Massachusetts has long led the way on health care legislation, passing a 2006 law that required residents to have health insurance and a 2012 law that sought to rein in cost increases.
Advocates, elected officials and medical professionals pitched state lawmakers Wednesday on legislation they said should be the next step on that journey: a package of policies intended to make the health care system more equitable and knock down structural barriers to care.
"We have a health care system that is a leader in the world, yet it is not accessible to all, especially to brown, Black and Asian populations," state Rep. Judith Garcia of Chelsea said.
Garcia joined three other members of the Black and Latino Legislative Caucus — Rep. Bud Williams, Sen. Pavel Payano and Sen. Liz Miranda — to testify in support of a multipronged health equity bill they jointly filed.
Several of the bill's provisions would directly affect patients and providers. It would extend full MassHealth coverage to all eligible residents regardless of immigration status and boost funding for safety net hospitals.
The bill also aims to build a more diverse health care workforce and to lower cost for certain medications that treat chronic conditions disproportionately affecting people of color.
Michael Curry, who leads the Massachusetts League of Community Health Centers, cited a Blue Cross Blue Shield of Massachusetts Foundation report that tallied the economic toll of racial and ethnic health inequities — including loss of productivity, avoidable medical spending and premature deaths — at an annual $5.9 billion.
The bill is backed by a group called the Health Equity Compact, a coalition of more than 80 leaders of color across health care institutions, charities, businesses, academia and other organizations.
"This is unprecedented in Massachusetts, not only because we have never seen this number of high-ranking Black and brown leaders in the commonwealth with the ability to bring their lived experiences to drive internal and external policy, but also because this broad group — arguably even broader than the coalition behind Chapter 58 in 2006; I was there — are working across their individual interests to advance health equity," Curry said, referring to the 2006 law mandating health insurance coverage.
The Legislature’s Health Care Financing Committee solicited testimony on the Compact-backed bill along with others involving equity issues, including legislation aimed at preventing discrimination against patients with disabilities.
Sen. Cindy Friedman, an Arlington Democrat who co-chairs the committee, opened up the hearing by acknowledging the topic as a “big conversation.”
“And it's time that we get very, very serious about addressing the issues that have been before us for so long,” Friedman said. “The disparate health outcomes we see and experience are preventable. The structural barriers to health care are breakable and discrimination in any form is unconscionable.”
After hearing comments in support of the omnibus health equity bill from Curry and Dr. Assaad Sayah, Friedman said she has some concerns with it.
“There's a lot of bureaucracy in this bill, and bureaucracy worries me because we can spend a lot of time on the bureaucracy and then we have not a lot to show,” Friedman said. “We have a lot of accountability in here, and we know throughout the years that we’ve learned how good people are checking boxes and say[ing], ‘Yes, we do that.’”
She mentioned to the data-collection requirements and proposed equity secretariat, and questioned why officials should go that route instead of taking steps like awarding more funding or mandating changes in education and workforce development.
Sayah responded that health equity has been “an afterthought” across different levels of governance, and the bill would bring it to the forefront.
“It needs to be a voice that's coming from inside at every list, in every conversation,” he said.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said insurers are “ready to work with the Legislature, Compact members and our provider and community partners to advance health equity in the Commonwealth.”
She praised some parts of the bill — like the creation of a cabinet-level health equity office and reporting on health equity data — but raised concerns that other components could make health care more expensive. Specifically, Pellegrini pointed to language that would permanently require insurers to reimburse for telehealth services at the same rate as in-person care for primary care visits and chronic disease management.
The Health Care Financing Committee can choose whether to advance the equity bill to the full Legislature, or could also put forward a rewritten version.
Attorney General Andrea Campbell testified that it’s a priority for her to see a “robust” health equity bill pass.
“The challenges we are confronting — unequal access to care, maternal health disparities, systemic racism affecting the health of our communities — are nothing short of a public health crisis,” she told the committee.
