Gov. Deval Patrick wasn’t in office when Massachusetts passed its landmark 2006 health care law, but it’s largely fallen to his administration to make sure the complex undertaking doesn’t collapse.
It’s a task Patrick has embraced.
That’s driven in part by his belief that access to health insurance should be as universal as possible. But the push to make the law work also has high-stakes political repercussions as the state helps blaze a path for the national health care law signed by President Barack Obama.
Not only was the national law modeled in part on the Massachusetts law, which was signed by former Republican Gov. Mitt Romney, but Obama is a close friend of Patrick, who is planning to stump for him during Obama’s re-election campaign. Romney launched a failed bid for president in 2008 and is expected to try again next year.
If Massachusetts’ law fails, it could strengthen Obama’s political foes, who could argue a similar fate awaits his overhaul.
Patrick’s latest efforts have focused on reining in the overall cost of health care, particularly soaring premiums. In February, Patrick filed legislation he said would help curb those costs by focusing on the quality of care, instead of the quantity.
Just this week, Patrick repeated his cost-control mantra, saying he’s sick of hearing “excuses” from insurers for why they can’t slow spiraling premiums. He also floated the idea that the growth of premiums could be reversed instead of just slowed. More than 98 percent of Massachusetts residents are now insured.
“Cost is a challenge whether you have a universal system or not,” Patrick told The Associated Press. “It’s not unique to Massachusetts. It’s not even more extreme here than in other places. But it has defeated a lot of other places and we want to show leadership.”
The bill Patrick filed in February would move the state toward a payment system in which doctors are rewarded by how healthy they keep their patients, not by how many procedures or office visits they schedule. The bill would set boundaries and standard criteria for providing patient care at lower costs.
The overall goal would be to significantly reduce fee-for-service payments and replace them by 2015 with alternative payment methods.
“If this passes and I expect it will, and we’re pushing real hard for it, then we will lead the nation in cost containment just as we have in coverage,” Patrick said. “What matters is that we make it work.”
Not everyone’s convinced Patrick is heading down the best path for cost containment.
Massachusetts Association of Health Plans President Lora Pellegrini said she agrees health premiums need to be curbed, but said focusing on insurers misses the mark.
Pellegrini said a bigger problem is the disparity that hospitals can charge for similar procedures. Those costs can vary widely, depending on a hospital’s geographic location and whether it has brand-name appeal.
The state needs to level that playing field, before costs can be addressed, she said.
“At the federal level we are going to have the same issue because I don’t think the federal law dealt in any substantial way with underlying costs” she said. “We definitely believe that paying providers for quality instead of volume is absolutely the right way to go, but there’s nothing to make us believe that that will lower costs.”
Monthly premiums for individuals in Massachusetts have climbed dramatically in the past decade. From 2001 to 2009, the median monthly premium for individual health plans jumped by 76 percent, from $251 to $442.
Regulators announced late last year that Massachusetts’ biggest insurers were slowing the rate of increases in health care premiums. State Insurance Commissioner Joseph Murphy said those rate increases for 2011 ranged from nearly 3 percent to just under 10 percent, a drop from prior years.
In December, Blue Cross and Blue Shield of Massachusetts, the state’s largest insurer, and doctors at Beth Israel Deaconess Medical Center in Boston signed an “alternative quality contract” designed to lower costs by paying doctors and hospitals for the quality of care, not the quantity.
“Most of the scholars of health care and those that study health care agree we spend enough in the aggregate for health care,” Patrick said. “By making some changes around how we pay for that care, paying for quality and outcomes rather than the quantity of care, we can both improve quality and pay less for it.”