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November 18, 2021

High healthcare costs are making behavioral health unaffordable, AG says

Photo | Courtesy of the Seven Hills Foundation A ribbon cutting at Seven Hills Foundation's behavioral health center on Gold Star Boulevard in Worcester

Citing both a need for additional investment in behavioral health and high health care costs that mean Massachusetts families and employers can't afford to pay more, Attorney General Maura Healey on Wednesday called for the state to consider changes in its efforts to rein in costs.

Speaking at the state Health Policy Commission's cost trends hearing, an annual exercise that explores the factors driving health spending growth, Healey said she hopes recommendations the commission put forward in September spark discussion "about how to address the urgent needs for investments in behavioral health and health equity without sending the bill to workers and families through increased premiums or higher deductibles."

"We need to think differently about government tools for cost containment and redistribution of health care dollars," Healey said. "These changes will be hard, and hard for some, but we can't afford to continue the way our health care spending has been going. Our new normal must be one founded on equity and access, which means controlling costs more effectively and directing investment where we need it most."

Health care spending in Massachusetts grew 4.3 percent from 2018 to 2019, marking the second consecutive year that the increase outpaced a state target and prompting the HPC to recommend a series of policy moves including price caps for the most expensive providers, greater scrutiny around hospital outpatient and ambulatory care expansions, new affordability standards for health plans and a reduction in pharmaceutical drug spending.

The commission's cost trends report also suggested improving access to behavioral health services and focusing investment in primary and behavioral health care, topics Gov. Charlie Baker addressed at the hearing in pre-recorded comments.

Baker and Healey's remarks came as each branch of the Legislature was preparing to take up separate health care bills, with the Senate keying on in expanding mental health access while the House's focus was on oversight of health system expansions into areas served by community hospitals.

Baker in 2019 filed a bill that sought to boost spending on behavioral health and primary care, while still adhering to the state's overall cost-growth benchmark. He said the pandemic "underscored that our health care system still needs meaningful reforms in several key areas."

Baker has said he plans to file a health care bill again this session, possibly in January.

"We know there's a lot more work to do to promote behavioral health parity and to get residents access to the treatment they need," Baker said Wednesday. "We remain committed to the provisions we filed in our initial health care reform bill, which incentivize payers and providers to focus more on these services. In the coming months we'll have more to say about our health care reform priorities so we can continue to address key challenges, like access to behavioral health services, which as we all know for both adults and kids coming out of this pandemic is something we need to put significant effort into if we plan to serve all the folks who are looking for access to behavioral health services coming out of this very difficult time."

He said more attention should be paid to "services that keep people healthy" like addiction services, behavioral health, primary care and services for seniors instead of a sole focus on the care that is needed when people are sick.

Healey described a need for more investment in the health care safety net along with the behavioral health system.

"Safety net hospitals in our gateway cities and elsewhere who serve higher proportions of Black and brown residents face extraordinary challenges, challenges in keeping their doors open, attracting and retaining experienced and dedicated staff, [and] making the capital investments necessary to acquire, develop and maintain buildings, medical equipment and electronic health record systems," she said. "But let me be clear, even though we need more money to address dire needs and behavioral health and health equity, we can't afford to pay more for health care."

Health Care for All Executive Director Amy Rosenthal, one of the advocates who testified at the hearing, said the state should pursue a "multi-pronged approach" to tackling rising costs, while keeping equity at the forefront and making sure savings are passed on to consumers.

She said her group "supports passing legislative reforms that closely align with the Health Policy Commission's recommendations, including eliminating co-pays for services and treatments for chronic conditions that disproportionately impact communities of color, enhancing transparency in the rate review process, establishing a consumer benchmark to control out-of-pocket costs and premiums, passing prescription drug reform legislation and reining in the highest cost hospitals."

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