Massachusetts "Fair Healthcare Pricing" Initiative (2016)
| Massachusetts "Fair Healthcare Pricing" Initiative | |
|---|---|
 | |
| Election date November 8, 2016 | |
| Topic Healthcare | |
| Status Not on the ballot | |
| Type State statute | Origin Citizens |
| Not on Ballot |
|---|
 |
| This measure was not put on an election ballot |
The "Fair Healthcare Pricing" Initiative did not make the November 8, 2016, ballot in Massachusetts as an initiated state statute.
The measure would have regulated non-government health insurance plan payments to healthcare providers. It would have ensured that payments were no more than 20 percent above or 10 percent below the average price paid to providers by that health plan for a certain medical service.[1]
Supporters of this initiative halted signature collection after the Massachusetts State Legislature passed compromise legislation in late May 2016. The legislation created "a new fund with $45 million over five years, distributed in a way that hospitals that charge lower prices to insurers will get more money."[2]
Petitioners were collecting signatures for a similar measure, the "Equitable Healthcare Pricing" Initiative, that would have ensured that payments be more than 20 percent above or 20 percent below the average price paid to providers. This measure also did not make the ballot.
Text of measure
Petition name
The petition name was as follows:[1]
| “ | Massachusetts Fair Health Care Pricing Act[3] | ” |
Ballot summary
The ballot summary was as follows:[4]
| “ | This proposed law would regulate the payments made by any non-government health insurance plan to health care providers for each medical service such that those payments would be no more than 20% above or 10% below the average price paid to all such providers by that health plan for that medical service.
The proposed law defines “health care provider” as an acute-care hospital and its contracting agents. The proposed law would require each health plan to calculate the relative price that it has agreed to pay health care providers for each medical service on a statewide basis and by provider type. A “relative price” is generally calculated by dividing the price paid to a particular provider for a medical service by the average price paid to all providers for that service. Health plans would report their relative prices to the state Division of Insurance on an annual basis, and the Division would publish this relative price data. The proposed law would prohibit any health plan from entering into or renewing any contract with a provider under which the provider would be paid a price for a medical service greater than 20% above the average relative price paid by that health plan for that service. This provision would not apply to specialty hospitals (such as pediatric or oncology hospitals), geographically isolated hospitals (defined as the sole acute-care hospital within a 20-mile radius), and hospitals that derive at least 63% of their patient revenue from government programs like Medicare and Medicaid. The proposed law would also prohibit any health plan from entering into or renewing any contract with a health care provider where the provider is paid a price for a service that is less than 10% below the average relative price paid by that plan for that service. The proposed law would take effect on January 15, 2017, but would apply to contracts entered into or renewed after July 1, 2016. The proposed law would require providers to furnish covered services as a condition of licensure and to accept payments consistent with the proposed law. Providers would be prohibited from billing the recipient of services for any additional amounts the provider would have received without the proposed law. Providers could not refuse to participate in a health plan’s provider network due to the plan’s compliance with the law. If a provider does not participate in a health plan’s network, but provides out-of-network services, it would have to accept payment at the health plan’s average relative price. The proposed law would require any net savings realized by health plans attributable to this proposed law, beyond the cost of complying with its price regulations, to be reflected in reduced health plan premiums, co-pays, and deductibles charged to the plan’s subscribers and would require the Division of Insurance to issue regulations concerning this requirement. The proposed law would prohibit providers whose prices are reduced as a result of the proposed law from charging more to other health plans or payers as a result and would authorize the state Attorney General to issue regulations on this point. The proposed law would establish a process for providers to apply to the Division of Insurance for an annual exemption. The Division could consider, among other things, health care costs, the financial condition of the provider, and patient access to the provider’s services. The proposed law would require the Division of Insurance to annually publish hospital price information as well as quality scores for hospitals. The proposed law also would require the Division to conduct an annual study on the impact of the proposed law. The proposed law states that, if any of its parts were declared invalid, the other parts would stay in effect.[3] |
” |
Full text
The full text of the measure can be found here.
