With hospitals at risk, Mass. eyes lifeline for broke insurer covering 460K public employees
Editor's note: Story was updated Thursday afternoon to include a statement from GIC.
Amid fears of 'serious financial consequences,' Massachusetts is working to create a lifeline for a Massachusetts agency that oversees health insurance for 460,000 public employees, retirees and their dependents after it could not continue to pay providers.
In January, state Group Insurance Commission (GIC) Executive Director Matthew Veno had flagged the agency's budget shortfalls as a concern.
'This is the largest variance that we've seen in at least a decade, and this is consistent across all of our plans, and is driven primarily by rising provider prices and a couple of other topics,' he said at the time. 'We don't know where this is going to head. My concern is that it is a persistent and steady trend going forward.'
Then in April, Veno said rising provider prices and increased utilization of prescription benefits, including for GLP-1 weight loss drugs, had caused the commission to run an average $20 million monthly deficit this fiscal year.
Massachusetts Health & Hospital Association (MHA) said it was 'unacceptable' for the insurance agency to have a lack of backup options and claims the disruption in payments 'will undoubtedly result in serious financial consequences.'
Read more: Mass. health insurance companies directed to limit growth of deductibles, copays
Mercy Medical Center in Springfield said it 'is not in a financial position to absorb budget shortfalls of the state Massachusetts Group Insurance Commission.'
'While we appreciate the financial situation of the GIC, we join them in advocating for funding to resolve its budget deficiency that will not further exacerbate the financial condition of healthcare providers,' the statement continued.
But the Massachusetts Legislature didn't act before GIC officially ran out of money on Monday. All claims have remained pending since then.
The commission had been counting on a $237 million appropriation request before the Legislature.
The appropriation was the largest single request in a $756 million short-term spending bill Gov. Maura Healey filed in early April.
However, in an email sent to providers earlier this month, the GIC warned that it 'does not know how soon the legislature will pass the bill and when the GIC will receive the requested funds.'
The claims will remain pending until GIC receives the additional funds or until July 1.
This week, Massachusetts began moving forward on the requested funds.
The House advanced a $240 supplemental budget for the agency on Monday. And the Senate passed it on Thursday.
'Ensuring that the hundreds of thousands of public employees and their loved ones have access to health insurance is one of our most important responsibilities,' said Senate President Karen E. Spilka, D-Middlesex/Norfolk.
Now it is set for Healey's desk.
'The GIC is grateful to the House and Senate for passing the Governor's supplemental budget request. We look forward to lifting the hold on claims payments and promptly resuming payment of pended claims following the Governor's signature of the legislation,' GIC said in a statement to MassLive. 'We appreciate the patience of plans and providers as we worked toward resolution in a way that would minimally impact our members.'
But this isn't unique to GIC.
'The Group Insurance Commission is facing a challenge that is not unique to any insurer, as pharmaceutical usage is going up and the costs of drugs are rising at an unsustainable rate,' said Senator Cindy F. Friedman, D-4th Middlesex, the Senate's chair of the Legislature's Joint Committee on Health Care Financing.
'The Senate is actively working on measures to address this larger issue, as well as other cost drivers throughout the health care system, to relieve the pressure on insurers and the premiums that residents in the Commonwealth face,' the Arlington lawmaker continued. 'As we work towards the end goal of stabilizing health care costs, this supplemental funding for the GIC will ensure that our state employees stay covered and healthy.'
