Latest news with #LindsaySabadosa
Yahoo
06-05-2025
- Health
- Yahoo
Co-pays, deductibles targeted by health care reform bill
BOSTON (SHNS) – Doctors last week prescribed an insurance reform designed to save primary care practices and ensure patients get timely care. Insurers, though, say another mandate is the last thing Massachusetts needs when health care costs are already a big problem and are asking lawmakers to seek a second opinion. Massachusetts has consistently struggled to rein in high and growing health care costs. The great expense of care and a dearth of primary care providers means that many people put off preventative care. That often means they eventually end up in more serious and more expensive situations that also further stress a strained hospital system. Rep. Lindsay Sabadosa's bill (H 1309) heard by the Financial Services Committee would require that so-called evaluation and management services be included as part of an insurer's basic benefits package, making those services exempt from patient deductibles, according to a bill summary. The Northampton Democrat said it meant that 'several critical conditions' would be included 'without co-pay or deductible, so that constituents can go in and get the health care that they need and not end up consistently in emergency rooms.' Doctors whom Sabadosa introduced to testify Tuesday said high deductibles play a big part in keeping many people away from primary care that can decrease the cost of care over the long run. 'Every time there's a cost-saving measure that doesn't think about how it affects primary care, it ultimately costs the health care system more,' Dr. Kate Atkinson told the committee. Doctors also said high deductibles end up hampering the very primary care practices that are already stressed by other factors. 'What people don't understand is that many patients actually do not pay their bills and their deductibles, and in so doing, that shifts the cost to medical practices as well,' Dr. Wayne Altman, who has a practice in Arlington and is chair of the Department of Family Medicine at Tufts Medical School, said, describing deductibles as a massive administrative burden for doctor's offices. 'When people have primary care practices, what they really want to do is take care of their patients. They don't want to bill patients for deductibles. We just want to take care of our patients. And this gets in the way.' Atkinson was clearly frustrated as she told lawmakers that she recently laid off 11 employees from her Western Mass. family medicine practice and is no longer offering Saturday hours. The Mass. Medical Society trustee said the legislation Sabadosa filed 'came from' the organization and that this year was the seventh time she's testified on the issue. 'It is really frustrating to come year after year and testify, and nothing has changed for primary care doctors in this state, nothing,' she said. 'In all of the past decade that I've been testifying, it's become harder and harder to keep my practice afloat, I'm on the edge of bankruptcy, and measures like this are minor measures for the insurance company, but would be a big effort to keep patients healthier and to keep my practice going, and not just mine.' Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said insurers are worried that Sabadosa's bill and others the committee heard last week would drive up health care premiums for small businesses and individuals at a time when affordability is an urgent health care challenge for the state. 'Each of these bills would impose new requirements solely on the fully-insured market—made up primarily of small businesses and individuals—exacerbating affordability challenges without reducing overall system costs,' Pellegrini said. Pellegrini said that federal law, including the Employee Retirement Income Security Act, is such that the additional costs would not be required to be covered by self-insured companies, which account for almost 60% of the insurance market. Federal regulations also prohibit eliminating cost-sharing for many services through high-deductible health plans, the choice of nearly 43% of commercially-insured Bay Staters, she said. MAHP said plans already cover medically necessary outpatient care consistent with state and federal laws, and that eliminating cost-sharing entirely 'would significantly drive up premiums.' The group urged lawmakers to defer action on the idea until the Center for Health Information and Analysis could complete a full cost impact analysis. 'Massachusetts is at a critical crossroads on health care affordability. With premiums continuing to rise, adding new mandates that increase costs for working families and small businesses takes us in the wrong direction,' the insurers' group leader said. 'MAHP urges the Legislature to protect affordability and oppose House Bill 1309, Senate Bill 764, House Bill 1227, and Senate Bill 809.' The other legislation that Pellegrini and MAHP opposed last week (H 1227 / S 809) would require the Group Insurance Commission, MassHealth and commercial health insurers to provide coverage for biomarker testing, which can be used to personalize treatment for cancer. 'With biomarker testing, this allows care providers and doctors to pinpoint exactly what kind of treatment is going to be the most effective for a patient going through this battle. It can eliminate treatments that are devastating, from causing a patient to suffer through that. And it can lead to better outcomes, better quality of life, and it can give us that precious gifts of time,' bill sponsor Rep. Meghan Kilcoyne said. 'And we're also seeing that this can have huge implications on other diseases beyond cancer, such as Alzheimer's.' MAHP said that CHIA has estimated the biomarker testing mandate could increase health care costs by up to $35 million annually, with a five-year total expenditure surpassing $168 million. The group said the bill would impose the coverage 'without sufficient standards for clinical efficacy or value.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. For the latest news, weather, sports, and streaming video, head to WWLP.
