Full Speed Ahead Beacon Hill Pushes To Reach A Consensus On Health Care Reform Legislation

The fast track. That’s where the Commonwealth’s health care reform legislation currently sits, only temporarily stalled after speeding toward the point at which the House and Senate must hammer out a compromise between rival plans that have some similarities, but also some major differences.

When reached, that compromise plan will go to Gov. Mitt Romney, who has forwarded his own health care reform proposal.

It remains to be seen what the final draft of this, the most recent attempt at reform legislation in Massachusetts will be. But legislators hope to have a plan in place by early January – an ambitious goal, given that the House and Senate approved their respective bills on Nov. 3 and 9.

But time is of the essence; A plan must be in place if the state is to qualify for $335 million in federal funding to pay for provisions within the reform package.

The speed at which legislators have moved to craft their respective measures — not to mention individual provisions — has been cause for concern among some in the health care industry, who fear that a hastily drafted plan could lead to problems in the future, such as health insurance plans with high deductibles or penalization systems.

But others contend that garnering that $335 million is necessary in order to foster change in the health care system.

“It is not the plan that will be important soon, but the funding behind it,” said Dr. Charles Cavagnaro, chief executive officer for Wing Memorial Hospital, and also a practicing physician. “Without it, we can’t implement anything. That federal funding is important to the state and the legislators, and they don’t want to lose it.”

The Power of Three

The three rival health care reform initiatives have similar goals: increasing coverage to the uninsured — thus shrinking or eliminating the Uncompensated Care Pool — and streamlining the state’s health care system.

All three plans, however, differ in several respects.

Essentially, the House, Senate, and Romney have proposed three separate plans for health care and health insurance reform in Massachusetts. And both the House and Senate bills followed an early, more global health care reform proposal set forth earlier in the year by the governor.

That proposal included a mandate that all Massachusetts residents obtain coverage, either on their own, through a statecontrolled program such as MassHealth, or through a low-cost policy program. It also advised improvement of the malpractice system and consumer access to health care provider quality and cost information, and increases in Medicaid reimbursement rates for providers.

Both the House and Senate bills include some provisions similar to Romney’s, however they also approach several issues, particularly the uninsured population, in different ways.

The House bill requires that people who can afford insurance purchase it, and would increase the number of people covered by Medicaid by tapping the tobacco settlement fund (in its entirety) – a figure of about $255 million a year.

The House bill also mandates that business owners provide insurance for their employees or pay into an insurance fund.

This controversial provision has drawn fire from state business groups such as the Associated Industries of Mass.

Currently, only Hawaii uses a system similar to that contained in the House version, and many state business leaders contend that the move would hurt the Commonwealth’s already fragile economy.

The Senate bill does not include such a mandate, however it does stipulate that employers who don’t pay for health insurance cover the health care costs of those workers who receive health care services.

Romney opposes the employer mandate set forth by the House, but has said he wants legislators to move quickly to reach a compromise, in order to tap $335 million in federal money to fund the finalized plan.

Jeffrey Ciuffreda, vice president for Government Affairs with the Western Mass. Economic Development Council, said that Romney got the ball rolling with an early set of health care reform proposals, in part to meet the deadline for acquiring those federal funds, but stepped back while the House and Senate drafted their bills.

“He deserves the credit for getting this started by using the bully pulpit and fueling the fire,” said Ciuffreda. “There were three pieces to this debate and there are still many, many moving parts, but now it comes down to the House and the Senate, and the plan they’re going to decide on between them.”

While Romney has steered clear of threatening a veto of any legislation that proposes mandated health insurance for employers, or penalties for those who do not provide it, Ciuffreda added that the governor is likely to enter the ring again if the provision shows up on the draft of the bill that emerges from conference committee sessions.

“He’s firmly against that employer mandate, and if needed, that’s where we’re going to see him weigh in,” he said.

Drawing Distinctions

Arguably, Romney’s proposal and the Senate bill are most similar in their approach to reform. The Senate bill is also considered more cautious than that of the House; Ciuffreda explained that the Senate bill lays out a plan to cover about half of the state’s uninsured over the next two years, whereas the House bill proposes that 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of that population’s insurance needs be immediately addressed through the mandated insurance requirements.

“The Senate’s bill could be considered conservative, while the House bill is more aggressive,” said Ciuffreda. “The House is trying to take 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of a problem and solve it, but the Senate is trying to help 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the uninsured population and provide assistance, then look at how the plan is working in a couple of years.

“That might mean that we have a better handle on who those people are in two or three years,” he continued, “and at that time it’s possible that an even better bill can be drafted.”

Not unlike the bills themselves, the impressions of professionals in health care of the current trifecta of legislation are varied.

Cavagnaro said hospital administrators support the general concept of reform as a step in the right direction.

“It’s safe to say that all hospitals are united in believing that this is something that needs to be done, but we are not as united in how that should be done,” he said.

Cavagnaro noted, however, that most hospitals agree that the impetus behind each piece of legislation is a good faith effort to improve health care in Massachusetts.

“In general, all three versions have merit,” said Cavagnaro. “I’m hopeful that all three parties will come to a compromise without trying to get each other’s goat.

“The bottom line is the health care system is broken across the country,” he added, “and it is particularly broken in Massachusetts, so it’s clear that something needs to be done.”

Cavagnaro said the free care pool has become the crux of the issue for many of the Commonwealth’s hospitals.

“For some, it is a huge burden,” he said. “It’s behind all of this legislation. Even a compromised bill would begin to address the needs of the free care pool.”

Proceeding With Caution

And, he added that the speed at which the proposals have been drafted on Beacon Hill could indeed contribute to a plan that will prove to have some holes. However, Cavagnaro said it could also be a necessary risk.

“It has definitely moved the discussion to a new level,” he said. “And it has put greater importance on it than has ever been there before. The attention to the matter alone is a step forward.”