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Report: More Massachusetts Employers Offering Health Insurance

Posted by Katie Holahan on Jun 26, 2019 10:28:35 AM

More Massachusetts companies of all sizes are offering health insurance to their workers but fewer employees are enrolling as costs accelerate, according to a new state study released this morning.

The report from the Center for Health Information and Analysis (CHIA) finds that the percentage of Bay State employers who provide health insurance increased from 65 percent in 2016 to 71 percent in 2018. Only 57 percent of employers nationally provide health coverage.

2019ChiaInforgraphicAt the same time, the percentage of eligible employees who accepted employer health insurance declined from 74 percent to 67 percent during the same period.

Part of the explanation could be the relentless increase in the cost of health insurance faced by both companies and their workers. The CHIA report says that average health-insurance premiums rose 12 percent for single policies from 2016 to 2018 and 13 percent for family plans. Employer contributions remained steady at 74 percent, but the average annual deductible soared 42 percent.

“Massachusetts employers deserve tremendous credit for expanding health insurance options at a time when the cost and complexity of health care continue to increase,” said John R. Regan, President and Chief Executive Officer of Associated Industries of Massachusetts.

“AIM members last year identified the cost of health insurance as the most important issue facing their companies. The numbers underscore the importance of our efforts to ensure that employers have the ability to provide affordable health insurance to their workers.”

CHIA is the primary center for the collection and analysis of information about the Massachusetts health-care market.  The agency’s biennial Massachusetts Employer Survey (MES) tracks and monitors employer health insurance offerings, employee take-up rates, health-insurance premiums, employer contribution amounts, plan characteristics, and employer decision making.

The most eye-opening conclusion of the study is that even small companies remain committed to offering health-insurance benefits. Although employers with fewer than 50 employees are no longer required by law to offer health insurance, 65 percent of these employers do. Seventy percent of small firms (3-199 employees) offered insurance, versus 99 percent of large firms (200 or more employees). 

Other key findings of the CHIA survey include:

  • The 2018 average total monthly premium was $617 for single coverage and $1,687 for family coverage.
  • The average employee contribution to health insurance in 2018 was 26 percent for single coverage and 30 percent for family coverage, unchanged from 2016. Employers continue to cover an average of 74 percent of monthly premium costs.
  • The average annual deductible for single coverage in 2018 was $1,508, slightly lower than the national average of $1,573, but more than the $1,065 average for 2016.
  • Massachusetts employees overall faced lower out-of-pocket limits than their national counterparts. The average out-of-pocket limit for single coverage in Massachusetts was $3,461 compared to $3,872 nationally.
  • Almost three quarters (70 percent) of Massachusetts employees were offered a High Deductible Health Plan (HDHP) in 2018. Thirty-nine percent were offered an HDHP with a savings option.
  • The most common reason given by employers (48 percent) for not offering health insurance was that they were not required to do so because of their firms’ small size. Thirty-eight percent cited the cost as being too high. The most common reason given by employers as to why they were offering health insurance was to retain employees (66 percent) and recruit new employees (63 percent).
  • Large companies were more likely than small ones to reduce their contributions toward employee premiums as a way to contain costs.

 

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

AIM Calls on Legislature to End MassHealth Assessment on Employers

Posted by Katie Holahan on Mar 26, 2019 1:52:06 PM

Editor's note - AIM Vice President of Government Affairs Katie Holahan today delivered the following testimony to the Legislature's Joint  Committee on Labor and Workforce Development in favor of ending the MassHealth employer assessment.

State House 2015Associated Industries of Massachusetts (AIM), on behalf of its member companies, supports H.1647, An Act relative to repealing the employer medical assistance contribution tax. We support an end to the two-year assessment imposed on employers to close a financial gap at the state’s MassHealth insurance program for low-income residents.

AIM believes the assessment is no longer necessary as employers last year paid tens of millions of dollars more than anticipated originally under the levy.

The prior, existing Employer Medical Assistance Contribution (EMAC) assessment increased from $51 to $77 per employee, and employers were required to pay up to $750 for each worker receiving public health benefits. By the time the EMAC assessment sunsets in 2019, Massachusetts businesses are on track to contribute $519 million instead of the $400 million envisioned under the 2017 legislation – or 30 percent more than originally estimated.

At the same time, enrollment in MassHealth has fallen as the administration has initiated steps to ensure that only those eligible for benefits receive them.

