Doctors, insurers clash over affordability

BOSTON – The Massachusetts Medical Society is fighting vigorously to defeat legislation that would create a new class of “affordable” health plans for small businesses with mandatory caps on providers’ pay and on insurers’ profits and administrative allowances.
The measure, backed by the Massachusetts Association of Health Plans and business groups, aims to lower insurance costs for employers with up to 50 workers, who have struggled the most to comply with the state’s employer coverage mandate amid fast-rising premiums.
A state report last year found that medical costs per member for Bay State HMOs rose by 55 percent from 2002 to 2006. By capping providers’ pay, limiting profits to 2 percent, and requiring that at least 85 percent of premiums go to medical costs, the “affordable” plans are expected to cut premiums by as much as 22 percent.
But at a State House hearing, MMS President Dr. Mario Motta testified that the bill would worsen the primary care shortage, reduce patient access to care, and alienate providers.
“Insurers now want to force physicians to participate in a health insurance product totally of their own design and whose reimbursement levels could bankrupt many physician practices,” he said. He also noted that the bill doesn’t require insurers to show they’re passing savings along to their customers, and he urged officials to take other cost-cutting approaches.
Specifically, Motta cited the Health Care Quality and Cost Council’s “Roadmap to Cost Containment” and Gov. Deval L. Patrick’s group-purchasing initiative for health insurance.
But Dr. Marylou Buyse, a practicing primary care physician and president of the Massachusetts Association of Health Plans, testified that this measure is the only one that would provide a more affordable option to small businesses, and she noted the impact it could make. The lowest-priced “bronze” package for a family of four, with two 40-year-old parents and two children, now costs about $800, she noted, and a 22-percent premium cut could save $176 per month or more than $2,100 per year.
More information from supporters of the Affordable Health Plan bill is available here. To read Motta’s blog post on this legislation, go here.