Groups Press To Improve Health Care Coverage

Doctor examining female through stethoscope in ICU

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BOSTON (State House News Service) - Massachusetts residents could gain expanded access to health care services -- such as gender-affirming and comprehensive reproductive health care spanning the prenatal to postpartum periods -- should lawmakers advance a bevy of bills this session designed to remove financial and bureaucratic hurdles.

Bay Staters could also potentially avoid the financial and emotional burdens that arise from managing chronic diseases and accompanying astronomical prescription costs, according to dozens of lawmakers, advocates and medical professionals who testified before the Joint Committee on Financial Services Tuesday. The hybrid public hearing featured strong support for expanding telehealth options too, which became popular and highly utilized during the COVID-19 pandemic, while ensuring equitable reimbursement rates to enable providers to continue providing the virtual service.

As lawmakers elsewhere across the country seek to strip away treatment options for the transgender community, Sen. Jo Comerford sought to generate support for her trans-inclusive health care bill (S 596) that would require health insurers to cover a procedure after receiving one letter -- also referred to as a verification or certification -- from a qualified provider.

The change would align state law with accepted standards from the World Professional Association for Transgender Health, the Northampton Democrat said. Comerford said many insurance providers currently require two letters, including from a mental health provider, creating a costly and time-consuming process as patients must contend with a shortage of providers.

"I know many on this committee would agree gender-affirming care is life-saving, life-affirming health care, and despite this, people who identify as transgender or gender diverse consistently -- and yes, in Massachusetts -- face barriers to accessing health care," Comerford said. "I want to ask the committee, for what other health-related issue do we require two separate letters from two separate providers to provide and approve a medical necessity, especially when the first provider is an expert in the field of care?"

Sen. Julian Cyr testified on his narrower transgender-related health care bill (S 621) to strengthen insurance coverage of gender-affirming hair removals procedures, including electrolysis. Cyr said it's "very difficult" for people who identify as two-spirit, transgender, nonbinary, intersex or gender diverse to obtain those procedures, even when they've been prescribed as medical treatments.

"There's a gap here between what the plans say is covered and what's actually on it," Cyr said. "When we speak to transgender and nonbinary folks who really struggle to access that care, in many instances they are paying out of pocket for that care."

Lawmakers last summer expanded protections for gender-affirming and abortion-related care in the aftermath of the Supreme Court's decision to overturn Roe v. Wade. But at the hearing, there was growing momentum to back proposals from Rep. Lindsay Sabadosa and Sen. Cindy Friedman (H 1137/S 646) that would guarantee insurance coverage stretches beyond abortion care and also encompasses prenatal, childbirth and postpartum care without any cost-sharing.

Sandy Wolitzky, assistant attorney general and deputy chief of the health care division, voiced AG Andrea Campbell's support for the full-spectrum pregnancy bills, which she said can help tackle racial disparities in maternal health outcomes. Representatives from Reproductive Equity Now and the League of Women Voters were among some of the groups to back the proposals, as did Kathryn Adamek, who paid $3,000 to give birth to her baby in 2020.

The hospital bill came as a "total shock" to Adamek, who assumed childbirth would be covered under her family's insurance plan -- particularly after encountering $30 copays for doctor's visits throughout her pregnancy. She ended up paying the bill over two years, and her daughter is now a toddler.

Had Sabadosa and Friedman's plans been implemented, Adamek said it would have removed "so much of a financial burden and stress."

"What's the point of insurance if cost-sharing is so high? With my public health background, I know how much being uninsured or underinsured leads to negative outcomes for families and children," said Adamek, a reproductive health researcher.

Lawmakers on Tuesday also heard testimony about proposals from Rep. Daniel Cahill and Sen. Brendan Crighton (H 953/ S 609) aimed at closing an insurance loophole for deductibles that patients and activists say can currently result in insurers getting paid twice.

For example, a patient with multiple sclerosis may secure financial aid from a copay assistance program to blunt the yearly cost of medications that can total $94,000.

But that copay assistance -- which insurers will accept -- doesn't necessarily count toward the patients' deductibles, meaning they could still face a steep price tag the next time they pick up a prescription or need an MRI, said Marissa Shackleton, executive director of the Elliot Lewis Center for Multiple Sclerosis Care. To make ends meet, patients may manipulate their doctor's instructions, such as taking a pill every other day instead of daily, but that could lead to ultimately more expenses in the form of hospital stays, symptom flare-ups and relapses.

"Not passing these bills would force patients to choose between paying for their medication and paying for their families' needs," Shackleton said. "Not passing these bills will lead to greater health care inequity, as only those who afford it will get the best medications."

Cancer patients, as well as individuals diagnosed with autoimmune or rare diseases, could also benefit from tailored treatment plans under bills filed by Rep. Meghan Kilcoyne and Sen. Su Moran (H 1074/S 689) to make biomarker testing more accessible and affordable with insurance coverage. The technology analyzes genes, proteins and molecules to determine the most effective and least invasive treatment plan -- which Kilcoyne said can lead to "better and healthier outcomes."

"I think many of us in this room have a friend, or family member, or they themselves have been touched by cancer," Kilcoyne said. "And for those of us that have seen the impact that disease has on loved ones or themselves know that in so many instances, not only is it so critical to catch early and to start treatment as quickly as possible, but sometimes that treatment can be invasive or just as painful as the disease itself."

Written By Alison Kuznitz/SHNS

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