The Legislature passed the assessment in July 2017, minus a set of structural reforms proposed by the governor to place the MassHealth/Medicaid program on a firm financial footing. The assessment fell most heavily upon companies whose employees elect to use MassHealth rather than the employer-sponsored health plan.

AIM member employers are proud to lead the nation in providing health care coverage to their employees. Sixty-five percent of Bay State companies offer health insurance coverage to their workers, compared with 56 percent of employers nationwide. A full 100 percent of Massachusetts employers with 200 or more employees offer coverage.

As health-care premium and utilization costs continue to grow, employers have fewer options and less flexibility to keep year-over-year increases in check, raising important concerns about their ability to offer comprehensive insurance to their employees. Adding the cost of the state’s public health insurance program is not a sustainable financial plan, long-term.

Employers stand ready to work with policymakers to make comprehensive structural reforms to both the MassHealth program and commercial insurance markets to make the financing of health care for all Massachusetts residents sustainable this year and for many years to come.

Topics: Massachusetts Legislature, Health Care Costs, Health Insurance

Health Spending Moderates, But Employers Still Waiting to See Benefits

Posted by Katie Holahan on Feb 13, 2019 2:35:28 PM

Health-care spending in Massachusetts grew less than a key state benchmark and less than the national average during 2017, but employers and workers are not yet seeing the benefits.

health_careThe annual Health-Care Cost Trends Report issued today by the state Health Policy Commission (HPC) indicates that total per-capita health-care expenditures in Massachusetts rose 1.6 percent during 2016, significantly less than the 3.6 percent benchmark set by the commission. The Massachusetts growth rate also fell below the national rate - 3.1 percent – for the eighth consecutive year.

But the health-insurance premiums paid by Massachusetts employers and employees increased 5.8 percent in 2017, leaving the average total premium for employer-based coverage among the highest in the country at $21,000 per year for a family plan and $7,000 for a single employee. These figures do not include out-of-pocket spending such as co-payments and deductible spending, which grew 5.9 percent in 2017 for commercially-insured enrollees.

Premiums for smaller employers increased 6.9 percent and are now the second highest in the country, according to the HPC. Fifty-seven percent of small-firm (1-50 employees) employees are enrolled in high-deductible health plans.

“AIM-member employers told us in a recent survey that the rising cost of providing health insurance to employees is their biggest concern,” said Richard C. Lord, President and Chief Executive Officer of Associated Industries of Massachusetts and a member of the Health Policy Commission.

“The HPC report contains good news about health-care expenditures, but also underscores the need to look at issues such as price variations among doctors and hospitals that are driving up insurance premiums.”

Part of the reason that employers are not seeing more benefit from moderating health spending may be the fact that commercial insurers in Massachusetts pay higher prices to providers than Medicare pays for the same services. For hospital inpatient care, average prices among the three largest Massachusetts insurers were 57 percent higher than Medicare prices for similar patients ($15,913 versus $10,117, respectively).

Commercial insurers also paid considerably more for typical outpatient services, including brain MRIs, emergency department visits, and physician office visits.

The HPC attributed much of the overall increase health-care expenditures to spending on prescription drugs (4.1 percent) and hospital outpatient services (4.9 percent). The commission also found that medical bills can vary as much as 30 percent from one hospital or medical group to another with no measurable different in quality of care.

The HPC makes 11 policy recommendations to continue health spending moderation. Highlights include:

Unnecessary utilization: The Commonwealth should focus on reducing unnecessary utilization and increasing the provision of coordinated care in high-value, low-cost settings. Payers and providers should reduce the use of avoidable high-cost care such as emer­gency department (ED) visits, behavioral health-related ED visits, readmissions, use of teaching hospitals and academic medical centers for community-appropri­ate inpatient care, and institutional post-acute care by ensuring access to high-value, low cost settings, and for shifting care, as appropriate, to these settings.

Provider price variation: Policymakers should advance specific, data-driven interventions to address the press­ing issue of continued provider price variation in the coming year.

Alternative payment methods: The Commonwealth should continue to promote the increased adoption of alternative payment methods (APMs). Also, as part of a strategy to reduce spending, payers should develop plans to lessen the unwarranted disparities in global budgets paid to different providers by establishing stricter targets for spending growth for highly paid providers, by moving away from historical spending as the basis of global budgets, and by using bundled payments for certain care episodes where evidence has shown effectiveness.

