\u201cHealth care is too difficult and too expensive for far too many people,\u201d said Healey, who has made affordability a key issue on the campaign trail in her reelection bid. \u201cSo we are taking the most comprehensive action in the country to make it faster, cheaper, and easier to get the care you need.\u201d <\/p>\n
Healey also announced a new working group focused on health care affordability that will include leaders in business, health care, insurance, and labor.<\/p>\n
The announcement is the second Healey has made around health care in the last two weeks that she has positioned as \u201cnation leading,\u201d to some skepticism. Last week, she announced that a $250 million state trust fund would help Massachusetts residents<\/a> confronting skyrocketing premiums for insurance from the Affordable Care Act marketplace.<\/p>\n Healey unveiled the changes at a time when she and Democrats nationwide are building their reelection efforts on a promise to make life more affordable for residents. Healey ran on a similar vow four years ago, and as she fends off Republican challengers who\u2019ve hammered the state\u2019s high cost of living<\/a>, she has repeatedly elevated her efforts to address it, be it through the trust fund, a 2023 tax relief package<\/a> she signed, or a sweeping housing law<\/a>.<\/p>\n The new Health Care Affordability Working Group will be led by former Health and Human Services Secretary and former Boston Medical Center CEO Kate Walsh as well as Lisa Murray, Massachusetts state president at Citizens Bank.<\/p>\n Updated insurance regulations would effectively eliminate the prior authorization approvals for emergency and urgent care services, primary care, chronic care, occupational and physical therapy, and certain prescription drugs. <\/p>\n The new regulations would also require insurers to respond to urgent requests within 24 hours, and patients\u2019 care isn\u2019t disrupted when they switch insurance plans.<\/p>\n The regulations will apply to all insurers that do business in Massachusetts, however would not apply to \u201cself-insured\u201d employers that pay health care claims directly \u2014 the majority of the commercial market. That means most large employers could still choose to require prior authorizations in the areas Healey has restricted.<\/p>\n The shifts will make a meaningful difference to some patients. For example, a patient with diabetes will no longer need a prior authorization for any service, state officials said, including devices and drugs associated with their chronic disease. <\/p>\n For other patients, the changes may be less consequential. The regulations solidify commitments many insurers have already made<\/a> around prior authorization, or they restrict things that may not often occur.<\/p>\n For example, the state\u2019s largest insurer, Blue Cross Blue Shield of Massachusetts, does not have any prior authorizations currently for inpatient acute care, urgent care, emergency care or primary care. <\/p>\n Additionally in June, a slate of insurers \u2014 including the state\u2019s two largest, Blue Cross Blue Shield of Massachusetts and Point32Health \u2014 announced commitments to reform prior authorizations. Among the changes: when a patient\u2019s insurance changes during a course of treatment, the new plan would honor existing prior authorizations for equivalent, in-network services for 90 days instead of immediately requiring a new one.<\/p>\n The new regulations seem to codify that approach. Under the updated rules, Healey\u2019s team said a patient with rheumatoid arthritis who has an existing authorization for treatment but who switched to a new insurer will have the approval honored for at least three months. <\/p>\n Standardizing and restricting prior authorization use will improve access to care and lower health care spending, as hospitals and providers won\u2019t have as much administrative burden, the administration said. The Council for Affordable Quality Healthcare, based in Washington, D.C., said the health care industry nationwide spent $1.3 billion on administrative costs related to prior authorizations in 2023 \u2014 a 30 percent increase from the previous year. <\/p>\n Other analyses, however, have suggested prior authorizations help constrain health care spending. A 2023 report<\/a> by Milliman, commissioned by the insurance trade group the Massachusetts Association of Health Plans, said eliminating prior authorizations would lead to increases in health care spending by $600 to $1,500 per member annually.<\/p>\n \u201cPrior authorization is not merely an administrative process; it is a core affordability safeguard that promotes evidence-based care, curbs unnecessary utilization, and protects patients and purchasers from avoidable costs,\u201d said Lora Pellegrini, the association\u2019s CEO, in a news release. <\/p>\n Regardless, the changes will be significant for some patients. <\/p>\n At Healey\u2019s news conference, a patient identified only as Melissa described trying to access a critical drug after being diagnosed with a serious autoimmune neurologic illness. The disease caused significant weight loss, cognitive dysfunction, hormonal disruption, damage to her tissues, and the shutdown of her basic bodily functions. While she waited three months for insurance approvals, her condition deteriorated. She teared up as she recounted the permanent harms the disease caused to her body and functioning during to the wait.<\/p>\n \u201cFor a patient in the world of neurology, [with an] illness like mine, three months is like three years,\u201d she said. \u201cWhy do I have to wait those three months and suffer that damage?\u201d <\/p>\n Dr. Paul Hattis, a senior fellow with the health care think tank the Lown Institute, noted that prior authorizations aren\u2019t going away in their entirety, and questioned how much health care spending would increase or administrative burdens would be reduced just by doing away with approvals in these specific areas. But he applauded what the changes would mean for consumers, whose care would no longer be complicated by delays.<\/p>\n \u201cQuite frankly, I\u2019m not sure there is so much cost savings associated with this decision as there is support for care needs of consumers,\u201d he said. <\/p>\n Healey\u2019s new working group will also develop proposals to make health care more affordable.<\/p>\n The group\u2019s members are lengthy, featuring representatives from a number of state agencies along with a bevy of trade groups, including the Massachusetts Health and Hospital Association, Massachusetts Medical Society, Massachusetts League of Community Health Centers, Massachusetts Biotechnology Council, Massachusetts Nursing Association, and the Massachusetts Association of Health Plans. Business groups from the Retailers Association of Massachusetts and the Massachusetts Business Roundtable are also members. <\/p>\n Healey suggested the group would get to work right away, saying she hoped to have some recommendations by June.<\/p>\n The state has previously created similar task forces focused on health care issues, with middling results. The Provider Price Variation Group was formed in 2016 to look at the different reimbursements health systems received for the same services. Though a report<\/a> was produced, little change occurred. <\/p>\n The state\u2019s health care watchdog, the Health Policy Commission, has spent over a decade studying and recommending legislative changes to reform health care and control ever-rising spending, with varied success.<\/p>\n Though the new group seemed to be the latest looking at health reform, Hattis was optimistic the work would finally result in real change.<\/p>\n \u201cIt will be different this time,\u201d Hattis said. \u201cThe affordability challenges now are so great and getting greater that I don\u2019t see how our Legislature can rationally sit by and do nothing and say they are doing the work needed on behalf of the Commonwealth.\u201d<\/p>\n Globe reporter Matt Stout contributed to this reporting.<\/p>\n Jessica Bartlett can be reached at jessica.bartlett@globe.com<\/a>. Follow her @ByJessBartlett<\/a>.<\/p>\n