In my January column, I mentioned the Medicare for All that is being considered by some of the Democratic presidential candidates. Such a bill, if passed, would be a revolutionary change for the United States, just as the inception of Medicare was in 1965. Medicare meets so many of the health needs of the elderly but, as I wrote, it is not the panacea that many people believe. For me, the jury is still out on whether Medicare for All is the right direction or is there is some other approach that will address the complexities of health care needs in our population.
Last month, I also said I was impressed with many of the elements in Massachusetts Governor Charlie Baker’s health care reform proposal. I will highlight just a few of his proposals here, but I encourage you to read the Massachusetts Health and Hospital Association’s analysis of H.4134, An Act to Improve Health Care by Investing in Value.
One of the most exciting areas in the governor’s proposal is the additional funding for behavioral health and primary care, with a target of a 30% increase above current expenditures over the next three years. There are also several changes to increase insurance coverage for behavioral health and increased specificity of the kinds of services health care organizations are required to have available for behavioral health patients. The proposal also would create a board of registry for recovery coaches and impose a 15% excise tax on the gross receipts for opioids manufactured and sold in Massachusetts. Taken together, these changes would be significant.
Behavioral health spending has not met the needs of the population for many years and behavioral health needs continue to grow. Providing the necessary care for patients with behavioral health problems will address some of the social problems we are seeing on the rise, such as homelessness, violence, and sexual assault. An investment in this vulnerable group could have significant impact on the overall health of our population.
Similarly, investing in primary care for patients is not only good for the patient, it’s good for health care providers and for the community. We have long known that primary care helps people stay healthy and when they do get sick, being able to access a primary care provider shortens the illness and prevents a small problem from escalating into a major crisis. We also know that people without a primary care provider often seek care in the emergency department for problems that are better (and far less expensively) treated in the community.
Both these investments have the potential to improve care to the underserved, reduce costs and improve the community in which we live. Both will also require an increase in the provider workforce to meet the demands associated with increased access and funding.
Another exciting component of the Baker proposal would add new protections for patients from receiving “surprise” medical bills for services and establish new notice requirements for disclosure of provider network status and referrals. A surprise bill is defined as one received by an insured patient for amounts other than plan cost-sharing for covered services provided by an out-of-network provider in an emergency, or by an out-of-network provider at an in-network facility. The Baker bill would require providers to determine network status and provide certain information to patients. We all recognize the complexity of navigating the health care delivery system. Even for those of us who have lived a lifetime working in health care, the byzantine system that drives access to care and subsequent billing is often too hard to understand. Having these protections for patients, most of whom find the experience of care overwhelming, is the right thing to do.
There were several changes proposed that relate to nursing including making Massachusetts a member of the Nurse Licensure Compact (NLC). This will allow nurses licensed in another NLC state to work in Massachusetts without having to go through the laborious process of endorsement. Having done this myself when I moved to Massachusetts, I would say it is major impediment for a nurse wanting to work in the Commonwealth. There were also several changes to advanced practice nursing scope of practice, including allowing qualified psychiatric nurse practitioners to admit patients to an inpatient psychiatric facility on a voluntary basis, or on an involuntary basis for a three-day period.
While there are many other aspects of the proposed legislation, increasing access to care and creating protections for vulnerable populations are central to addressing our imperfect health care system. I hope you take the time to read Governor Baker’s proposal and let his office know what you think about it. While we have far to go to make our health care system work for everyone, I believe H.4134 is a step in the right direction.