Pharmaceutical spending: The Commonwealth should act to reduce drug spending growth. Specific areas of focus should include authorizing the Executive Office of Health and Human Services to establish a process that allows for a rigorous review of certain high-cost drugs, increasing the ability of MassHealth to negotiate directly with drug manufacturers for additional supplemental rebates and outcomes-based contracts, and increasing public transparency and public oversight for pharmaceutical manufacturers, medical device companies, and pharmacy benefit managers.

As a leader of the Massachusetts Employer Health Coalition, AIM is working with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members. Please check out our website for resources and information.

Topics: Health Care Costs, Health Insurance, Health Care

How to Help Employees Find Appropriate Health Care

Posted by Katie Holahan on Dec 11, 2018 3:10:01 PM

A coalition of employers led by AIM and the Massachusetts Taxpayers Foundation today unveiled resources to help employers speak to workers about the benefits of receiving medical care outside of hospital emergency rooms.

ER.2018The Massachusetts Employer Health Coalition plans to work with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members.

At a kickoff breakfast in Boston, Coalition officials previewed sample social media posts, newsletter articles and posters that employers might use to help employees obtain “the right care, in the right place at the right price at the right time.” Also among the resources is a document called “My Care, My Options” that allows workers to identify alternatives to emergency rooms, including their primary care physician, urgent-care center and retail clinic.

The Massachusetts Health Policy Commission says that one out of three Massachusetts residents who get health insurance through their employers reported that their last visit to an emergency room was for a non-emergency condition. The most common non-emergency conditions for which people seek treatment in the ER were neck pain, hives, sciatica, sinus infections and bronchitis.

Download the Employer Resources

Almost three-quarters of non-emergency visits to the ER are for care needed outside the normal operating house at the doctor’s office. The average visit to an emergency room costs $1,220, while the average bill for treatment at a doctor’s office is $165.

Companies such as AIM member Cummings Properties of Woburn have successfully worked with their employees for many years to create a system in which 80 percent of all medical care is delivered by high-quality community health organizations.

Bill Grant, CFO of Cummings, an AIM director and chair of the association's Health Care Committee, said the company also offers a wellness program that identifies issues such as high cholesterol that need additional attention.

But employers also acknowledge the challenge of communicating the importance of seeking care in appropriate settings.

“For us, it’s about communicating the value proposition for the individual employee…what’s in it for them,” said Lisa Collentro, Chief Administrative Officer, Chestnut Hill Realty another AIM member.

Employer coalitions in other areas of the country have already made progress curbing unnecessary use of emergency departments. Louise Probst, Executive Director of a regional health improvement collaborative serving the state of Missouri, and the St. Louis Area Business Health Coalition, told 150 people at this morning’s coalition kickoff that her organizations saw a 5 percent decrease in emergency-room visits from 2016 to 2017.

“There was a lot of shared interest” among employers, physicians, insurers, hospitals and others seeking to control the cost of health insurance, she said.

The St. Louis effort is paying measurable dividends,” Probst said:

  • Employers are talking about their emergency department usage rates and avoidable visits.
  • New worksite clinics are emerging, and roles of established clinics being reconsidered.
  • Primary care physicians are working with patients to develop alternatives to ER visits. Some medical groups have implemented condition-specific action plans for chronic diseases such as urinary tract infections or chronic obstructive pulmonary disease.
  • Two orthopedic practices have walk-in hours each evening.

The Employer Health Coalition is made up of 22 business organizations and five “strategic partners’ from the health-care industry.

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Launch Effort to Reduce Unnecessary ER Use

Posted by Katie Holahan on Dec 4, 2018 9:00:00 AM

A coalition of employers led by AIM and the Massachusetts Taxpayers Foundation will formally initiate a campaign on December 11 to moderate the cost of health care by reducing avoidable use of hospital emergency departments (EDs).

EmergencyThe Massachusetts Employer Health Coalition will work with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members.

The good news is that employer coalitions in other areas of the country have already succeeded in curbing unnecessary use of emergency departments. The Massachusetts groups plan to kick off their initiative on the 11th with a breakfast at which they will hear comments from Louise Probst, Executive Director of a regional health improvement collaborative serving the state of Missouri, and the St. Louis Area Business Health Coalition, an employer coalition supporting more than 60 leading, self-insured employers.

