The Time Has Come for Health Reform

On Beacon Hill, legislators are debating ways to increase the number of people with health insurance coverage. The outcome of that debate will reshape the health insurance landscape, protect the health of more of your friends and neighbors, and affect your medical costs.

Change is coming, and it is needed. Though they differ on specifics, the governor, the Senate president and the speaker of the House all agree on that point. For the wellbeing of hundreds of thousands of Massachusetts residents, we must seize this once-in-a-generation moment.

Health insurance enables patients to access the preventative care that saves lives, so it is time to set ourselves on a path to affordable, meaningful coverage for everyone. It is at the heart of what hospitals stand for in this debate.

Coverage should take the form of expanded Medicaid for the needy and new, more affordable private health insurance.These options should truly meet peoples’ medical needs. Reform that offers benefits that are low and co-pays and deductibles that are high will not work.

There must also be a recognition that no matter how generous the benefits, no matter how broad the coverage, there will still be those who will fall between the cracks.There must be a safety net for them and for those who provide their care. The form of such a safety net can be debated, but there should be no disagreement about its necessity.It’s not realistic to assume that we won’t need a safety net once health reform becomes law. That will put vulnerable people in harm’s way.

As lawmakers focus on reform, one of the great challenges confronting them is affordability to consumers, businesses and taxpayers. As you might expect, in the current system, all sides try to reduce costs.But if a business chooses to cut expenses by dropping coverage for employees, we all end up paying for that choice as those employees become state-subsidized ‘free care’ patients. At the vast majority of good businesses that offer health benefits, some employees who are financially capable of enrolling sometimes gamble by opting out. And these aren’t the only “free riders.” The state has a track record of consuming services through Medicaid and paying for far less than the cost of those services.

That is why coverage for all requires ‘shared responsibility’ by all. Without it, the cost of caring for the uninsured will still be unfairly carried, in the form of higher premiums, by responsible citizens and companies. For state government, shared responsibility means stepping up with fair Medicaid payments.

For individuals, it means living up to the personal responsibility to purchase insurance.Reform can help make insurance more affordable, and it is fair to offer public subsidies to help those who find that insurance is just beyond their financial grasp.

Employers – including hospitals – that provide coverage to their workers should not have to bear the cost for those who do not. Businesses that are struggling to offer health benefits should not be put at a competitive disadvantage against those that are not making the same effort. It may also require assistance to small businesses that want to step up and do the right thing on health benefits.

Hospitals have a critical role to play in the affordability challenge. We support efforts to reduce administrative costs, to manage costs more effectively, and to be publicly accountable for the care we provide.Better information technology is a key component. We also know that, depending on the needs of a patient, care should be delivered in lower cost settings. All patients deserve the right care, at the right place, at the right time.

These lofty goals can be realized. But, it will take more revenue, whether it comes from tobacco money, gaming revenue, assessments on employers who do not provide coverage, or increased Medicaid reimbursements.

This is Massachusetts and this is the moment. With commitment, collaboration and, most importantly, leadership, we can make coverage for all a reality. Let’s do it.

Ronald M. Hollander is President and CEO of the Massachusetts Hospital Association. (781) 272-8000.