State health plan legislation could add $20M to healthcare costs
Erik Linzer, executive vice president, Massachusetts Association of Health Plans
Calls from lawmakers and advocates to have insurers cover health care services from fertility preservation to medical marijuana ran headlong Tuesday into an industry that said the Massachusetts Legislature already mandates it to cover more than any other state in the nation.
The testimony before the Joint Committee on Financial Services began Tuesday morning with representatives and senators rattling off phrases like "require insurance carriers to..." or "requires health plans to reimburse..." and "make insurance cover..." as they detailed a wide array of bills up for consideration.
As those mentions piled up, the Massachusetts Association of Health Plans said that the scope of mandates included in the legislation before the committee would add between $17 and $20 million a year to the cost of health care in Massachusetts.
"MAHP and our member health plans recognize the challenges that employers and consumers face with rising health care costs. However, proposed legislation that mandates health plan coverage of additional services and treatments may not be efficacious or safe and will significantly increase health care costs in Massachusetts for small employers and individuals purchasing insurance," the organization said.
Massachusetts health plans are already required to cover more than 50 benefits, which MAHP said is "the most legislative mandates of any state." Those mandated benefits account for more than $2 billion in annual state health care spending and for almost 20 percent of the premiums paid by Massachusetts residents and workers, the group said.
The cost of health care has been a focus of lawmakers for years. A 2012 cost control law created the Health Policy Commission and charged it with annually reporting on cost trends in the health care world. At the same time, many Massachusetts lawmakers take pride in the state's robust care offerings and its status as a state that served as a model for the federal Affordable Care Act.
The push-and-pull dynamic between services and costs was on the mind of Sen. Cynthia Creem as she pitched legislation (S 640/H 1116) she filed with Rep. Kevin Honan to require health insurers to cover fertility preservation treatments for people whose medical diagnosis or treatments may impact fertility.
"I know that the committee is concerned about the impact that new insurance mandates will have on insurance premiums. I understand that concern. This bill will have a minimal impact on premiums," Creem said.
She said the bill was referred to a study by the Center for Health Information and Analysis last session and that the agency estimated the bill would raise premiums about two cents per member per month.
Also on the committee's docket were a number of bills (H 1098, H 1176, H 1184, H 4145) that deal with colon cancer and screenings. Rep. James Arciero and a constituent spoke to his bill (H 4145), which would provide for GIC, MassHealth and private insurance coverage for colorectal cancer screening as determined and directed by a primary care physician starting at the age of 30, and would eliminate co-pays for such services.
"We can do better at screening for this serious disease, which has been affecting people at younger and younger ages," he said. "Currently, health care coverage applies to screenings only for those patients at the age of 50 or with a family history of colorectal cancer."
Alexa Morell of Chelmsford was diagnosed with stage-four colorectal cancer at the age of 29 and told the committee Tuesday that early screening is the best way to address the experts' predictions that there will be more cases in younger people in the coming years.
"Colorectal cancer used to be known as something that affected older people and that is not true," she said. Citing statistics from the Dana Farber Cancer Institute, Morell added, "Since 1994, the rates of young-onset cancer incidences have increased by about 51 percent. It's expected to double by 2030. So someone born in 1990, like myself, now has double the chance to get colorectal cancer than someone born in the 50s."
Rep. Ruth Balser called for a favorable report for her bill (H 1043) that would require health plans to cover what she called "a more modern form of mammography," and Rep. Daniel Carey testified on a bill (H 1215) that would require insurers to cover specialized hospital-grade breast pumps often needed by babies born prematurely.
Though it was not a centerpiece of Tuesday's hearing, the Financial Services Committee on Tuesday gave its official airing to legislation (H 1143/S 649) that the Massachusetts Patient Advocacy Alliance said would "legalize" health insurance coverage for medical marijuana products and related clinical visits for qualifying registered medical marijuana patients in Massachusetts.
"Insurance formularies should reflect the need for medical marijuana among Massachusetts patients -- and under this legislation, they'd be able to," chief Senate sponsor Sen. Julian Cyr said in a statement. "Whether the patients are older adults managing chronic pain, veterans working through post-traumatic stress, HIV patients experiencing wasting syndrome, or countless other potential beneficiaries, their lives would be drastically changed by an insurance option that covered medical marijuana."
Rep. David LeBoeuf, who filed the House version of the bill, said that "[i]t makes no sense that we subsidize physically addictive and often deadly opioids but fail to have a pathway for access to an effective, regulated, and scientifically tested natural cannabis treatment."
The legislation is also supported by the Massachusetts Community Action Network, which said that the bill "will make it more financially feasible for registered qualifying patients to be able to acquire medical cannabis so they can have a more healthy life which we want for all people."
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