Yahoo
08-04-2025
- Health
- Yahoo
Cabinet secretary warns of 'enormous' Medicaid cuts
BOSTON (SHNS) – Having spent her roughly 100-mile drive listening to the national news Monday morning and then hearing her colleagues at a budget hearing dig into the policy and finance specifics of crucial state programs, Rep. Lindsay Sabadosa got a sinking feeling. 'I feel like we're trying to budget on quicksand at the moment,' the Northampton Democrat said as she and the rest of the Joint Ways and Means Committee gathered to review Gov. Maura Healey's fiscal year 2026 budget plan (H 1) with the part of state government that could face the deepest and most immediate consequences of looming federal shifts, the Executive Office of Health and Human Services. While Beacon Hill continues its usual budget process, President Donald Trump has been moving to reshape the federal government and its spending, with all signs pointing to disruptions in the relationship between D.C. and states like Massachusetts. Medicaid is in the crosshairs of a pursuit for trillions of dollars in tax cuts and federal spending reductions over the next decade, and that could have massive impacts on MassHealth. The state Medicaid and Children's Health Insurance Program system affords health care coverage to about 2 million Bay Staters and brings about $15 billion of federal revenue to Massachusetts. Proposals under consideration in Congress 'would likely translate into billions of dollars of cuts for MassHealth for next year,' Health and Human Services Secretary Kate Walsh said Monday, and 'will force some very, very difficult choices.' MassHealth is the largest single chunk of spending in the state budget, representing about $22.599 billion gross (a $8.672 billion net cost to the state after federal reimbursements) or 36% of line-item spending in Healey's proposal. The governor's plan would increase the MassHealth budget by $1.04 billion gross or $415.8 million net compared to estimated total spending during the current budget year. Healey's budget, filed before the threat of deep Medicaid cuts became clear, expects federal reimbursement for Medicaid spending to increase by $1.8 billion to $14.2 billion, per the Massachusetts Taxpayers Foundation. While the scope of federal spending cuts may not become clear for weeks or months, the state budget is on its typical timetable, with the House and Senate planning to pass their spending bills in April and May. When Attleboro Rep. James Hawkins asked how MassHealth is 'preparing to continue serving residents in the face of these threats,' Assistant Secretary for MassHealth Mike Levine responded that 'a lot of this is going to come back to budget and appropriations and hard choices.' 'It is a matter of identifying our key populations and what we're going to do to support them, and collectively coming up with answers,' Levine said. 'Because you might have a point of view on, you know — 'If we're on track to spend $8.7 billion out of the General Fund and [fiscal] 26, that number can go no higher than X' — that's really going to clarify our choices and what we're able to continue to do and what we're going to have to stop doing.' Excluding MassHealth, Healey's fiscal 2026 proposal recommends funding EOHHS at $10.156 billion, which the administration said would represent a $452.5 million, or 5%, increase over the budget the governor signed last summer. The increased budget allotment pays for $207 million for new provider rate increases through the Chapter 257 reserve, $524.2 million to annualize provider rate increases from the current budget year, and $460 million for projected caseload growth. The uncertainty about federal support for Medicaid comes as Beacon Hill Democrats are redrafting Healey's budget while the state's spending demands are elevated and general purpose tax revenue growth is modest. A reduction in federal funding could force state budget managers closer to considering unpopular steps, potentially including allowing federally-funded services to end, cutting back on state support for programs, dipping into preciously-guarded state reserve accounts, or raising taxes to bring in more revenue. Walsh told Sabadosa that her morning drives are often very similar, and that she has shifted her thinking to 'trying to figure out, well, there must be a better way to do this.' She said most important is understanding what Massachusetts values and 'the basic things that we need to do,' and then finding ways to 'do it differently and better.' The secretary said the state has to be able to deliver services at a lower cost, but also warned that 'we will be cutting' programs that she, her staff and lawmakers have become attached to. 'We're just going to have to think more creatively and differently. And I think it's going to really challenge the — going back to the values, what's made us all so proud to do this work, which is that we've built programs … that have really saved people's lives, or may enable them to live the best life they could possibly live, and that's easier in this state than probably any other state on the planet,' Walsh said. 'And so how do we get there from here? And I don't know the answer, but we really are at an inflection point.' The response is going to require a partnership between lawmakers and the administration to make potentially uncomfortable trade-offs, she said. 'So you might want to save a food pantry in your district. And I might say to you, 'no, we need to do this another way,' because it's going to be a more efficient way to get a meal to everyone in the commonwealth,' the secretary said. 'And I think that those trade-offs that you'll have to make for programs again, you've built, sponsored, earmarked, supported — we might not be in the position to do that.' Walsh added later in her response to Sabadosa, 'That's why I applaud people like [Department of Mental Health] Commissioner [Brooke] Doyle, who came forward and said, 'OK, if I have to cut, this does the least damage.' And we have to trust each other, because we are going to be cutting.' Healey's budget proposes slashing the DMH case manager workforce from 340 to 170 positions, a move that her administration says would save $12.4 million. Overall, the DMH budget would increase by 7% to about $1.2 billion under Healey's bill, Walsh said. The proposed cut to the DMH caseload manager workforce was one that a handful of lawmakers took issue with Monday. Another recurring topic of questions from lawmakers was Healey's proposal to level-fund the personal care attendant program and tie PCA spending to health care spending benchmarks from the Health Policy Commission. The PCA program allows seniors and people with disabilities to hire personal care workers to help with daily tasks like bathing, dressing, meal preparation, and grocery shopping. It helps keep people independent and not in nursing facilities, but the program's costs have soared from $1.2 billion in fiscal 2020 to an estimated $2 billion by fiscal 2027. 'While people in their heads think about PCA and homemaker services as things that are paid for and something that you require when you get old and might be covered by Medicare, in fact, it's paid 100% by the Medicaid program, which we have just identified as in for enormous cuts,' Walsh said. 'So this is a very good example of one of the very hard choices that we're facing.' Lawmakers did not go along last year with a Healey proposal to trim $57 million from the PCA program, which would have meant that 6,000 people would have lost access to PCA services. That, Walsh said, 'was an example of us trying to get cost under control' but now represents 'the kinds of cuts that we will not be able to look away from in the future.' 'Like-minded people can disagree about whether or not the program's been cut too much, slowed too fast, growing too fast,' she said. 'I think we're in a situation where these will be the good old days and the cuts that were contemplated will be, 'Wow, wish we could have done that.'' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