In addition to Ms. Probst, a panel including AIM members will discuss cost savings initiatives they have implemented, as well as the challenges to reducing health-care costs for both large and small employers.

Register for the Coalition Kickoff

“The rising cost of providing health insurance to employees remains the most pressing issue facing the 4,000 employers who are members of Associated Industries of Massachusetts,” said Richard C. Lord, President and Chief Executive Officer of AIM.

“The Massachusetts Employer Health Coalition is a great example of employers stepping up and taking action to ensure that their workers can access the right care in the right place, maximizing both health care quality and affordability.”

The objective, according to Lord, is to reduce health-care costs and provide rate relief for small businesses and patients, while optimizing resources to ensure quality care for those in need of emergency care.

Most ED use is necessary, appropriate, and in many cases life-saving. However, providers and payers broadly agree that shifting ED use for non-urgent health problems to more timely, appropriate settings will improve quality and patient experience, and lower the cost of care.

The cost of an ED visit can be five times that of care provided in a primary care or urgent care setting. Upper respiratory infections, skin rashes, allergies, and back pain are among the most common conditions for which Massachusetts patients seek care in the ED unnecessarily.

The Coalition is expected to use the December 11 event to unveil resources that employers will use to engage with their workers about the importance of seeking medical care in appropriate settings. These resources will include educational materials, along with procedures to help employers and employees identify local care options.

AIM plans to provide links to the resources for its employer members.

The Coalition plans to focus on four tactics for change:

  1. Educating Employees: Work with employers to communicate information about avoidable ED use with employees and families so they can get the best possible care in settings such as primary care practices, retail clinics, and urgent care centers.
  2. Learning from Data: Track and publicly report the rate of avoidable ED visits so employers, stakeholders, and the public may understand and tackle the scope of the issue.
  3. Collaborating Across the Health Care System: Work with labor unions, health care providers, health plans, employers, and employees to reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.
  4. Advocating for Policy Change: Advocate for policy changes that will advance new care delivery and payment models, such as Accountable Care Organizations (ACOs), telemedicine, and mobile integrated health, which combined, can improve access to timely care in the right setting.

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Face New HIRD Form Tomorrow

Posted by Katie Holahan on Oct 31, 2018 11:14:31 AM

Starting tomorrow, the Commonwealth of Massachusetts will implement a new Health Insurance Responsibility Disclosure (HIRD) form for employers.

Health.EnergyThe new form is different than the HIRD form established under the 2006 Massachusetts Health Care Reform law and later repealed in 2013. 

The purpose of the new HIRD form is to collect employer-level information about company-sponsored insurance offerings, to assist the state in identifying individuals with access to employer-sponsored insurance who may be eligible for MassHealth’s Premium Assistance Program.

MassHealth is the state's Medicaid health-insurance program for low-income residents.

This will help some employers to avoid the EMAC Supplement tax, while still ensuring comprehensive insurance coverage for employees.

  • Employers will have to complete the HIRD form once – annually, in November – detailing the health insurance benefits that they offer their employees.
  • The form will be accessible through the Department of Revenue’s MassTaxConnect online portal.
  • Employers have until November 30 to complete the form. There will be no penalty this year for employers who fail to complete the new HIRD form.

Unlike the old HIRD form, employees do not have to fill out the document. Only the employer is required to fill it out.

Here is an overview of the Premium Assistance Program and additional details for employers who are interested in the program.

Read HIRD Form FAQs

Need more information? Contact Katie Holahan at kholahan@aimnet.org.  

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Health-Care Costs Burden Small Employers

Posted by Jessica Bartlett on Oct 19, 2018 4:06:22 PM

Editor's Note - The following article appeared in the Boston Business Journal. It was written by reporter Jessica Bartlett and is re-posted here with permission.

health_careHealth care costs are hammering small employers, with premiums for small businesses coming in as the second highest in the country.

That's according to a report presented by the state’s health care oversight group, the Health Policy Commission, on Tuesday during the first day of the state’s annual Cost Trends Hearing. According to the data, small employers with fewer than 50 employees paid close to $8,000 for the average premium. Large employers in Massachusetts — those with more than 50 employees — paid closer to $7,000 for the average premium, the 10th highest in the U.S.

The U.S. average pegs average premiums at approximately $6,250 for both small employers and large employers.

Massachusetts premiums have gone up drastically since 2013, when the average for Massachusetts-based small and large businesses was close to $6,500. In 2013, the U.S. average for small and large employers was around $5,500.

