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Sect. Bigby Testifies on FY09 EOHHS Budget and a Lot More

Sect. Bigby Testifies on FY09 EOHHS Budget and a Lot More

February 18, 2008

Lots and lots of interesting details from this State House News Service account of MA Health & Human Services Sect. JudyAnn Bigby's testimony this past Friday on the Adminstration's FY09 budget proposal for Health & Human Services:

FRANKLIN, FEB. 15, 2008…..Reprising Gov. Deval Patrick’s warning to lawmakers of the “cost of inaction,” Health and Human Service Secretary JudyAnn Bigby said on Friday the governor’s budget is a mix of cuts, reforms, efficiencies and targeted investments that lay the groundwork for economic growth.

“Failing to make these targeted investments will weaken the very assets that make Massachusetts a wonderful place to live, work and grow a business,” she told House and Senate budget chiefs at a hearing in Franklin.

Bigby is the overseer of 16 state agencies that take up nearly half of the $28.2 billion budget, at $13.54 billion. That’s a 4.5 percent increase over the allotment in the budget enacted last year, according to state officials. In testimony and prepared remarks, state officials touched on the state’s Medicaid waiver extension, which is pending before the federal government, efforts to curb prison suicides, and being patient in the face of rising health costs.

Highlights from Friday’s public hearing hosted by House and Senate Ways and Means committee members:

-- A senator on the budget committee questioned the need to establish a $1 million Office of Health Equity within the health and human services secretariat, as the health care side of Patrick’s budget does. Sen. Karen Spilka (D-Ashland) pointed to the existing Health Care Quality and Cost Council and Health Disparities Council as already tackling the issue of ethnic and racial disparities. “Neither of those entities is responsible for day to day activities that would move us toward eliminating disparities,” said Bigby, who chairs the cost council. The office would coordinate efforts across the agencies and other secretariats, with a director providing staff support to the Health Disparities Council, and provide an annual report card that tracks progress and the effectiveness of programs across the state, according to her testimony. Rep. Byron Rushing (D-Boston) filed a bill last year, with 40 co-sponsors, creating a similar office.

--The state council involved with the cost control side of health care reform, the Health Care Quality and Cost Council, is getting its budget raised to $1.9 million under Gov. Patrick’s fiscal 2009 plan. But the figure falls below the $2.3 million request its executive director urged in December. Requesting specifics on the council, Sen. Karen Spilka noted that the council’s website for consumers has yet to go online, saying this “spring would be nice.” Secretary Bigby appeared reticent to set a firm date, with later this year as a better bet. Bigby said the legislation establishing the council requires it to collect every piece of health care claims data. “You have to realize, this represents millions and millions of pieces of data,” she said. The council has hired a company to go through that process and another company to do focus groups for the future website. Bigby said the council meets next week to discuss how they will contract with a vendor and figure out how to get the data, analyze it and post it on the website. Asked by Rep. Mary Grant (D-Beverly) if a person with a clinical background needs to be added to the council’s make-up, Bigby pointed to the council’s advisory board. “The number of people who can sit on that advisory committee are endless, quite frankly,” she said, adding that she recently made some suggestions to the governor on a few names that could be added.

-- State and federal officials are working on an extension to the state’s Medicaid waiver, health care reform’s core financing mechanism, Medicaid officials said Friday. The current three-year, $11 billion waiver ends on June 30, and state officials are seeking an additional three years and upping the number to $13 billion. “I think it’s fair to say we’re solidly in the fact-finding stage with CMS [federal Centers for Medicaid and Medicare Services] about what exactly’s happening in Massachusetts, what we think is going to happen with health care reform moving forward,” Tom Dehner, the state’s Medicaid director, told lawmakers. Gov. Patrick’s budget includes $8.6 billion for MassHealth, the state’s Medicaid program, a 4.4 percent increase over last year’s budget.

-- Some members of the state’s business community can breathe a sigh of relief, for now at least: Health officials say they haven’t yet decided whether to increase the $295 per employee charge upon employers that do not make a “fair and reasonable” contribution to their employees’ health plans. “We’re doing a bunch of analyses, looking at that issue,” said Secretary Bigby. “We need more data. I wouldn’t specifically say it’s on the table.” Added Sarah Iselin, commissioner
of the Division of Health Care Finance and Policy: “It’s still early.” Lawmakers pushed health officials to use the reports they’ve been developing. The division is expected to put out a number of important reports in the next few months, including a cost-and-benefit analysis of the health care reform’s various mandates, a biennial survey of Massachusetts employers and their health insurance policies and practices, and the division’s legislatively-mandated list of employers with 50 or more employees using public health assistance each year. The division has reconfigured the methodology for the latter, and it “will support a more accurate count of employees and expenditures than we have been able to capture in prior years,” Iselin said. Lawmakers also voiced concerns that while some businesses are struggling under the weight of the health care law, there are others that have more employees using public health assistance than they’d like to see. Rep. Paul Loscocco (R-Holliston) asked if they were finding any evidence of corporate employers restructuring, possibly setting up two corporations with 10 employees each in a bid to get around the health care law, which applies to employers with 11 employees and over. Bigby said she had spoken with Labor Secretary Suzanne Bump, who can monitor that kind of information and had said that the restructuring costs would amount to too much.

--As lawmakers pressed her and her top aides on rising health care costs in the headlines, Secretary Bigby pleaded for them and others to wait and see the results of the state’s massive health care reform effort. “Massachusetts has to
be patient and make sure we don’t say it’s too expensive before we allow it to work,” she said. Costs will eventually trend downward, she and other health care officials said, pointing to an announcement, reported by the News Service Wednesday, showing that state’s six largest non-profit health plans will hold average premium increases in the Commonwealth Choice program to five percent, rate limits that were accompanied by some benefit changes. “It’s certainly better than 8, 9, 10, percent,” Bigby said.