BOSTON — Health care providers and insurers would be required to boost their spending on addiction services, behavioral health, primary care and geriatric services by 30 percent over the next three years under a sweeping health care bill that Gov. Charlie Baker filed Friday afternoon.
The bill would also restrict how hospitals and doctors bill patients and require walk-in clinics to treat low-income patients on Medicaid.
The governor’s bill, which also seeks to help “distressed” community hospitals and community health centers, marks the first volley in what is likely to be a months-long effort on Beacon Hill to overhaul the state’s health care laws after last session’s attempts collapsed at the end of formal legislative business.
“We can no longer undervalue primary and behavioral health care. Our system should reward organizations that invest in a comprehensive set of physical and behavioral health services and that’s why today we’re proposing to flip the script,” said Baker, the former CEO of Harvard Pilgrim Health Care.
The governor said his bill is designed to lower costs and streamline health care.
“We need to prepare our health care system for the future, focus our efforts on achieving the best outcomes for patients and bring down costs,” Baker said in a statement.
His legislation would outlaw “surprise” bills for emergency room care and rein in certain hospital fees. Baker cited the example of an individual who gets an unexpected bill after going to the emergency room for a broken arm and getting an X-ray by a radiologist who turns out to be out of the patient’s insurance network.
Drug companies would be penalized for raising prices on medications by more than 2 percent a year over any cost adjustments for inflation.
Primary care and behavioral health care are two main focuses. Baker’s office said the administration has invested $1.9 billion in behavioral care since January 2015, but the system is still failing patients.
“Consumers consistently report long waits for appointments, lack of treatment available at the right time and at the right place and difficulty finding providers who take insurance,” it said.
Baker’s overhaul also would require retail clinics and urgent care centers — which are exploding in growth nationwide as health care options after hours and on weekends when traditional doctors’ offices are closed — to provide care to Medicaid patients and other low-income individuals.
1199SEIU United Healthcare Workers East, a major industry union, said Friday the legislation “is a good first start as Massachusetts works to make health care more affordable and accessible for patients.”
Less than 15 percent of total medical expenses in Massachusetts are currently spent on primary care and outpatient behavioral health services combined, Baker said. His bill would establish statewide spending targets for primary and behavioral health care at 30 percent above calendar year 2019 spending, which the governor said would be “all within the parameters of the state’s overall health care spending benchmark.”
Total spending on health care in Massachusetts accelerated faster in 2018 than in recent years, rising 3.1 percent to $60.9 billion, a Center for Health Information and Analysis annual report released earlier this month found.
Health and Human Services Secretary MaryLou Sudders said investing in primary care and behavioral health will increase access, particularly for early identification and treatment, and will help drive down consumer health care costs.
Sudders said half of all licensed behavioral health care providers do not accept insurance right now. “Finding a practitioner that accepts one’s insurance is one of the biggest issues that I hear about,” she said.
The bill (HD 4547) also attempts to address hidden consumer costs by placing prohibitions on facility fees and surprise billing for any unplanned emergency service provided by an out-of-network provider at an in-network facility, and to hold drug companies accountable for “unjustified” price hikes.
The Baker administration also announced that it had approved $15 million to be deposited into the Health Safety Net Trust Fund to support care provided to uninsured and underinsured patients by acute care hospitals and community health centers.
Stabilizing community hospitals and limiting the growth of consumer health costs were central tenets of the bills passed last session by the House and Senate. Scrambling to wrap up other major bills, the two branches were unable to craft a compromise bill by the end of July 2018, with House Majority Leader Ronald Mariano saying at the time, “We were just too far apart philosophically to a come to a resolution that fit our agenda.”
On Friday, Baker said that his latest bill incorporates many of the elements he liked — and on which House and Senate negotiators agreed — from last sessions’ legislative proposals.
“There were a lot of elements of both those bills that were pretty common ground, and many of them are reflected in the way we’ve proposed a number of the elements in this bill,” he said. “I do think, based on the conversations I’ve had with leaders in both the House and the Senate, that people want to do a health care bill in this session. I think we believe that we should do a health care bill in this session. Many of these issues are things people have talked about wanting to get done for many years.”
Baker, who has seen his health care reforms rejected by the Legislature in recent sessions, said he plans “to work very hard on this” as it wends its way through the Legislature.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said her organization is pleased that the bill Baker announced “targets areas that drive up medical spending, including important provisions to address the rising cost of prescription drugs and increased transparency to better understand how pharmaceutical manufacturers set drug prices.”
The national Pharmaceutical Research and Manufacturers of America was less enthused by the governor’s plan.
“We are deeply disappointed that Governor Baker is attempting, once again, to implement dangerous price controls that would have a devastating impact on patients. The biopharmaceutical industry is committed to working with legislators to ensure patients have access to medications, that the industry has the ability to continue their efforts to develop new treatments and cures, and to lower health care costs in a commonsense way,” said Tiffany Haverly, a PhRMA spokesperson. “While conversations about affordability are important, arbitrarily capping prices will never be the answer.”
Massachusetts Biotechnology Council President Robert Coughlin said what Baker put forward Friday “misses the mark by not including any proposals that would directly control skyrocketing health insurance premiums and patient out-of-pocket costs.”
This story includes information from The Associated Press.