The legislature wrapped up their formal sessions last night (early this morning, actually).
Two key HCFA priorities – health reform funding and the health care cost control bill — passed and are waiting the Governor’s signature. Two other priorities – an oral health and children’s mental health bill – were not approved. These bills continue to have broad support, and we expect their passage during the informal sessions over the next few weeks. There was lots of activity and some drama yesterday. Here’s our report:
MassHealth Equality
The day started out with Governor Patrick’s exuberant signing ceremony for two pieces of legislation advancing marriage equality for same-sex couples. While most attention was paid to the bill repealing the 1913 restriction on out-of-state couples, the Governor also signed the MassHealth equality bill. The bill, championed by Rep. Liz Malia, assures that same-sex married couples are treated as married for purposes of Medicaid benefits despite federal prohibitions. Here’s what the Governor said as he signed the bill:
We are also here to mark another milestone in our fight for equality, the passage of the MassHeath equality bill. This legislation will grant married same-sex couples in Massachusetts the same access to Medicaid benefits as heterosexual couples. The bill will protect the spouses of gay and lesbian seniors from the potentially catastrophic costs of long-term care, including impoverishment and, in the worst cases, homelessness. The MassHealth equality bill is the first piece of legislation in the Commonwealth to codify the Goodridge decision extending legal marriage and its protections, benefits, and obligations to same-sex married couples in our state. And it’s the first piece of legislation in the nation to reject discrimination in the Federal Defense of Marriage Act.
Cost Control Drama
The issue of pharmaceutical company gifts to doctors in the cost control bill was a prime focus for the House and Senate all night. The original Senate bill, introduced by Senate President Therese Murray, banned all gifts, required the reporting of payments to doctors from drug companies and device manufacturers, and required the registration of drug company sales representatives. The House version just asked drug companies to abide by their own internal codes of conduct, with no state enforcement. The House also dropped the reporting and registration provisions. The House added a section prohibiting data mining, the sale of individual prescription records to aid marketing.
Negotiations were intense and strained over the drug issues, going to the last minute. The final bill strikes a compromise between the two approaches. DPH will enforce standards that at least meet the pharma code, in effect, calling the industry bluff. The data mining and registration provisions were out, but the payment reporting was retained. The Mass Prescription Reform Coalition (MPRC) supported the compromise as a positive step forward, despite the significant dropoff from our preferred outcome (see MPRC statement).
Pharmaceutical and biotech interests aggressively tried to scuttle the agreement before it came to vote, despite the approval by the conference committee. Legislators demanded changes and threatened to filibuster, on the last night of the session. The press conference and votes were delayed again and again. Claims were made that the reporting requirement would cripple research, despite similar provisions in other states and the fact some pharma firms voluntarily report all payments anyway.
With the House gallery packed to standing room only with industry lobbyists, along with HCFA and MPRC representatives, the bill finally came to the House floor around 11:00 pm. Health Care Financing chair Patricia Walrath, who will be retiring at the end of the session, spoke in broad terms in favor of the bill. Then, Michael Rodrigues, House Chair of the Consumer Protection Committee, spoke in opposition to the drug provisions of the bill, and urged a no vote. Speaker DiMasi called for a voice vote, and no voices were heard in opposition, and no one called for a recorded roll call. With that, the bill went to the Senate, where it was approved in a unanimous roll call, shortly after midnight.
Other provisions
The final cost control bill also includes several quality provisions initiated by our Consumer Health Quality Council, and a provision for a payment reform special commission to recommend a complete overhaul of payment methodologies in the state. We see this commission as having the potential to make the fundamental realignment of our health care system, towards a payment structure that rewards primary care and keeping people healthy, rather than one tilted towards high-intervention specialty care. You can read my comments as well as commentary pro and con in Martha Bebinger’s report on WBUR.
While we were disappointed that the oral health and children’s mental health did not make it all the way through last night (the kids bill just needs procedural votes), we are confident that both have no opposition and can pass during the informal sessions that will continue into the fall. With the earlier enactment of the EOHHS Office of Health Equity as part of the budget, HCFA ends the legislative session with an impressive number of major accomplishments.
We cannot thank enough the profound leadership on health issues shown by Speaker DiMasi and Senate President Murray. From their stalwart support of health reform implementation two years ago through last night’s imbroglio, both leaders showed a remarkable commitment to expanding quality, affordable health care. Equally, we are deeply grateful for the leadership and hard work put in by Health Care Financing Chairs Senator Richard Moore and Representative Patricia Walrath. They and their outstanding staffs went above and beyond in their dedication to improving the health of Massachusetts. Representative Walrath will be missed immensely, but her mark on dozens of large and small initiatives will continue to make history.
Brian Rosman
