The Lamont administration released their first budget today. In healthcare, it is mostly good news, but also some we’ll wait-and-see, and a bit of bad news.
The good news:
There are no cuts to HUSKY parents eligibility, no cuts to Medicaid Savings Program (mostly), and no plans to return to private insurers managed care. Let’s rest there a minute – that is all very very good news. Advocates across the state are breathing a sigh of relief.
In other good news, the proposal includes an evidence-based diabetes prevention program for HUSKY that gives lifestyle support to help prevent and manage the disease without drugs. The savings are modest, but the improvement in quality of life and health outcomes could be significant.
The Governor also proposed raising the age to purchase tobacco products to 21, taxing e-cigarettes, and taxing sugary beverages – all good public policy. They also propose paid family and medical leave – a long overdue health and quality of life innovation. They also want to apply for a federal Medicaid waiver to address gaps in substance abuse treatment.
The wait-and-see news:
The proposal acknowledges Medicaid’s success in improving Medicaid cost savings and improved quality and access to care. But it goes on to propose “additional areas of focus” including rebalancing long term services and supports (good), Medicaid supportive housing benefit for high-cost, high-need members (very good), pharmacy rebate optimization, step therapy for new drug classes, and expanding the pharmacy purchasing pool (good, but not enough), value-based payments (could mean anything), utilization management (who knows?) and holding hospitals accountable for readmissions (it depends on how this is done).
The proposal sets a maximum price the state employee health plan will pay for services based on a percentage of Medicare prices. The budget also proposes to create a new preferred network with lower premiums linked to quality and to expand the Smart Shopper Program that rewards members for choosing high-value providers for their care. The state employee program is very expensive and needs reform, but it remains to be seen if this is it.
The bad news:
The budget proposes asset tests for the Medicare Savings Program. It only applies to bank accounts, stocks and bonds, not homes, one car, burial plots or accounts (up to $1500), household or personal possessions. But the limits are pretty low — $7,560 for singles and $11,340 for couples. Perhaps the biggest problem is how hard, and expensive, these programs are to administer. The juice just isn’t worth the squeeze.
The budget also proposes adding dual eligibles into the controversial PCMH Plus program. That program cost the state money with no discernable improvement in cost control or quality improvement in its first year. Adding fragile seniors and people with disabilities is not just premature, it’s a very bad idea.
Now it’s on to the legistlature.