Mass. Lawmaker: Health Care Costs 'No. 1 Concern' For Patients

A new WBUR poll conducted in partnership with the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation finds that 78 percent of Massachusetts residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year say the cost of health care is a serious problem.

These findings come as state lawmakers are trying to get rising health care costs under control, and last week the Massachusetts House approved a bill meant to do just that.

WBUR's All Things Considered host Sacha Pfeiffer spoke about the poll with Rep. Steve Walsh, House chair of the Joint Committee on Health Care Financing.

Sacha Pfeiffer: Does it surprise you that the polling numbers came out so high that many people consider rising health care costs serious or quite serious for their families?

Steve Walsh: I would think it would be 100 percent. It doesn’t surprise me at all. I mean, we traveled the state, we visited 54 hospitals, and we had some 800 or so meetings statewide. It’s the No. 1 concern on folks’ minds. We keep hearing this mantra that "the market is moving," "the market is working," and in some areas it is. In terms of lowering health care costs for consumers, it is not.

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Is there anything specific you can point to in the bill that would say to a patient, "Here’s how we can tell you that it is going to bring your health care costs down?"

Sure. We set a goal of tying the health care market to gross state product minus a 0.5 percent or potential gross state product minus a half. Over 15 years that will save $160 billion to the market and small businesses three years from now will begin to see their family plans go down about $2,400 a year. I mean, that’s real money for families.

But how will that trickle down to consumers? You just gave us the big dollars. How does that end up turning into actual money saved per year by a family on their health care costs?

Well, small businesses' largest increase in cost is their health insurance. That's the largest cost that they see. We talk to small businesses all over the state that are making decisions not to hire new employees because they can't afford their health insurance. So when their premium costs go down, their cost-shift to their employee goes down. Their employee pays less money out of each weekly paycheck to health insurance. They take more money home and put less in health care.

Even people with health insurance — and in Massachusetts, of course, that is most people — have this growing sense that it's almost as if they don’t have insurance; they have to spend so much out-of-pocket, often, before their coverage kicks in. Is there anything in this bill that addresses this concern?

Well, you're going to see those products begin to go away over time.

Products like higher-deductible products?

Higher-deductible products and tiering products. [Those will go away] when you realign the incentives to reward you for being well and not reward you for being sick. Because the current fee-for-service system only rewards you if you’re sick. So when you get sick and you go and you have a higher co-pay or a high deductible, you pay more out of pocket and you become a cost center. So you’re over-tested. You walk into a center and we’re going to run you through the health care car wash and charge you as much as we possibly can at each stop along the train.

When you begin to pay globally, or through an alternative payment methodology like an accountable care organization, your care is coordinated and actually works much better because you reward people for being out of the hospital, not in the hospital.

To clarify, are you saying that these high-deductible, high co-pay and even co-insurance type products — even though they seem to be becoming very popular and common now — are actually on the way out?

I predict that they are not taking up a large space in this market in five years from now.

In the House bill, is there any recourse offered to patients who feel that their doctor or a hospital isn’t giving them what they need, or their insurance isn’t giving them coverage they think they deserve?

There’s a very robust patient education consumer protection piece where they have a very quick appeals process at no cost to them if they feel something is medically necessary that they have been denied.

This poll also confirms what we've already known, which is that in Massachusetts, if you have more money you get better care. Is there anything the House bill can do to address that?

There is. I think in Massachusetts you can get great care, regardless of your income. But there is a problem in some of our urban centers where there are large consolidations of poorer folks. And one of the things this bill does, which I think is terrific moving forward, is it’s a risk-adjusted global payment. So you actually can make more money on poor people than you can on some that are maybe healthier or wealthier.

Explain that to me. What is the incentive to treat those people?

When you get a global payment for a patient, you’re paid globally for whatever that patient’s personal health profile is. The less healthy patient has a payment that might be higher. So there’s money to be made on making sure that person becomes healthier. We also create a prevention trust fund that will be making grants into some of our urban settings. So we have a two-pronged approach that is actually going to have a byproduct of it that some of our poorer neighborhoods are going to see an increase in their health.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce Sick in Massachusetts. The foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact-checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the poll results.