“It’s tough to balance cost increases of 10 percent every year, and whether it’s premium increases… or increasing copays or deductibles, we don’t have the resources,” said Liora Stone, owner and president of Uxbridge-based Precision Engineering, Inc., who testified Tuesday morning as a representative of the state’s small business community.

Read the Full Article

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Announce Initiative to Reduce Health Costs

Posted by Katie Holahan on May 30, 2018 11:30:32 AM

AIM and 19 other prominent Massachusetts business organizations today announced an initiative to save $100 million in health care costs by reducing avoidable use of hospital emergency departments (EDs).

Health.EnergyThe newly formed Massachusetts Employer-Led Coalition to Reduce Health Care Costs will work with doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that 40 percent of ED visits are avoidable, a pattern that costs $300-$350 million annually for commercially insured members alone.

Coalition leaders Richard C. Lord, President and CEO of the Associated Industries of Massachusetts (AIM), and Eileen McAnneny, President of the Massachusetts Taxpayers Foundation (MTF), say the group will help employers take a direct role in the health and health care of their employees and beneficiaries.

(Read the full statement of the Massachusetts Employer-Led Coalition to Reduce Health Care Costs here).

Health care industry organizations – including the Massachusetts Health and Hospital Association (MHA), Blue Cross Blue Shield of Massachusetts (BCBSMA), the Massachusetts Association of Health Plans (MAHP), and the Massachusetts College of Emergency Physicians (MACEP) – are committed to be strategic partners with the Coalition.

The Coalition’s goal is to shift as many avoidable ED visits as possible to high-value, lower-cost settings to relieve crowded EDs, reduce the cost of care, and improve quality. The vision is a health care system that delivers the right care, in the right place, at the right time.

“The rising cost of providing health insurance to employees remains one of the most troublesome issues facing the 4,000 employers who are members of Associated Industries of Massachusetts,” said Lord.

“AIM has always been active in the health care policy arena, advocating for changes to our delivery system that balance access to care and efficiency. Today, we are taking this collaborative step to ensure that employers and their workers can access the right care in the right place, maximizing both health care quality and affordability.”

McAnneny stated, “As an organization dedicated to the long-term economic and fiscal health of the commonwealth, the Foundation recognizes the need to address the costs of health care by taking unnecessary cost out of the system. I am proud to co-chair this newly formed coalition that will provide employers with the tools they need to educate their employees on getting appropriate care at the appropriate setting.”

McAnneny added, “Not only will this reduce health care costs and provide rate relief for small businesses and patients, it also allows us to optimize resources to ensure quality care for those in need of emergency care.”

Most ED use is necessary, appropriate, and in many cases life-saving. However, providers and payers broadly agree that shifting ED use for non-urgent health problems to more timely, appropriate settings will improve quality and patient experience, and lower the cost of care. Upper respiratory infections, skin rashes, allergies, and back pain are among the most common conditions for which Massachusetts patients seek care in the ED unnecessarily and the cost of an ED visit can be five times that of care provided in a primary care or urgent care setting.

“For several years the HPC has identified reducing avoidable ED use as a target area for health care improvement and has recommended coordinated action to address it,” said David Seltz, Executive Director of the Massachusetts Health Policy Commission. “This new coalition represents an exciting commitment by employers to work collaboratively to address one of the underlying drivers of health care costs. We are excited to be a strategic partner in this effort, consistent with the HPC’s goal of reducing health care cost growth without compromising quality or access.”

The strategic partners, MHA, BCBSMA, MAHP, and MACEP, will engage with the Coalition in a collaborative process to uncover solutions and support changes in the health care delivery system. Additionally, the Coalition intends to engage collaboratively with other important health care stakeholders, including health plans, hospitals, physicians, consumer advocates, labor unions, government agencies, and community organizations.

The Coalition will focus on four tactics for change:

  1. Educating Employees: Work with employers to communicate information about avoidable ED use with employees and families so they can get the best possible care in settings such as primary care practices, retail clinics, and urgent care centers.
  1. Learning from Data: Track and publicly report the rate of avoidable ED visits so employers, stakeholders, and the public may understand and tackle the scope of the issue.
  1. Collaborating Across the Health Care System: Work with labor unions, health care providers, health plans, employers, and employees to reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.
  1. Advocating for Policy Change: Advocate for policy changes that will advance new care delivery and payment models, such as Accountable Care Organizations (ACOs), telemedicine, and mobile integrated health, which combined, can improve access to timely care in the right setting.

