Governor Charlie Baker of Massachusetts ordered a new probe into the health insurance market. Under executive order 589, the new Merged Market Advisory Council will gather and verify information about insurance rates, producing a helpful report for lawmakers to adjust insurance legislation.
The report is due on April 30, 2020.
The Council
The newly formed council consists of 13 members, 10 of them experts in the health insurance industry. This report’s entire purpose is to give an overview of the merged market based on analysis to “ensure the long-term stability of coverage for individuals and small employers in the merged market and the affordability of insured health benefit plan products offered therein.” (No. 589 Merged Market Advisory Council)
To help balance the report and keep it truthful, the council members will operate by considering:
- The general stability of the merged market risk pool
- Trends correlating with the risk pool and their impacts on premiums
- What drives health care costs to increase
- Policies that threaten market stability
- Strategies to help keep market costs down
Why It Was Formed
Baker supported his own recommendation for a fact-finding committee by arguing for the complex nature that the market presents. No two people have the same view of it, and it gets even murkier as you talk to both providers and the people purchasing the premiums.
Essentially, Massachusetts’ hospitals, physician groups, and insurers will report their spending on primary care and behavioral health to the state agency. The projected spending increase in these areas is 30% over the next three years, an unreal amount considering the state’s cap on spending is 3.1% annually.
Hospitals are already in a losing situation here, with those two healthcare options losing money for them, especially behavioral health. They just don’t provide the same insurance reimbursement as the more sensational options like cancer.
The bill will also touch on drug prices. After review, state representatives can place regulations on predatory prescription drug practices like:
- Gag rules, preventing patients from hearing about cheaper drug options
- Drugmakers who charge more annually than the 2% inflation can keep up with
- Any drug that costs someone $50,000 or more
The Results
If lawmakers are to better understand ways to improve insurance legislation (specifically to help with rapidly increasing healthcare costs), the first step is to compile accurate information for how the market is affected.
The creation of this council instills hope in Massachusetts’ citizens. Informed decisions are how our government should operate. With such a convoluted case like insurance, an advisory council will provide verified facts to create a better healthcare system, with more satisfied individuals.
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