THE STEWARD HEALTH CARE bankruptcy debacle revealed several large cracks in Massachusetts’ health care system, but so far the House and Senate have not been able to reach agreement on what the state’s response should be.
“What I know is that our health care system is incredibly fragile right now,” Sen. Cindy Friedman, of Arlington, said on an episode of The Codcast hosted by Paul Hattis of the Lown Institute and John McDonough, a professor at the T.H. Chan Harvard School of Public Health.
“If you look at all of our hospitals, even our historically financially secure ones, all of them are struggling,” said Friedman, the Senate chair of the Joint Committee on Health Care Financing. “All of our community health centers are struggling. And I don’t mean just that we’re trying to clean up little pockets here and there. They are really struggling. The cost of health care is just beyond what anyone I think had envisioned it would be, especially since Covid. So nobody’s on great footing.”
Even insurers are in an uneasy place, she said. After a breakdown in negotiations between hospitals and Point32 Health, nearly 40,000 patients could soon lose access to their primary care doctors and specialists. On the podcast, Friedman said she had just been on a call regarding Blue Cross Blue Shield moving a thousand people off of their Medicare Advantage plan, “telling everybody, ‘go find another insurer.’”
By contrast, Friedman said, pharmaceutical companies and pharmacy benefit managers seem to be doing quite well.
Hattis asked Friedman about the prospects for new health care reform legislation, which stalled along with other major policies in the late hours of the recent legislative term. Speaker Ron Mariano, Hattis noted, recently said competing House and Senate hospital oversight bills are “still being discussed” but the bills “don’t line up the way we would like them to line up.”
There has been little insight into the horse trading. Rep. John Lawn, the House chair of the Joint Committee on Health Care Financing, did not respond to a request from Hattis and McDonough to be on The Codcast.
Friedman said the Senate’s leadership has “reached out” and “we are ready to engage in deep and thoughtful conversations to understand where we both are and what our priorities are. But we’re really pushing to get something done.”
She didn’t delve deeply into the “sticking points” between the chambers, on which the hosts pressed her. But Friedman did say she “would argue that if we don’t kind of bring pharmaceutical companies to the table and their cost trends in a very meaningful way, I think we’re missing the mark. Because right now they are the largest grower of health dollars.”
Friedman also added that if the state does not ensure some kind of way of enforcing protections from private equity groups trying to take over health care organizations, “I’m not sure what we would be doing that would be meaningful.”
McDonough pushed Friedman on the legislative process itself, which is under particular scrutiny this year in light of State Auditor Diana DiZoglio’s quest for a ballot question allowing her office to audit the Legislature.
Friedman said the Senate is comfortable publishing committee votes and conducts financial audits each year. A good legislative process, she suggested, involves lawmakers having frank discussions out of the public eye so they can express and challenge their preexisting opinions on certain subjects.
“I think that when people talk about transparency, I’m not totally sure what they mean by that,” she said. “I am not going to sit down and have a conversation in public around a very hot topic in this environment, because I know that with anything I say, each word can be taken out of context and turned into something else. I can’t learn anything in public.”
When McDonough asked Friedman if she thinks “the Senate gets unfairly paired with the House,” she quickly answered, “of course I do.”
Both chambers’ health care bills look to give the Health Policy Commission additional regulatory authority. Friedman said the Senate feels that there must be “some entity or group that is tasked with evaluating what is happening in the marketplace and having some real say in whether or not that is something that is gonna benefit the people of Massachusetts.” To that end, the Health Policy Commission needs more authority to craft and enforce certain conditions for provider organizations looking to buy a health care practice, she said.
The House and Senate health care bills, McDonough noted, include the “resurrection of statewide health system planning,” which Massachusetts essentially stopped doing on the statewide level in the 1900s.
Piecemeal health care responses are not ideal, Friedman said. The “number one goal” is a statewide plan with a map of healthcare resources, so “you can easily and with clarity understand, when something happens, how we can best respond so that people get health care.”
She said the state needs to have a good count of doctors and where they are, what companies are doing health care business in the state, and what chain of events might occur when a practice closes, for example. Friedman said she is optimistic that a final bill would include the health system planning component, adding “we’re flying blind if we don’t have it.”
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