Health Care Costs Overhaul Bill On Its Way To Gov.'s Desk

A sweeping health care cost-containment bill is heading to the desk of Gov. Deval Patrick.

Patrick and the Legislature are celebrating the bill, which has broad support, but is being received with more wariness and trepidation than recent major health care efforts, including the landmark coverage law. As we’ve heard again and again, tackling health care costs is going to be hard.

Trying to hold down health care costs is one of those third-rail issues that many politicians won’t touch. As he introduced the bill, House lead author Rep. Steve Walsh stressed that while it’s projected to save $200 billion over 15 years, that’s not the only goal.

"What should be important to us is our son or daughter, or our husband or wife, or our mother or father," Walsh said. "And making sure that the health care that they need, that they deserve, is available to you, your constituents and your families in time of need. And there's nothing that we have done in any way, shape or form here today that will inhibit that."

The Legislature is expecting health care to grow around 3.6 percent next year, as compared to recent years of 6 to 8 percent increases.

Walsh and other authors of this complex bill are getting credit for taking on the challenge. As the presiding officer thanked Walsh, his colleagues and members of the public looking on burst into a rare standing ovation.

Walsh and House Majority Leader Ron Mariano say they realize it won’t be easy for hospitals and doctors to keep health care costs in line with the rest of the state’s economy.

"We are moving the Titanic, but we’re moving it," Mariano said.

Specifically, the Legislature is expecting health care to grow around 3.6 percent next year, as compared to recent years of 6 to 8 percent increases, and the bill says the change is supposed to start in January.

"You can’t bring that down easily in one year, yet that’s what the bill calls for," said Lynn Nicholas, president of the Massachusetts Hospital Association. "We’re going to try."

Nicholas said the good news for hospitals is that there’s no hammer at the end of next year if they don’t make the goal. Instead they’ll be asked to produce a corrective action plan. Even though many hospitals won’t hit the state spending target right away, Nicholas said it’s a good idea.

"The idea of setting an aspirational goal is the catalyst that we need to pull this whole thing together," she said. "It's just like the mantra before was 'cover all of our citizens.' We've got a mantra now. We need everyone to work and do their part to achieve that."

So what will it take? Some people will tell you that Massachusetts can reach the goal by getting rid of waste. That might mean not repeating an MRI because your doctor wants to do his own, or having to fix a procedure that didn’t go well the first time. But Richard Aghababian, president of the Massachusetts Medical Society, said patients are going to have to spend money more wisely too, and be ready for some changes.

"To get to a goal of Gross State Product, we're going to have to look at cutting back on some services, not just in decreasing the indications for doing certain procedures," Aghababian said. "I think it may affect accessibility to physicians. It may mean that some patients can't get in to a procedure because there's no one to staff the machine or to do the procedure, at least as quickly as they have been up to this time."

The trade-off may be big savings, the $200 billion that Walsh and some health economists say is possible. But there are concerns about the sweeping changes the bill encourages, such as continuing the move to put providers on a budget. Just one lawmaker was willing to voice his concerns during the House debate Tuesday.

"Because of this bill, patients may not get the care they deserve," said Rep. James Miceli. He suggested that most legislators didn’t know what was in the bill’s 308 sections. The document was available for only about 16 hours before members took a vote.

"I really believe deep down that we’re going to live to regret what we do here today," he said.

That ominous warning was largely ignored as the House passed the bill 132-20. It cleared the Senate unanimously after a single speech from the Senate’s lead author, Richard Moore.

"This bill will continue the leadership of Massachusetts in the forefront of health care reform across the nation," Moore said.

Patrick, who has said that health care cost control is a top priority, is expected to sign the bill soon.

"This is the next in several steps — and I don't think the last step, by the way — in a commitment that this broad coalition has had for a long time, going back to 2006, to really make health care affordable and high quality for every single resident of the commonwealth," Patrick said. "I’m very proud of that."

When the governor signs this bill, it will be the fourth major piece of health care legislation passed on Beacon Hill in eight years. The test will be to see if this time, the state is able to hold the reins on health care costs.