analysts have estimated that additional revenue for the state would top $150 million. Gov. Patrick indicated today that he looked favorably on the cigarette tax, “particularly if we dedicate it to health care reform.” THE SENATE PRESIDENT’S BILL Patrick also praised major Senate legislation to control health care costs, championed by Senate President Murray, which stakeholders have dubbed phase two of health care reform. The bill, S 2526, would finance and promote the switch from paper medical records to an electronic filing system. It would also ban pharmaceutical companies from plying doctors with gifts and would require public hearings anytime a health insurer recommends a rate increase of more than 7 percent. A second prong of the bill is aimed at stemming a shortage of primary care providers. Health care leaders around the state worry that a lack of incentives for primary, preventive care professionals have led to a greater influx of highly paid specialists. To counter that trend, the legislation would offer loan forgiveness to medical students who set up primary care practices in Massachusetts, and it would also require insurers to list nurse practitioners as primary care providers, increasing options for consumers. A legislative committee estimated on Wednesday that the bill would initially cost $49.6 million, though that bottom line may change as the bill is amended in the House and Senate. On Thursday, Gov. Patrick said he was supportive of the Murray’s bill, calling it “a start.” Jon Kingsdale, executive director of the Connector, told the News Service Thursday morning that the Senate president’s bill is “one more very important step” toward universal health care. “I don’t think it’s the last step,” he said. “”We have to actually change the way of how we finance health care, in the end, to contain health care costs.” On balance, Kingsdale called it “a very happy anniversary” for the much scrutinized health care law. FEDERAL SUPPORT One major question facing policymakers as they consider the future of health care reform is federal cooperation and funding support. Massachusetts is in the process of renegotiating a three-year Medicaid waiver with the U.S. Department of Health and Human Services, at a time when the national economy is on the verge of recession. The state’s current waiver expires this summer. State Secretary of Health and Human Service JudyAnn Bigby told the News Service she was “very pleased” with the negotiations. “We’re not going to have less federal support,” she said. “That’s not even an option on the table.” At the anniversary celebration, Speaker DiMasi and Gov. Patrick thanked outgoing Health Care for All Executive Director John McDonough, who is heading for a job in U.S. Sen. Edward Kennedy’s office, which is also involved in waiver talks. “Bring us the money,” DiMasi said to McDonough in a half-joking aside, prompting the governor to turn and say, smiling, “Did you hear what the speaker said? Bring us the money.” U.S. Secretary of Health and Human Services Michael Leavitt visited Boston two weeks ago and suggested that the level of federal support may partially be contingent on progress of the switch from paper to electronic medical records. “We support the idea that we can be more efficient and can probably do more to assess and improve quality if we have health information technology that is of the 21st century instead of years past,” Bigby said. This story is courtesy of the State House News Service. |
