Single Payer; A Busy Week at the State House

U.S. Department of Justice Files Court Brief on Overturning ACA

The Trump Administration on May 1 argued in a federal court brief that the entire Affordable Care Act (ACA) should be struck down. The administration had signaled its intention to gut the ACA in a one-page filing in late March; last week’s 50-page brief contains the details of its argument.
A group of ACA defenders – including the Democratic-controlled U.S. House of Representatives and state Attorneys General, including the Bay State’s AG Maura Healey – have 21 days to respond to the U.S. Department of Justice filing.
Oral arguments before the Fifth Circuit Court of Appeals in New Orleans are expected in July and the case may be decided before the end of the year. Whatever the decision, it is likely to be appealed before the U.S. Supreme Court.
Tens of millions of people would lose health insurance coverage if the ACA is struck down. The Trump Administration has not come up with an alternative coverage plan, but the president tweeted in April that a “really great” one is in the works and that a vote on it will occur after the 2020 election.

Medicare for All: Tens of Trillions and Cuts to Providers

The U.S. House held its first ever “Medicare for All” hearing on April 30 before the House Rules Committee, chaired by Massachusetts Representative Jim McGovern (D). The House Ways & Means Committee, chaired by Chairman Richard Neal (D-Mass.), also announced it would hold a Medicare for All hearing at some point.
In his opening remarks, McGovern said the hearing was the beginning of a process to expand healthcare coverage to all Americans and that the bill being debated – H.R. 1384, The Medicare for All Act of 2019 from Rep. Pramila Jayapal (D-Wash.) – would guarantee that people with disabilities receive the care they need and would improve the life of countless individuals.
But Ranking Member Tom Cole (R-Oklahoma) said Medicare for All would result in higher taxes for everyone and result in millions of Americans being moved off their employer-sponsored plans. He also said H.R. 1384 would enroll millions of younger individuals into the Medicare program even though they have not fully contributed to the Medicare Trust Fund.
The witnesses were also split on the benefits of the sweeping healthcare legislation. Dr. Charles Blahous, a senior research strategist for the Mercatus Center at George Mason University, said Medicare for All would cost between $32 and $40 trillion over a 10-year period. He also noted that H.R. 1384 would increase total healthcare spending to $50 or $60 trillion over 10 years, with those cost increases driven by the coverage of new services and an expected uptick in utilization. He also projected that hospital payments would be reduced by 40% while physician payments would decline 42%.
Dr. Dean Baker, senior economist, Center for Economic and Policy Research, said H.R. 1384 could lower administrative costs because providers would only have one payer to manage. He said that after incorporating the elimination of administrative costs, the bill would cost approximately $25 trillion over 10 years. He also said there could be significant potential savings from reforming the way healthcare is delivered and purchased by high-cost patients. Dr. Baker added that Congress could lower healthcare costs by eliminating the patent protections for prescription drugs and lowering Medicare payment rates to providers.
Many healthcare interests, including MHA, have argued that defending and shoring up the Affordable Care Act is the more important current healthcare option.

CBO Weighs in on Single-Payer

The Congressional Budget Office (CBO), best known for putting a price tag on various legislative proposals, has released a new report that describes the primary features of a single-payer system as well as some design considerations Congress would have to take into account when creating one – but it does not delve into the question of its cost.
Key Design Components and Considerations for Establishing a Single-Payer Health Care System states, somewhat obviously, that changing the current system to a new single-payer system would result in shifting expenditures from private to public sources. That would “significantly increase government spending and require substantial additional government resources. The amount of those additional resources would depend on the system’s design and on the choice of whether or not to increase budget deficits.”
Administrative costs would probably be lower, but demand for services would be higher, the report concludes, adding, “Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system, such as provider payment rates."

The report notes that about 70% of U.S. hospitals are privately owned. A single-payer system “could retain current ownership structures, or the government could play a larger role in owning hospitals and employing providers,” the CBO wrote, noting that the government would then “have more control over the healthcare delivery system, but it would also take on more responsibilities.”
The CBO clearly does not provide any concrete answers about a proposal that represents one of the most comprehensive changes to the U.S. economy. But its 30-page report does paint a broad picture of the topic.

Senate Proposed Budget Due Tomorrow

The governor released his proposed state budget in January and the Massachusetts House passed its $42.7 billion budget in April. Now, it’s the Massachusetts Senate’s turn. On Tuesday, the Senate is expected to release its proposed budget, with amendments to it due by Friday, May 10.

Legislature in Full Swing with Healthcare Hearings, Bills

In addition to the State Senate releasing its proposed budget tomorrow, a series of committees with jurisdiction over the healthcare sector are holding hearings on Tuesday – and each has a slew of bills of interest to hospitals.
The Joint Committee on Health Care Financing is meeting in Gardner Auditorium at 10:30 a.m. Among the 30 bills before it are ones concerning price variation, funding for disproportionate share hospitals, the financial stability of the Health Safety Net, MassHealth reimbursement rates, transparency of facility fees, and administrative burdens.
The Joint Committee on Financial Services is meeting at 10:30 a.m. in Room A-2 to hear testimony on bills relating to surprise billing, out-of-network billing, retroactive insurer claw-backs for behavioral health services, and transparency of insurer provider networks, among many other topics.
The Joint Committee on Public Health, meeting at 1 p.m. in Room B-1, will hear testimony on, among other things, the establishment of a mid-level dental practitioner known as a dental therapist, reauthorization of the Prevention & Wellness Trust Fund, and a number of other bills that the committee has previously given favorable reports to.
And the Joint Committee on Revenue, meeting in Room B-2 at 1 p.m. will be looking at an MHA priority bill – H.2529, An Act to Promote Healthy Alternatives to Sugary Drinks, filed by Rep. Kay Khan (D–Newton).


Carolyn Jackson is the new CEO of Tenet Healthcare’s Massachusetts market, which includes MetroWest Medical Center (with its Framingham Union and Leonard Morse campuses), and Saint Vincent Hospital in Worcester. She will also serve as CEO of Saint Vincent Hospital. Jackson is currently chief operating officer for the Hospital of the University of Pennsylvania. She received a bachelor’s degree in chemical engineering from the University of Delaware in Newark and an MBA from Harvard Business School. She begins her new duties on May 20.
David R. Lincoln retired as president and CEO of Covenant Health on April 26 and has been replaced by Stephen J. Grubbs, who has served as Covenant’s CFO since September 2018. Lincoln had served as president/CEO since Covenant Health’s founding in 1986. Grubbs earned his undergraduate degree in accounting from the University of Kentucky and his MBA from Bethel University.

TeamSTEPPS Master Training Class

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. It has become the gold standard in healthcare team training. The Master Training Course is a two-day, in-person course with a train-the-trainer approach. It educates participants on TeamSTEPPS Fundamentals, provides them with resources for training others, and ensures that they gain the knowledge and training required to implement and coach the behaviors needed to achieve positive results. The course will be taught by Karyn Baum, M.D., professor of Medicine & Interim Chief Medical Officer, University of Minnesota Medical Center, and Master TeamSTEPPS Trainer. We encourage hospitals to send three or more individuals to the trainings. The classes take place Wednesday, July 10 & Thursday, July 11, from 8 a.m. to 4:30 p.m. at MHA Conference Center, Burlington, Mass. Learn more here.

John LoDico, Editor