A sweeping package of reforms supporters said aimed to fix broken elements of the state's health care system while also saving consumers money passed the Senate on a 33-6 vote at midnight Thursday.
The bill sets a target for reducing hospital readmissions and imposes new oversight on the pharmaceutical industry. It aims to cut down on unexpected consumer costs like out-of-network charges and facility fees, and to increase access to telemedicine and mobile integrated health, which involves paramedics performing non-emergency services.
"The bill is really about the consumers and doing everything we can to make health care affordable to consumers," Sen. James Welch, who led the working group that wrote the bill, told reporters after the vote.
While senators frequently tout their bipartisan work, Democrats were unable to attract any Republican votes for their bill, which passed on a party line vote with the chamber's six Republicans dissenting and objecting to solutions they said rely on more bureaucracy.
Whether any provisions actually make their way into law depends on action in the House, where Rep. Peter Kocot, Welch's co-chair on the Health Care Financing Committee, said Thursday he hopes to have a bill ready for debate early next year after he wraps up his own meetings and analysis. The Senate bill (S 2200) was developed by a group of senators, outside the traditional joint committee process.
Gov. Charlie Baker on Thursday said the bill "doesn't save the state any money" and the Senate was "not trying to chase reforms that are going to make" MassHealth more affordable, one of the goals that punctuated the health care debate earlier this year.
"What they're doing are chasing a variety of initiatives they believe will make the system better," Baker told reporters.
Senate Ways and Means Chairwoman Karen Spilka, who has said the bill could yield $114 million in savings from MassHealth reforms and $475 million to $525 million from its commercial market reforms by 2020, said after the bill passed that she was "very surprised" and "dumbfounded" by Baker's characterization.
"I understand the governor's concerns," Welch said. "He comes from the health care industry, comes from the insurance industry, and I'm sure obviously still has relationships in the health care industry that would make him concerned or that members of the health care industry might be concerned about. But I think the way we approached this bill is really to focus on the consumer."
Debate began on Wednesday, and behind-the-scenes discussions both days involved negotiations around contentious measures proposing to automatically enroll MassHealth-eligible consumers participating in the home care program into Senior Care Options, a managed care program that covers services normally paid for through Medicare and MassHealth, with no copays. Senior advocacy groups opposed the plan.
Just before midnight, the Senate adopted an amendment that Spilka said preserved the passive enrollment while adding in extra protections and spelling out specifics of the opt-out process.
"We remain fundamentally of a different mind that older people are smart enough to pick their own plans, but the Senate, I give them credit for working hard to come up with language that would protect older people from any kind of dislocation of service and to make sure that the people who arrange their care are not financially at risk," Mass. Home Care executive director Al Norman told the News Service.
Some of the most heated moments in the two days of debate came as Republicans tried unsuccessfully to beat back an element of the bill they dubbed the "name and shame" list — an annual public report identifying the 50 Massachusetts employers with the highest number of employees "who receive medical assistance, medical benefits or assistance through the Health Safety Net Trust Fund."
Tarr said the amendment was an attempt to shame people into changing their behavior, while Sen. John Keenan of Quincy said it was a way to gather data to understand how many people with access to employer-sponsored insurance are enrolling in MassHealth, and which employers are not providing coverage that's accessible to their workers.
In a back-and-forth with Keenan, Tarr said the bill tries to "somehow avoid directly the problem" of increased enrollment and subsequent higher costs at MassHealth. He called the bill "incredibly cumbersome" and repeatedly said it defaults to bureaucracy instead of direct action to try to control costs.
Before passing the bill, senators agreed to modify the way it attempts to shrink the gap between rates paid to the most expensive, larger hospitals and lower-paid community hospitals.
"We view that this is a market failure, and we're asking the market to correct itself, and if it is unable to do so, then and only then would you turn to government regulation," Senate President Stanley Rosenberg said.
The bill would raise rates for lower-paid hospitals to 90 percent of the statewide average for the previous year, and set a target rate of growth for total hospital spending.
While senators stopped short of imposing a rate cap at the upper level, they adopted a Sen. Jamie Eldridge amendment specifying that efforts to meet the target "do not directly contribute to increased consumer health care costs."
The Senate overwhelmingly endorsed studying how the costs of a single-payer health care model would compare to the state's current health care spending, which the Center for Health Information and Analysis tallied at $59 billion in 2016.
On a 35-3 vote, the Senate adopted an amendment calling for state officials to measure health spending against the estimated costs of providing health care to all residents through a single-payer system. If the single-payer projections prove to be less costly, the Health Policy Commission would need to submit "a proposed single payer health care implementation plan" to the Legislature for potential action.
Sen. Julian Cyr of Truro, the amendment's sponsor, compared the current health care system to "one of those rubber band balls you get at Staples," pointing to interconnected pieces that would be difficult to unwind without an extensive plan. He stressed the amendment would not commit the state to pursuing single-payer but said it would "keep all doors open."
Tarr voiced concerns about the possible cost of a single-payer system, saying by some estimates it could double the state's health expenditures, but ultimately voted for the amendment. Republican Sens. Vinny deMacedo, Ryan Fattman and Donald Humason voted against, and Sen. Richard Ross, a Wrentham Republican, voted present.
In 2012, a similar single-payer benchmark proposal failed 15-22 in the Senate.