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January 24, 2024

State lawmakers weigh which health equity policies to advance this session

A man and a woman sit at a table with microphones on it Image | Courtesy of Sam Doran/State House News Service Rep. John Lawn and Sen. Cynthia Friedman, co-chairs of the Joint Committee on Health Care Financing, participate in a health equity panel discussion hosted by MASSterList on Jan. 23, 2024.

A sprawling proposal to bolster health equity by expanding MassHealth coverage regardless of immigration status, ensuring telehealth payment parity, growing the health care workforce and diversifying state agencies may not remain intact as top lawmakers contemplate which policy priorities to advance this session.

Sen. Cindy Friedman, Senate co-chair of the Joint Committee on Health Care Financing, acknowledged that lawmakers always need to pick their battles when asked about the Legislature's ability to tackle health care disparities alongside other crises, including financial challenges at Steward Health Care that could lead to more facility closures across Massachusetts.

Friedman's committee has yet to advance health equity legislation, which had a hearing in September, from Reps. Bud Williams and Judith Garcia and Sen. Pavel Payano (H 1250 / S 799) that's supported by more than 80 leaders of color who are part of the Health Equity Compact. The proposal also looks to establish a secretary of equity and Executive Office of Equity, provide funding to safety-net hospitals and community providers to address disparities, require continuing education focused on health equity, and set primary care and behavioral health spending targets, among other initiatives.

"Can we do it all now? Possibly, over time," Friedman said during a MASSterList event Tuesday. "I think the way we need to look at this is, what do we need to know more about and what can we do now? And there are things in the Health Equity Compact bill that some of them are, you need to plan and understand this, and some of them are, this is a no-brainer, just do it."

The Arlington Democrat mentioned bills dealing with midwives and doulas and added, "We can do things now. We know things about maternal health now."

She also prodded the House to take up a drug pricing reform bill, passed unanimously by the Senate in November, that would lower or eliminate costs for medications to treat chronic illnesses.

"Partly, priorities become what's happening in the moment and what you can do right at that moment, right?" said Friedman, who named maternal health as her priority when asked to identify a policy area she would commit to championing this session.

The rate of severe maternal morbidity nearly doubled from 2011 to 2020, with complications highest among Black people, the Department of Public Health said last year. Health inequities among people of color are costing the state nearly $6 billion each year, according to a report from the Blue Cross Blue Shield of Massachusetts Foundation.

Williams, asked about the implications of not advancing the entire health equity bill, replied, "Same old, same old." The legislation is a matter of life or death, said Williams, co-chair of the Joint Committee on Racial Equity, Civil Rights and Inclusion.

"We would hope we get the bill done in its [entirety]. Being realistic, we know that's not going to happen," the Springfield Democrat said, as he called deductibles and telehealth provisions a "no-brainer."

"There are things in this bill that could have been done many, many years ago if we had had what, the appetite, the will, the determination, to get it done," Williams continued.

Rep. John Lawn, House co-chair of the Joint Committee on Health Care Financing, pledged that every bill reported out of the panel will maintain a focus on health equity, and he said more legislation will be released "very soon." Lawn mentioned the committee in October favorably reported legislation, which is now before the Senate Ways and Means Committee, that would enable eligible undocumented children and young adults under 21 to gain access to MassHealth coverage. 

Lawn signaled it is possible to tackle the health equity legislation in its entirety, though the Watertown Democrat also pointed out lawmakers need to juggle limited state resources. Gov. Maura Healey recently announced $375 million in budget cuts after six months of revenue collections falling short of budget-writers' expectations.

"The Health Equity Compact has provided us a roadmap, has put these glaring figures and data in front of us, and over 80 people, Black and brown health professionals, have come together and gave us a very good blueprint of what we should do. And now have to try to figure out what we can do, and what we can do right away," said Lawn, who emphasized that health equity and workforce development are intertwined issues.

Lawn said lawmakers need to break down barriers in Black and Brown communities and provide career pathways in health care. He added, "We have so much to do."

Meanwhile in the executive branch, public officials announced they have begun a pilot program analyzing stark racial disparities in maternal health care and cardiometabolic diseases, such as diabetes and heart disease, in certain communities across the state, as the start of a more extensive strategy to close life expectancy gaps among marginalized communities.

In their equity work at the Executive Office of Health and Human Services, officials have chosen to focus on analyzing 10 geographic areas where residents are dying prematurely of cardiovascular disease compared to the state average.

They're located around the Berkshires, Boston, Brockton, the Cape, Chelsea and Lynn, Fall River and New Bedford, Springfield, and Merrimack Valley, as well as north central and south central swaths of the state, according to a presentation from Undersecretary of Health Dr. Kiame Mahaniah. More municipalities should be incorporated into their analysis next year, he said.

"If you are living in one of the communities of color in South Boston, you are going to live 10 years less than if you were living in Brookline or Newton," Mahaniah said. "When we talk about 10 years, it's not simply that you as a person died 10 years earlier; it means that your family loses you 10 years earlier, it means that people are orphans 10 years earlier."

As officials determine how to combat disparities at the local level by using the power of state government combined with input from community stakeholders, Mahaniah said those findings will translate into long-term health care interventions for all residents. Inequities will not be reversed in two or three years, though Mahaniah said officials expect to see positive changes over the next decade.

"In health equity, where there's this huge pressure to have something that you can publicize in the media, there is the danger that good ideas overtake data and outcomes," he said. "We intend on using outcomes to truly measure what we're doing."

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