The Massachusetts Senate issued its comprehensive health care reform bill this Tuesday, and Health Care For all participated in the release of the legislation. Health Care For All’s executive director, Amy Rosenthal, spoke during the event and highlighted some of the priorities of consumers in the current system. The bill contains over 150 sections, and many elements of the bill align with the needs of consumers.
Watch our executive director's full comments on the legislation here.
Public Health and Social Determinants of Health
The bill was put together by a Senate working group, who spoke on different aspects of the bill. Senator Jason Lewis emphasized the importance of public health, saying that “the social determinants of health are absolutely critical in determining health outcomes and health disparities.” He pointed out that promoting health outcomes also helps to decrease health costs, as healthier populations require less care.
This legislation promotes public health in several ways. It reauthorizes the Prevention and Wellness Trust Fund, a successful pilot program which promotes community disease prevention by supporting healthy behavior and increasing preventative care.
The legislation also addresses housing as an important social determinant of health by establishing a housing security task force to investigate housing programs, including prioritizing shelter beds for homeless patients discharged from emergency rooms, and by allowing housing providers and health care plans to coordinate location-based care.
Amy Rosenthal also emphasized the importance of public health, saying “We focus too much on curing people when they’re sick, and not enough on prevention and keeping them healthy.”
This legislation would help promote telemedicine services by permitting the coverage of telemedicine services through MassHealth and updating requirements for commercial health plans to provide coverage for telemedicine.
Telemedicine has been proposed as a way to help increase access to services for those with limited mobility and for those who live far away from medical professionals, particularly in rural areas. Behavioral health is often considered to be one field where telemedicine may be particularly effective.
Senate Majority Leader Harriette Chandler spoke on the importance of promoting dental health. “Dental health is just as important as any other health care pursuit, but so many people in this state lack access to this service.
This legislation aims to increase access to dental health by establishing a dental therapist certification. Dental therapists are mid-level providers who are trained to provide basic but vital services, such as preventive dental care and filling cavities. This bill would allow dental therapists to deliver care in community settings, such as schools and nursing homes, which would help ensure access to populations who may have a difficult time traveling to the dentist’s office. “With dental therapists,” said Senator Chandler, “dental health services are delivered directly to those in the most need.”
Dental therapists would also help to decrease health care costs. Because they are mid-level providers with a more restricted scope of practice than dentists, dental therapists generally charge less for services than dentists do. Increasing access to preventive dental care will also help lower costs by decreasing the number of patients who utilize the emergency department for oral health issues.
Amy Rosenthal also spoke on oral health, saying that “We need to get people the oral health care that they need, and get them out of emergency departments when that’s not where they should be.”
Prescription Drug Costs
Prescription drug costs are one of the main drivers of rising health care costs, and growth in prescription drug spending is one of the most rapidly increasing parts of health care spending.
This legislation takes several steps to address these costs. The legislation increases transparency for providers and consumers. It would establish an academic detailing program to educate prescribers on drug outcomes based on medical evidence and not pharmaceutical advertisements. It would also require pharmacists to inform a consumer if the amount they are paying for a drug through insurance is higher than the direct retail rate that they would pay without insurance, which is sometimes the case due to the complex and hidden factors in drug pricing. If the price with insurance is higher, the consumer would be able to buy the drug at the lower retail rate.
The legislation would also create reports on the impact and potential cost saving of the state engaging in prescription drug bulk purchase consortiums.
Surprise Out-of-Network Billing
Amy Rosenthal said that “We need to… shut down surprise medical bills.” Surprise out-of-network billing refers to a situation where a patient is receiving care in a hospital that is in their insurance network, but is treated by a specific doctor who does not accept that insurance, resulting in an unexpected and large fee for the patient. This is a major financial stress for consumers. This legislation would guarantee that the patient would not have to pay an additional copay or deductible when this happens.
- Sean Connolly