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Consumers Share Personal Stories in Support of HCFA’s "No Copay" Bill

Consumers Share Personal Stories in Support of HCFA’s "No Copay" Bill

October 15, 2015

At Tuesday’s Joint Committee on Health Care Financing public hearing, legislators heard testimony from advocates, consumers and health providers on a number of important bills, including three of HCFA’s priority bills:

  • H. 984/S. 606, An Act to keep people healthy by removing barriers to cost-effective care;
  • H. 964/S. 595, An Act to preserve affordable health coverage for Massachusetts residents; and
  • H. 1025, An Act relative to preventing unnecessary medical debt.

Senator Lewis and Representative Farley-Bouvier testified first in support of H.984/S. 606, An Act to keep people healthy by removing barriers to cost-effective care, also known as the No Co-pay Bill. The bill, which is one of HCFA’s main legislative priorities, would eliminate co-pays for certain high-value, cost-effective drugs and treatments for people with chronic conditions. As Senator Lewis explained, cost is a major barrier for many patients. While price tiering is a useful method to prevent overutilization, it harms those with chronic conditions who have no choice but to take multiple medications to stay healthy. In the long run, Representative Farley-Bouvier stated, this approach, based on the premise of value-based insurance design, will provide a large health benefit for consumers at a comparatively low cost.

Next to testify in support of the No Copay bill was Ruthie Liberman from the Crittenton Women’s Union (CWU). As Ms. Liberman noted, CWU, whose mission is to promote the economic independence of women through housing and employment programs, doesn’t typically testify on health care bills. However, a study by CWU based on surveys and interviews found that medical debt was a critical factor keeping many families in the cycle of poverty. Specifically, the prohibitive cost of copays and deductibles was a source of debt for over one third of survey respondents. Ms. Liberman emphasized the importance of affordable medical care in eradicating poverty for Massachusetts residents.

Finally, we heard from a panel of HCFA grassroots activists introduced by HCFA senior health policy manager Alyssa Vangeli. Their personal stories illustrated the devastating effect high co-pays can have on patients and made a strong case for eliminating cost-sharing for certain high-value drugs and treatments. Mercy Nunez, for example, has a number of different conditions, including high cholesterol, congestive heart failure, and type I diabetes. She has to take over 14 medications, and her poor health prevents her from holding a job. Struggling with the high cost of her copays, Mercy was unable to afford all of her medications; as a result, she had a medical emergency that landed her in the ER, where she was admitted to the hospital for two months. The cost of her entirely preventable hospital admission was far higher than if she had been regularly taking her medications.

Maria Melendez is another patient who, burdened by exorbitant copays, tried to take her health into her own hands because of high out-of-pocket costs. Maria has type I diabetes and has to pay over $200 each month for daily treatments to manage her disease and stay healthy. A few months ago, feeling pinched economically, she began undereating in order to reduce the amount of insulin she needed. After an appointment where her doctor detailed the devastating effects her behavior could have on her health, she began adhering to her medication plan. The added cost, however, forced her to move back in with her mother. Valerie Spain also shared her story of struggling to pay for diabetes supplies due to high copays.

In addition to oral testimony, HCFA submitted written testimony, a policy brief, and a sign-on letter, with support from a number of organizations including Atrius Health, Boston Children’s Hospital, Health Law Advocates, Joslin Diabetes Center, National Alliance on Mental Illness MA, AIDS Action Committee, Crittenton Women’s Union, 1199 SEIU and American Heart/American Stroke Association.

Suzanne Curry, a senior health policy manager at HCFA, and Vicky Pulos from the Massachusetts Law Reform Institute provided testimony on another one of HCFA’s priority bills, H. 964/S. 595, An Act to preserve affordable health coverage for Massachusetts residents. The 2006 Massachusetts health reform law created the Commonwealth Care program to offer affordable health coverage to low and moderate income adults. In 2013, when that law was amended due to changes under the federal Affordable Care Act, many residents were forced to pay higher premiums and cost-sharing. In response, the state created the ConnectorCare program in order to keep coverage as affordable as it was prior to the ACA.  However, without putting protections into state law, such affordability of coverage could be undone.

This bill ensures that premiums and cost-sharing remain affordable for residents who receive subsidies to purchase health insurance through the Health Connector by extending subsidies to residents living at or below 300% of the federal poverty level. As Representative Balser stated in her testimony, "This bill is not a change – just an affirmation.” The same affordability protections have been maintained as a matter of policy, she said, and this would maintain them as law.

Finally, Lorianne Sainsbury-Wong, from our sister organization Health Law Advocates, testified in support of H. 1025, An Act relative to preventing unnecessary medical debt. The bill would establish new debt collection practices and hospital charity care policies to prevent patients from incurring unpayable medical bills.

A significant portion of the hearing also focused on testimony in favor of two bills that HCFA supports: H. 3678, An Act relative to protecting health care consumers, and H. 267, An Act advancing and expanding access to telemedicine services. H. 3678, supported by House Majority Leader Representative Mariano and Attorney General Maura Healey, would bolster enforcement of the Health Policy Commission’s (HPC) cost and market impact reviews (CMIR). It would allow the Attorney General’s Office (AGO) to pursue legal action (under consumer protection laws) against proposed changes in the health care market, such as mergers or acquisitions, if the HPC review finds the proposed change fits three criteria perceived to negatively affect patient affordability and access. Supporters for the bill include hospitals, health plans, interfaith groups and employer groups.

H. 267 would increase use of telemedicine by simplifying and standardizing credentialing requirements, as well as establishing rules for insurers and providers. Representative Scibak’s testimony was bolstered by two panels of providers and consumers organized by Boston Children’s Hospital and the Massachusetts Hospital Association. Panel members similarly emphasized convenience as a crucial benefit of telemedicine, especially for those with behavioral health issues and patients in remote areas who may be unable to make in-person appointments.

                 -- Kate Frisher