Mass. health insurance companies directed to limit growth of deductibles, copays
'Unacceptable': Health insurer for 460K Mass. public workers goes broke without backup plan
Insurance program for 460,000 Mass. residents runs out of money Monday
Read the original article on MassLive.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
UPI
17 minutes ago
- UPI
CPAP or Zepbound? Patients, doctors debate sleep apnea treatment
Doctors favor treatment with continuous positive airway pressure, or CPAP, machines, researchers are slated to report this week at a meeting of the American Academy of Sleep Medicine. Adobe stock June 9 (UPI) A clash is brewing between doctors and patients when it comes to treatment for sleep apnea in those with obesity, a new study reports. Doctors favor treatment with continuous positive airway pressure, or CPAP, machines, researchers are slated to report this week at a meeting of the American Academy of Sleep Medicine. The machines keep airways open using mild air pressure provided through a mask patients wear while sleeping. But patients would rather treat their sleep apnea with tirzepatide (Zepbound), a GLP-1 weight-loss drug, researchers found. "The results highlight a need for real-world comparative effectiveness data of CPAP versus tirzepatide, and a potential mismatch between patient and provider preferences when managing comorbid obesity and obstructive sleep apnea," lead researcher Ahmed Khalaf said in a news release. He's a sleep technician in the pulmonary, critical care and sleep medicine division at University of California-San Diego. Nearly 30 million adults in the United States have sleep apnea, a disease in which the upper airway collapses during sleep, causing people to wake repeatedly. CPAP has been considered the gold standard for treating sleep apnea, but some patients find the machines too bulky and noisy. About 50% of people prescribed CPAP either can't use it often enough to matter or find it too bothersome, according to Harvard Medical School. Common problems include mask discomfort, dry mouth, breathing that feels out of sync and noise from the machine. Late last year, the U.S. Food and Drug Administration approved Zepbound as the first drug to treat people with obesity and sleep apnea. At the time, the sleep medicine society hailed the approval as "a positive development for patients and clinicians, who now have another treatment option for this sleep disorder," according to a statement from the academy. But Zepbound is only for people with obesity and sleep apnea, the society noted. Also, Zepbound can reduce the severity of sleep apnea through weight loss, but might not cure the problem. For the new study, researchers analyzed nationwide online survey data from 365 patients, and also spoke to 17 sleep medicine professionals at UCSD. Doctors favored CPAP over Zepbound 53% to 26%, while patients favored Zepbound over CPAP 48% to 35%. Both doctors and patients supported treatment that combined CPAP and Zepbound, but doctors were more enthusiastic about combination therapy, 88% versus 61%. The patients' preferences are likely driven by their own experiences -- 78% said they were either current or former users of CPAP, results show. By comparison, only 23% of patients said they'd ever used Zepbound or Ozempic (semaglutide), the other prominent GLP-1 drug. Principal investigator Dr. Chris Schmickl, an assistant professor of medicine at University of California-San Diego, expressed surprise at the level of disagreement between patients and providers. "Recognizing differing attitudes toward treatment is crucial for developing a realistic and achievable action plan," he said in a news release. "Additional research to understand the underlying reasons behind these preferences will offer valuable insights for providers to guide treatment decisions." Researchers are scheduled to present these findings Wednesday at the society meeting in Seattle. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal. More information Harvard Medical School has more on managing CPAP problems. Copyright © 2025 HealthDay. All rights reserved.
Hamilton Spectator
26 minutes ago
- Hamilton Spectator
Minnesota budget deal cuts health care for adults who entered the US illegally
ST. PAUL, Minn. (AP) — Adults living in the U.S. illegally will be excluded from a state-run health care program under an overall budget deal that the closely divided Minnesota Legislature convened to pass in a special session Monday. Repealing a 2023 state law that made those immigrants eligible for the MinnesotaCare program for the working poor was a priority for Republicans in the negotiations that produced the budget agreement. The Legislature is split 101-100, with the House tied and Democrats holding just a one-seat majority in the Senate, and the health care compromise was a bitter pill for Democrats to accept. The change is expected to affect about 17,000 residents. Democratic Gov. Tim Walz, who insisted on maintaining eligibility for children who aren't in the country legally, has promised to sign all 14 bills scheduled for action in the special session, to complete a $66 billion, two-year budget that will take effect July 1. After an emotional near four-hour debate, the House voted 68-65 to send the bill to the Senate, where Majority Leader Erin Murphy, of St. Paul, had already said she would supply the necessary Democratic vote to pass it. Under the agreement, the top House Democratic leader, Melissa Hortman, of Brooklyn Park, was the only member of her caucus to vote yes. 'This is 100% about the GOP campaign against immigrants,' said House Democratic Floor Leader Jamie Long, of Minneapolis, who voted no. 