Gov. Healey Focuses On Inequities, Benchmarking In Health Care

Young woman is patient in hospital clinic discussing healthcare options with doctor

Photo: Courtney Hale / E+ / Getty Images

BOSTON (State House News Service) - As Massachusetts families are squeezed by high, and growing, health care costs, widespread provider staffing shortages and social determinants of health need to be addressed, Gov. Maura Healey said Wednesday.

The governor kicked off a policy discussion at the Health Policy Commission's annual cost trends hearing with her remarks.

Healey, Attorney General Andrea Campbell and other speakers agreed that health care costs have grown out of some families' reach, and that cost disparities persist across income, racial and ethnic groups, though neither Healey nor Campbell laid out policy recommendations to address the crisis.

This year's hearing comes against the backdrop of the Legislature positioning itself to tackle major policy changes in health care in 2024. Once again, House and Senate Democrats have different ideas about which areas to target with new policies.

Gov. Healey's Remarks

Healey highlighted some steps her administration has taken regarding health care affordability, including repaying loans for 3,000 health care workers in the state, and signing off on a two-year pilot program to expand the income limits for ConnectorCare health insurance, which the state advertises as offering "$0 or low monthly premiums, low out-of-pocket costs, and no deductibles."

"The areas we're looking at, in particular, are support for, you know, the social determinants of health, what we're doing in terms of making sure that we're supporting primary care, behavioral health services so needed, you know, across the state. Growing a workforce. We know that health care is a space where they're getting real workforce challenges," Healey told reporters after her keynote address.

The governor said small businesses are paying more in premiums as costs rise, and the administration is "looking forward to partnering with HPC and with the Legislature on steps we need to take to reduce health care costs for residents and businesses across the state."

The HPC's annual report, which is published every September with information on health care cost trends, showed the average expense of employer-based private health insurance for a family of four in 2021 climbed to $22,163, outpacing the growth in wages and salaries. Including copayments, deductibles and out-of-pocket spending, the HPC reported, the cost for that family plan neared $25,000 annually.

During her keynote remarks Healey focused on "social determinants of health," or non-medical factors that influence health outcomes, such as housing and poverty.

"It's why we've advanced a comprehensive affordability agenda out of our office working with our partners in the Legislature to do a few things already, making schools meals, or breakfast and lunch, free for every public school kid in the commonwealth, making community college free for students aged 25 years and older, making a big investment of $500 million to expand affordable child care and better pay for early education workforce," Healey said.

The governor also took the speech as an opportunity to promote her $4.1 billion housing bond bill, which is meant to increase production of housing units and lower costs for homeowners and renters. She said housing is "absolutely a fundamental health issue."

Since her election, Healey has touted "affordability, competitiveness and equity" as the main pillars of her administration's goals.

She echoed the sentiment Wednesday, saying "I believe making life more affordable for folks is essential to making us more competitive." She later added, "The most important theme today is equity; disparities and health outcomes stem from inequities in health care access."

Healey did get into some more specifics regarding health insurance affordability for small businesses, who face unique challenges from rising health care costs.

Jon Hurst, president of the Retailers Association of Massachusetts, has said state-run programs to relieve high insurance costs put greater pressure on small business plans, as employees increasingly move to the state-run Health Connector, therefore driving up costs for the shrinking pool of people insured in Massachusetts' small group marketplace.

The small group marketplace, which covers businesses with 50 or fewer employees, has shrunk from 822,000 in 2006 to 335,000 in 2022 -- a 59 percent decrease, according to data from RAM.

"The Connector has been partnering with the Health Policy Commission to explore higher-value plan options for small businesses and individuals. These are plans that need affordability targets, and are branded to help highlight their competitive premium. We look forward to working with our small business leaders to develop this option into a meaningful solution that delivers real results," Healey said Wednesday.

The governor said residents of color are less likely to be insured, due to "systemic flaws" and said this issue was something "we need to fix."

"Commercial health care spending is flowing disproportionately to the highest income, most well-resourced communities. Providers like our community health centers, that care for lower-income or diverse populations, are consistently at the lower end of provider payments," Healey said.

The HPC estimated that if Massachusetts health care spending grew 3.6 percent annually from 2024 to 2030, rather than the current trajectory of 5.8 percent, total commercial spending on health care would be reduced by $23.2 billion.

This could lower family premiums and out-of-pocket spending by 14 percent by 2030, the commission reported.

The governor said the state would "continue to build on these strengths" of state-run Connector Care and Affordable Care Act health insurance coverage, but that "we can't subsidize our way out of health care costs that are too high and rising too fast."

"We have to address the root causes of cost increases," Healey said. "We need to recognize the real financial stress among many of our health care providers, from our community hospitals to nursing homes. We need structural solutions to bring greater stability and value across the board for everyone."

Healey said she supported the HPC's policy recommendations, which includes urging the Legislature to update the state's health care benchmark framework "to prioritize affordability and equity."

She also supports "addressing gaps and transparency among the drivers of health care costs" through "sharpening the tools at the HPC and the [Department of Insurance]," as well as "the long-term prioritization of how we're spending by investing in behavioral health, primary care and the social determinants of health."

Updated Health Care Spending Benchmark

The HPC's proposed "affordability benchmark" seeks to reform the state's health care cost growth benchmark, which the Legislature created over a decade ago to give the commission an oversight role in how much the state's health care spending can grow each year.

Between 2017 and 2021, on average, total health care spending growth in the state exceeded HPC's benchmark.

In 2020-2021, the most recent year for which there is data, total health care spending rose 9 percent -- almost 6 percentage points higher than the 3.1 percent benchmark the HPC set that year.

Under the proposed affordability benchmark, the HPC would develop a new accountability framework which would, among other things, allow the HPC "to apply tougher, escalating financial penalties for above-benchmark spending or non-compliance, similar to efforts in other states with health care growth targets."

The HPC recommends that under the new benchmark policy, an affordability index should be measured annually to track health plan premiums and consumer out-of-pocket spending by income, geography and market segment.

Asked about the proposed, tougher benchmark, Massachusetts Association of Health Plans President Lora Pellegrini said she hoped any new policy would not put affordability solely on the backs of health insurers.

"Health plans cannot be responsible for affordability alone. We need the providers, we need pharma to be accountable. So there needs to be strong legislative provisions that hold the providers and pharma accountable," she said. "The health plans will not be successful if it's just us alone, but if they include pharma and providers, it's an interesting idea."

Attorney General Campbell's Remarks

Attorney General Andrea Campbell, who leads the state's office in charge of consumer protection, said there has been an increased amount of work related to behavioral health parity and "unlawful conduct that makes it harder, or more expensive, to access health care."

Her office's health care helpline, which offers help in several languages for residents dealing with insurance companies and related bills, received over 2,000 calls last year, Campbell said. She anticipates that number will go up this year.

The attorney general highlighted her new reproductive justice unit, which she launched shortly after taking office.

"We're looking at the full spectrum of reproductive care. It's not just about access to abortion, it's about maternal health, it's about comprehensive sex ed and so much more," she said.

Campbell mentioned a maternal health grant program her office launched in August. Through it, she said, $1.5 million was made available for community organizations dealing with maternal health.

The attorney general also said she sees "a lot we can do" in regard to the mental health epidemic in the state.

"We're suing Meta for its contributions to the youth mental health crisis, for purposefully designing applications they knew would be addictive and harmful to our kids. This is not just a priority for me as AG. I'm a mother of two young, I will say, beautiful young boys," Campbell said. "We're also looking at emerging industries -- mobile sports betting, gaming -- and making sure we're advocating for our young people in those spaces."

Written By Sam Drysdale/SHNS

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