More details on the Coalition’s framework to reduce avoidable ED use are included in the statement here.

The Coalition was built and organized throughout the beginning of 2018, and plans to kick off its public activities in September. The rest of the major initiatives are planned to begin in early 2019. If successful, this collaborative effort will provide a model for future coordinated efforts to tackle other drivers of health care costs.

“I urge employers of any size to participate in the Coalition’s initiatives,” added Lord. “These efforts are an opportunity to engage with each other by sharing our successes and difficulties in managing health care costs – while also actively educating our employees about their ability to drive down health care costs through patient choice. We want to raise the bar for all employers in Massachusetts.”

The Employer Members of the Coalition are:

Associated Industries of Massachusetts
Associated Subcontractors of Massachusetts
Boston Municipal Research Bureau
Greater Boston Chamber of Commerce
Massachusetts Bankers Association
Massachusetts Business Roundtable
Massachusetts Competitive Partnership
Massachusetts Food Association
Massachusetts High Technology Council
Massachusetts Package Stores Association
Massachusetts Restaurant Association
Massachusetts Society of CPAs
Massachusetts Taxpayers Foundation
NAIOP Massachusetts
National Federation of Independent Business
North Shore Chamber of Commerce
Retailers Association of Massachusetts
South Shore Chamber of Commerce
Springfield Regional Chamber of Commerce
Worcester Regional Chamber of Commerce 

The Strategic Partners are:

Blue Cross Blue Shield of Massachusetts
Massachusetts Association of Health Plans
Massachusetts College of Emergency Physicians
Massachusetts Health and Hospital Association
Massachusetts Health Policy Commission

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

AIM to Senate - Control Health Costs, Reform MassHealth

Posted by Katie Holahan on Nov 8, 2017 11:50:22 AM

Editor's note - The following are excerpts of a letter that AIM sent to Senate President Stan Rosenberg and members of the Senate as they began debate on a health-care reform measure. The Senate passed its health reform bill last week.

Dear Mr. President and Members of the Senate:

After eleven years of universal health insurance, Massachusetts has made great strides to ensure our residents have access to some of the best health care in the nation and the world. Thus far, we have failed to make comparable progress in containing the cost of both health-care services and insurance for employers and their work forces.

MedicalRecordSmall.jpgMassachusetts residents are assured of access to high quality health care, without the assurance that they can afford it. Our complex, confusing health-care system leaves both consumers and employers at a disadvantage when it should empower them to advocate for their long-term health and productivity.

According to the most recent data available from the Centers for Medicare and Medicaid Services (CMMS), Massachusetts was the second highest-spending state for health care in 2014 shelling out 30 percent more than the national average. Personal health-care spending in Massachusetts, per capita, has increased more than 12 percent in five years – from $9,417 in 2009 to $10,559 in 2014.

Cost growth like this is unsustainable and has increased unabated in the face of attempts by both employers and the commonwealth to contain it.

Employers, especially smaller employers, have almost nothing to show in the way of cost savings and efficiencies five years after Massachusetts’ major push toward health-care cost containment. These cost increases are occurring in an industry in which experts agree that at least one-third of all care is unnecessary – delivered in the wrong setting; marked by a lack of coordination; provided with an inadequate emphasis on prevention; harmed by medical errors; burdened with rules and fraud; or just plain excessive.

We are pleased by the Senate’s focus on difficult and expensive issues like Massachusetts’ high re-admission rates, to encourage more efficient care focus on keeping consumers healthy and out of care settings. We also support the Senate’s efforts to include provider costs in the commonwealth’s efforts to track and contain year-over-year spending increases.

We would like to express our support for Amendment #38, filed by Senator Donaghue, and Amendment #67, filed by Senator deMacedo, both of which return assessments on carriers and providers to rate payers in the form of premium reductions. The most meaningful immediate health-care reform for employers and workers is a reduction in their monthly premiums.

