The Massachusetts Medical Society's policy on federal health care legislation was guided by policy on universal coverage adopted by the House of Delegates five years ago, when the Massachusetts Legislature was debating state health care reform.
- Health care coverage should be universal
- Health care coverage should be continuous
- Health care coverage should be affordable to individuals and families
- The health insurance strategy should be affordable and sustainable for society
- Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable
- Coverage should include a non-disruptive and evolutionary approach that is politically and economically viable and sustainable, and includes quality and public health components
- Health care coverage should be sufficiently comprehensive to provide meaningful health care, and be affordable and obtainable through appropriate purchasing pools for individuals or smaller employers
- Coverage should offer a bi-modal approach of expanding public and private payer responsibilities. Patients should have a choice between private and public financing
- Coverage should include Individual and employer mandates, provided that affordable private health insurance and/or appropriate subsidies are made available
In our view, the federal legislation passed by the House on March 21 makes significant strides in expanding health care coverage, protects the expansion of coverage in Massachusetts, implements major insurance industry reforms, addresses several workforce issues, invests millions in the public health infrastructure, and more.
Yet it fails to address several areas that physicians believe are necessary in order to implement comprehensive reform of our health care system; reforms that are needed by patients and physicians. The MMS is committed to working tirelessly with all stakeholders to achieve these objectives.
Major Benefits of the Federal Legislation
- Provides coverage to 32 million additional people, with appropriate subsidies for low-income households. With this provision, 95% of legal residents will have insurance. (While this provision does not direct affect Massachusetts residents, it establishes a floor for the future.)
- Extends Medicaid coverage to households with incomes up to 133% of the federal poverty level. Subsidies are provided up to 400% of poverty.
- Protects and enhances the Massachusetts health reform law, by providing up to $4 billion in additional funds
- Insurers are required to provide dependent coverage up to age 26
- Closes the gap in Medicare's Part D prescription drug coverage ("the doughnut hole")
- Offers tax credits to small businesses to purchase health insurance for their employees
- Provides significant insurance reforms, including:
- Prohibits insurers from rescinding coverage, except for fraud
- Prohibits insurers from denying coverage due to pre-existing conditions
- Prohibits annual limits on coverage
- Limits enrollment for waiting periods to 90 days
- Limits deductibles in small-group insurance products
- Requires insurers to uniformly report their medical loss ratio. Orders rebates to consumers when the ratio is below 85% in the large-group market and 80% in the individual and small group market
- Reduces the administrative complexity of health care by adopting a single set of operating rules for:
- Claims or equivalent encounter information
- Eligibility verification and claims status
- Referral certification and authorization
- Electronic funds transfers and health care payment and remittance
- Increases Medicaid funding for primary care services to the Medicare level
- 10% bonus for primary care physicians, and a 5% bonus for surgeons practicing in under-served areas
- Funds more primary care slots in graduate medical education
- Loans and scholarships for medical students to enter primary care
- Medical liability reform: It authorizes the states to experiment with alternatives to traditional tort reform measures. Provides $50 million over the next five years.
- Supports a wide range of diversity, public health, wellness and preventive care programs, such as:
- Eliminates cost-sharing for preventive services in Medicare and Medicaid
- Requires qualified private plans to provide minimum coverage without cost sharing for recommended immunizations; preventive care for infants, children and adolescents; additional preventive care and screenings for women
- Offers comprehensive health risk assessment and personalized prevention plans to Medicare beneficiaries. Incentives offered to beneficiaries who complete behavior modification programs
- Incentives for employers that establish wellness programs. Authorize employers to grant "wellness awards" to employees who participate in such programs
- Requires Medicaid coverage for tobacco cessation services for pregnant women
Issues that Require Further Work
- Repeal Medicare's physician payment formula (Sustainable Growth Rate) and establish a new baseline for the physician payment system
- Independent Payment Advisory Board (IPAB): Eliminate provisions that disproportionately expose physicians to initiatives to limit national health care expenditures. Provide more oversight to Congress.
- Reform the value-based purchasing program. Require that its measures are accurate, evidence-based and statistically reliable and valid, with the right to appeal designations
- Improve the Physician Quality Reporting Initiative (PQRI), so that it is voluntary, non-punitive, provides access to data in a timely manner, and provides a fair appeals process
- Strengthen medical liability laws to explicitly include full disclosure, early offer, and apology. Provide more protections to physicians who follow evidence-based guidelines
- Fair and appropriate Medicaid payment levels for all providers
- Meaningful anti-trust relief for physicians
