
By Jim O’Sullivan, State House News Service
Mass. House legislation due to emerge next week will scale back the Senate’s farther-reaching bid for reduced healthcare costs, while borrowing provisions to spread small business rate increases across several years and to impose new checks against consumers looking to exploit loopholes, the bill’s primary author said July 8.
The leadership draft, likely to receive a vote in the House but facing an uncertain fate against a bolder Senate version, will avoid Gov. Deval Patrick’s proposal to reopen contracts between providers and insurers in search of rate relief and the Senate’s assessment on hospitals, Assistant House Majority Leader Ronald Mariano told the State House News Service.
Still in development, the rewrite will follow the Senate in replacing the current method of measuring employees’ ages in five-year increments with one-year gauges, intended to curb fluctuations as employee groups grow older. Similarly, the bill will adopt the Senate plan shifting to an open enrollment period for insurance-purchasers, geared at curbing the practice of buying plans for specific and expensive treatments and then dropping coverage.
The Senate bill includes an “efficiency guarantee” for insurers to pledge at least 90 percent of their premium revenues on care rather than administrative spending, threatening carriers who do not opt for that threshold with Division of Insurance reviews aimed at keeping premium hikes at or below the medical inflation rate.
Mariano said he would not include a Senate provision requiring hospitals with large reserves and profit margins over 2.5 percent to pay one-time assessments to the state as a funding filler while policymakers eye more fundamental reforms. Aides to Senate President Therese Murray said an aggregate $100 million payment from hospitals would curb small business health insurance costs by 2.5 percent.
“There’s some inequity in how it’s assessed,” the Quincy Democrat said of the Upper Chamber’s charge.
Mariano laughed off the notion that his bill was “some major treatise on healthcare.”
“I think what the thrust of the bill is going be is to give some relief to small businesses and the swings in premiums that they’ve been getting, the big upticks,” he said.
Healthcare costs have emerged as a major policy dilemma for the state, after a decade of double-digit hikes. Dragging the issue into the governor’s race, where chief rival Republican Charles Baker has been dinged for his role as a health insurance CEO, Gov. Deval Patrick in February launched a cutback on premium increases by imposing a cap on insurers, a move that has sparked court battles. As a complementary measure, he asked the Legislature for authority to set a similar limit on the rates providers level at insurers. Lawmakers have largely ignored that request.
And the issue’s seeming intractability is reflected in House Speaker Robert DeLeo’s recruitment of Mariano, a key combatant in the ultimately successful battle in 2005 and 2006 for sweeping healthcare access expansion, to craft the bill, rather than an issues committee chair. Murray aides crafted the Senate bill, similarly withdrawing the policy from the oft-poisoned relations between the House and Senate sides of committees.
“I’m looking at ways to put the brakes on the whole system, so we don’t have some of these huge jumps, but we let the market play more of a role,” Mariano said. While DeLeo said earlier Thursday the bill would likely emerge early next week, Mariano indicated later in the week was more likely.
Winnowing the disparity in the financial health of “the haves and the have-nots” among hospitals remains a riddle, Mariano said, calling nourishment for hospitals that lean on subsidized insurance elusive. He said Attorney General Martha Coakley’s report, which found the state’s more prominent hospitals had little care-based rationale for their sharply higher reimbursement rates than the smaller hospitals, should serve “as a basis to begin the discussions.”
Mariano called the House bill a sort of conversation-starter for the 2011-2012 legislative session, for which the state will have either reelected Patrick or chosen another governor, and when at least 34 of the 200 legislative seats will have new occupants.
“This is a very small first step in a very large process that will continue after the election, after we find out who’s still here and who’s not here,” he said.
Murray’s office declined comment.