'From Trump's renewed travel ban announced this week, to his effort to expel those with protected status, to harassing students here to study, to disproportionate military and law enforcement responses that we've seen from Minneapolis to L.A., this all comes back to attacking immigrants and the name of dividing us.' But GOP Rep. Jeff Backer, of Browns Valley, the lead author of the bill, said taxpayers shouldn't have to subsidize health care for people who aren't in the country legally. Backer said California Gov. Gavin Newsom, a Democrat, has proposed freezing enrollment for immigrants without legal status in a similar state-funded program and that Illinois' Democratic governor, JB Pritzker, has proposed cutting a similar program . He said residents can still buy health insurance on the private market regardless of their immigration status. 'This is about being fiscally responsible,' Backer said. Enrollment by people who entered the country illegally in MinnesotaCare has run triple the initial projections, which Republicans said could have pushed the costs over $600 million over the next four years. Critics said the change won't save any money because those affected will forego preventive care and need much more expensive care later. 'People don't suddenly stop getting sick when they don't have insurance, but they do put off seeking care until a condition gets bad enough to require a visit to the emergency room, increasing overall health care costs for everyone,' Bernie Burnham, president of the Minnesota AFL-CIO, told reporters at a news conference organized by the critics. Walz and legislative leaders agreed on the broad framework for the budget over four weeks ago, contrasting the bipartisan cooperation that produced it with the deep divisions at the federal level in Washington. But with the tie in the House and the razor-thin Senate Democratic majority, few major policy initiatives got off the ground before the regular session ended May 19. Leaders announced Friday that the details were settled and that they had enough votes to pass everything in the budget package. Error! Sorry, there was an error processing your request. There was a problem with the recaptcha. Please try again. You may unsubscribe at any time. By signing up, you agree to our terms of use and privacy policy . This site is protected by reCAPTCHA and the Google privacy policy and terms of service apply. Want more of the latest from us? Sign up for more at our newsletter page .
Yahoo
37 minutes ago
- Yahoo
Minnesota budget deal cuts health care for adults who entered the US illegally
ST. PAUL, Minn. (AP) — Adults living in the U.S. illegally will be excluded from a state-run health care program under an overall budget deal that the closely divided Minnesota Legislature convened to pass in a special session Monday. Repealing a 2023 state law that made those immigrants eligible for the MinnesotaCare program for the working poor was a priority for Republicans in the negotiations that produced the budget agreement. The Legislature is split 101-100, with the House tied and Democrats holding just a one-seat majority in the Senate, and the health care compromise was a bitter pill for Democrats to accept. The change is expected to affect about 17,000 residents. Democratic Gov. Tim Walz, who insisted on maintaining eligibility for children who aren't in the country legally, has promised to sign all 14 bills scheduled for action in the special session, to complete a $66 billion, two-year budget that will take effect July 1. After an emotional near four-hour debate, the House voted 68-65 to send the bill to the Senate, where Majority Leader Erin Murphy, of St. Paul, had already said she would supply the necessary Democratic vote to pass it. Under the agreement, the top House Democratic leader, Melissa Hortman, of Brooklyn Park, was the only member of her caucus to vote yes. 'This is 100% about the GOP campaign against immigrants,' said House Democratic Floor Leader Jamie Long, of Minneapolis, who voted no. 'From Trump's renewed travel ban announced this week, to his effort to expel those with protected status, to harassing students here to study, to disproportionate military and law enforcement responses that we've seen from Minneapolis to L.A., this all comes back to attacking immigrants and the name of dividing us.' But GOP Rep. Jeff Backer, of Browns Valley, the lead author of the bill, said taxpayers shouldn't have to subsidize health care for people who aren't in the country legally. Backer said California Gov. Gavin Newsom, a Democrat, has proposed freezing enrollment for immigrants without legal status in a similar state-funded program and that Illinois' Democratic governor, JB Pritzker, has proposed cutting a similar program. He said residents can still buy health insurance on the private market regardless of their immigration status. 'This is about being fiscally responsible,' Backer said. Enrollment by people who entered the country illegally in MinnesotaCare has run triple the initial projections, which Republicans said could have pushed the costs over $600 million over the next four years. Critics said the change won't save any money because those affected will forego preventive care and need much more expensive care later. 'People don't suddenly stop getting sick when they don't have insurance, but they do put off seeking care until a condition gets bad enough to require a visit to the emergency room, increasing overall health care costs for everyone,' Bernie Burnham, president of the Minnesota AFL-CIO, told reporters at a news conference organized by the critics. Walz and legislative leaders agreed on the broad framework for the budget over four weeks ago, contrasting the bipartisan cooperation that produced it with the deep divisions at the federal level in Washington. But with the tie in the House and the razor-thin Senate Democratic majority, few major policy initiatives got off the ground before the regular session ended May 19. Leaders announced Friday that the details were settled and that they had enough votes to pass everything in the budget package.