With that in mind, we would urge careful consideration of any new policies, with particular focus on potential financial implications. A number of amendments have been filed that expand the mandated benefits required for coverage in Massachusetts. Although many health-care services are worthy, before acting to expand benefits we must understand the complete financial effects of any such changes, particularly since the Affordable Care Act requires that states pay for any mandated benefits enacted after December 31, 2011 in excess of the federally required essential health benefits.1

AIM would oppose the implementation of any new mandated benefits, without the completion of a fiscal analysis by the Center for Health Information and Analysis. The following amendments contain some form of expanded mandated benefit:

LettertoSenate.jpg

We should, instead be further supporting innovative products and practices that lower costs and encourage healthy habits and practices. We would like to express our support for Amendments #51 and 101, filed by Senators Moore and Timilty, respectively, to reinstate the Wellness Tax Credit for small employers.

AIM also supports Senator Moore’s Amendment #45, which would remove confusion about the definition of telemedicine and would allow licensed providers to prescribe certain medicines. We are supportive of facilitating market-based solutions that could help employers innovate and bring down costs.

However, in a state facing an alarming deficit in its Medicaid program, employers are now shouldering the escalating costs of the public healthcare system. For the next two years, employers statewide will provide at least $200M annually in funding for MassHealth. This is in addition to the cost and administrative burden of providing commercial health insurance to their workers.

Most importantly, employers are tasked with closing a funding deficit absent any of the long-term structural reforms needed to solve the underlying financial problems with the program. Over the past eleven years, employers have implemented wellness programs, purchased innovative insurance products, embarked on employee educational programs – all with the goal of providing higher quality insurance that keeps their employees healthier and costs lower.

The same cannot be said of the public health insurance program. We oppose any amendments that expand the current MassHealth program, including Amendments #2, 93, and 153. Regardless of enrollment rates, action must be taken to improve the efficiency and cost-effectiveness of this currently unsustainable program. The result will not be simply cost reductions, but higher quality of care for enrollees in the long term.

Thus, we express our support for Amendments #74 and #122, filed by Senator Tarr, which not only eliminate the buy-in option for MassHealth, but also provide a framework for efficiently determining eligibility so those who truly need it can access much-needed health-care services.

We would like to voice our strong support of Amendment #57, filed by Senator deMacedo, which would eliminate the so-called Name and Shame list.

The Affordable Care Act (ACA) reversed existing Massachusetts law and now allows income-eligible employees to decline employer coverage and seek insurance through MassHealth. That change created a migration of newly eligible individuals to MassHealth, substantially increasing the Commonwealth’s financial burden. The ACA made public health insurance an economically rational choice for eligible residents in a state known for its expensive health-care system, and employers should not be publicly shamed for a choice they cannot control.

As MassHealth enrollment grows, the commonwealth experiences the reality that employers have faced for years: the high cost of health-care coverage in this state threatens the underpinnings of our economy. Policymakers who have concentrated almost exclusively on access and coverage now face a renewed imperative to lower the cost of health insurance for everyone in Massachusetts.

We are active participants in providing health insurance to the majority of residents in the commonwealth, a role that we have played for the past 10 years and more. It is an integral part of the Massachusetts economy and we look forward to working with you to bring the same level of innovation and sustainability to health care coverage, traits which Massachusetts is known for worldwide.

Topics: Health Care Costs, Health Insurance

Health Reform Must Address Employer Costs

Posted by Katie Holahan on Oct 24, 2017 11:33:45 AM

Associated Industries of Massachusetts (AIM) is pleased that the state Senate on Monday conducted a hearing on a proposal to address the challenging issue of healthcare affordability. The primary question for AIM in evaluating any such proposed legislation is whether it eases the burden of employers struggling to provide good health insurance to workers.

health_care.jpgIn 2006, employers joined with doctors, hospitals, patient advocates, and lawmakers to forge a health-reform law that required everyone to share the responsibility for improving access to health care. Eleven years later, Massachusetts residents enjoy the highest levels of health-insurance coverage in the nation.

Yet we have failed to make progress to contain the unsustainable increases in health-care costs.

According to the most recent data available from the Centers for Medicare and Medicaid Services (CMMS), Massachusetts was the second highest-spending state for health care in 2014, shelling out 30 percent more than the national average.

Personal health-care spending in Massachusetts, per capita, has increased more than 12 percent in five years – from $9,417 in 2009 to $10,559 in 2014. Cost growth like this is unsustainable and has increased unabated in the face of attempts by both employers and the commonwealth to contain it.