Support
The union-led Campaign for Fair Care is leading the support for the initiative.[5]
Supporters
- Service Employees International Union 1199 United Healthcare Workers East[5]
- Ralph de la Torre, president and CEO of Steward Health Care[6]
Arguments in favor
Tim Foley, who filed the initiative, said in a release:[7]
| “ | Massachusetts consumers will save hundreds of millions of dollars on insurance premiums each year by reining in expensive medical centers through the Massachusetts Fair Health Care Pricing Act. The bill will also provide a major boost to community hospitals, which provide excellent patient care and are major economic engines for Massachusetts cities and towns. ... Across the Commonwealth, voters recognize that their communities are at risk of losing more of these vital institutions unless we take immediate steps to rein in excessive payments to a few large, expensive medical centers. That’s why healthcare workers are excited to see an overwhelmingly supportive response, so far has yielded more than the signature threshold necessary to ensure the petition reaches the ballot.[3] | ” |
State Sen. Benjamin Downing (D) said,[8]
| “ | We ought to reject the idea that the status quo is sustainable. ... It doesn’t make any sense to me that if the quality outcomes are the same in a community hospital and academic hospital that they should be paid differently.[3] | ” |
Kim Bassett, president of Norwood Hospital, said,[8]
| “ | Let me be clear, I am not asking the Legislature to increase hospital rates. I am urging the Legislature to level the playing field and give community hospitals a fair chance to compete with large, high-priced hospitals and physician groups who offer the same quality of care that community hospitals offer, yet are reimbursed at vastly higher rates than local hospitals.[3] | ” |
Ralph de la Torre, president and CEO of Steward Health Care, said,[6]
| “ | For now, I’m with the ballot initiative because it’s the only solution out there. ... If someone presents another solution, then I’ll evaluate that. But for right now, I’m having to choose between what may be an imperfect solution and no solution, and we need a solution. | ” |
Opposition
Opponents
Individuals
- Gov. Charlie Baker (R)[5]
Organizations
Arguments against
Lora Pellegrini, president of the Massachusetts Association of Health Plans said,[8]
| “ | While well intentioned we do not believe any initiative petition is the appropriate mechanism to decide public policy. ... We believe action may be necessary at the legislative level to address market dysfunction.[3] | ” |
Path to the ballot
Supporters had until December 2, 2015, to submit at least 64,750 valid signatures. A total of 68,755 signatures were submitted to the secretary of state's office and were certified mid-December 2015. The proposal was then put before the Legislature. May 3, 2016, was the deadline for the legislature to take action on the initiative.[10][11]
The legislature did not enact this initiative. To qualify it for the November 2016 election ballot, petitioners needed to collect another 10,792 signatures and submit them to local clerks by about June 22, 2016, so that the petitions could be submitted to the state by a legal deadline on July 6, 2016.[12]
Supporters suspended signature collection after the Massachusetts State Legislature passed compromise legislation in late May 2016.[2]
State profile
| Demographic data for Massachusetts | ||
|---|---|---|
| Massachusetts | U.S. | |
| Total population: | 6,784,240 | 316,515,021 |
| Land area (sq mi): | 7,800 | 3,531,905 |
| Race and ethnicity** | ||
| White: | 79.6% | 73.6% |
| Black/African American: | 7.1% | 12.6% |
| Asian: | 6% | 5.1% |
| Native American: | 0.2% | 0.8% |
| Pacific Islander: | 0% | 0.2% |
| Two or more: | 2.9% | 3% |
| Hispanic/Latino: | 10.6% | 17.1% |
| Education | ||
| High school graduation rate: | 89.8% | 86.7% |
| College graduation rate: | 40.5% | 29.8% |
| Income | ||
| Median household income: | $68,563 | $53,889 |
| Persons below poverty level: | 13.1% | 11.3% |
| Source: U.S. Census Bureau, "American Community Survey" (5-year estimates 2010-2015) Click here for more information on the 2020 census and here for more on its impact on the redistricting process in Massachusetts. **Note: Percentages for race and ethnicity may add up to more than 100 percent because respondents may report more than one race and the Hispanic/Latino ethnicity may be selected in conjunction with any race. Read more about race and ethnicity in the census here. | ||
Presidential voting pattern
Massachusetts voted for the Democratic candidate in all seven presidential elections between 2000 and 2024.
More Massachusetts coverage on Ballotpedia
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See also
- Massachusetts 2016 ballot measures
- 2016 ballot measures
- Massachusetts Legislature
- List of Massachusetts ballot measures
Footnotes
- ↑ 1.0 1.1 Mass.gov, "15-19," accessed December 4, 2015
- ↑ 2.0 2.1 MassLive, "Gov. Charlie Baker signs hospital pricing compromise into law," May 31, 2016
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
- ↑ Mass.gov, "SUMMARY OF NO. 15-19," accessed December 4, 2015
- ↑ 5.0 5.1 5.2 5.3 The Berkshire Eagle, "Efforts to level out insurance revenue to hospitals advance as voter signatures certified," December 26, 2015
- ↑ 6.0 6.1 Commonwealth, "De la Torre backs hospital pricing ballot question," March 29, 2016
- ↑ The Daily Free Press, "Ballot measures ready for action from Legislature," December 3, 2015
- ↑ 8.0 8.1 8.2 WWLP.com, "Ballot question could spur lawmakers to tackle health price variations," March 8, 2016
- ↑ WCVB, "Group forms to fight hospital financing ballot question," April 11, 2016
- ↑ The Millbury Sutton Chronicle, "Major signature hurdle cleared by seven ballot question campaigns," accessed December 23, 2015
- ↑ The Boston Herald, "Ballot initiative supporters face key deadline," November 29, 2015
- ↑ Sentinel & Enterprise, "New signature deadline in Mass. for ballot question backers," May 4, 2016
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