Businesses, in fact, have almost nothing to show in the way of cost savings and efficiencies five years after Massachusetts made a major push toward health-care cost containment in 2012. The commonwealth has exceeded the 3.6 percent spending growth benchmark established as part of the health-cost control law of 2012 in two of the past four measurement periods.

Total Health Care Expenditures (THCE) grew by 4.2 percent from 2013 to 2014, and by 4.1 percent from 2014 to 2015. These cost increases are occurring in an industry in which experts agree that at least one-third of all care is unnecessary – delivered in the wrong setting; marked by a lack of coordination; provided with an inadequate emphasis on prevention; harmed by medical errors; burdened with rules and fraud; or just plain excessive.

Massachusetts employers have strong ideas about some of the policies included in the draft Senate health-reform legislation:

MassHealth Reforms

In a state facing an alarming deficit in its Medicaid program, employers are currently shouldering the escalating costs of the public health-care system. For the next two years, employers statewide will provide at least $200 million annually in funding for MassHealth in addition to the cost of providing commercial health insurance to their workers.

More importantly, employers are being asked to close a funding deficit absent any of the long-term structural reforms needed to solve the underlying financial problems with the program. Action must be taken to improve the efficiency and cost-effectiveness of this currently unsustainable program.

Optional expanded Medicaid plan

AIM must raise grave concerns with the notion of expanding the MassHealth program through an optional Medicaid plan (SECTION 123) without first addressing existing policies that encourage and sustain needlessly expensive health-care habits.

Employers have long sought to contain costs in commercial health insurance by encouraging cost-effective habits like relying on primary care physicians for non-emergency care. The same cannot be said for the MassHealth program. The inappropriate use of emergency rooms is an example of one major cost driver identified by the Health Policy Commission. To contain costs and facilitate coverage, we must address our greatest cost-drivers in health-care utilization across the entire spectrum of both commercial and public health insurance before we implement any sort of further programmatic expansion.

“Name and Shame” List

AIM also opposes the so-called “Name and Shame” list (SECTION 38), highlighting employers with workers in the MassHealth program. The 2006 health-reform law made employees who were offered employer-sponsored health insurance ineligible for MassHealth. The intent was to balance the requirement that employers do their “fair share” with concerns about the financial burden on the MassHealth system.

The Affordable Care Act (ACA) reversed that policy and allowed income-eligible employees to decline employer coverage and seek insurance through MassHealth. The change created a migration of newly-eligible individuals from their employer-sponsored insurance to MassHealth, substantially increasing the commonwealth’s financial burden. The ACA made public health insurance an economically rational choice for eligible residents in a state known for its expensive health-care system.

Provider Price Variation

Provider price variation includes both reasonable and unreasonable variation in the pricing of health care services. Reasonable variation in pricing should be supported and limited by a transparent marketplace in which consumers have access to clear cost and quality metrics. By mandating a minimum increase in provider prices (SECTION 111) without alleviating existing high-cost drivers, we facilitate the continued increase in price variation without seeking to understand and differentiate among the cost-drivers that result in both reasonable and unreasonable price variation.

Innovative Insurance Products

While we support market-based solutions through innovative insurance products like limited and tiered-network products, we are concerned that the differential limitations alone will be insufficient to leverage this new approach. Without a requirement that all providers participate in the contracting for such products, insurers will not always have the negotiating power to construct products in all regions of the commonwealth.

Scope-of-Practice Expansions

AIM supports the various scope-of-practice expansions included in the draft legislation. Expanding access to vital care from qualified providers for all residents of the commonwealth is a common-sense reform that helps to move us closer to a healthcare system that is efficient and effective.

Telemedicine

AIM supports the inclusion of telemedicine services (SECTION 94) to facilitate innovative, cost-effective health-care services for consumers across the commonwealth. Telemedicine services could provide additional care options for consumers with limited access, preserve productivity, and reduce time lost traveling great distances to providers. A vital component of this policy is requirement that payment for telemedicine services cannot exceed the costs related to an in-person visit. We must prioritize innovative policies that both increase access and decrease costs for residents statewide. Telemedicine should and could do exactly that.

AIM-member employers are active participants in providing health insurance to the majority of residents in the commonwealth. Moderating the cost of that insurance and putting health care on a financially sustainable business is critical to the future of the Massachusetts economy.

Please contact me at kholahan@aimnet.org if you would like to be updated on the progress of health reform in Massachusetts.

Topics: Massachusetts senate, Controlling Health Care Costs, Health Insurance

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