{"id":95444,"date":"2025-07-27T00:54:09","date_gmt":"2025-07-27T00:54:09","guid":{"rendered":"https:\/\/www.europesays.com\/us\/95444\/"},"modified":"2025-07-27T00:54:09","modified_gmt":"2025-07-27T00:54:09","slug":"the-urgency-of-tackling-health-care-affordability","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/95444\/","title":{"rendered":"The urgency of tackling health care affordability\u00a0"},"content":{"rendered":"<p><strong>OUR STATE<\/strong> has a chance to make big changes in our health care system right now \u2013 the kind of transformation that can only come about in a crisis.\u00a0\u00a0<\/p>\n<p>There\u2019s no question we\u2019re in a critical moment. The new federal tax and spending bill is likely to pose extraordinary challenges to our hospitals, health plans, and ultimately, many of our neighbors in the Commonwealth who will need health care in the years to come.\u00a0\u00a0<\/p>\n<p>But our problems predate the legislation President Trump signed earlier this month.\u00a0\u00a0<\/p>\n<p>There has long been a chasm between government reimbursement for care and its actual costs \u2013 and that gap has long been filled by commercial plans like ours, with our employer customers and members picking up the tab. That structure is straining under recent unprecedented cost increases for drugs and medical care.\u00a0<\/p>\n<p>Businesses are forced to make painful choices between investing productively in new hires, wage increases, new equipment \u2014 or sinking their funds into health insurance.\u00a0<\/p>\n<p>A <a href=\"https:\/\/www.bluecrossma.org\/aboutus\/sites\/g\/files\/csphws2321\/files\/2024-03\/BCBSMA%20March%202024%20Statewide%20Poll%20-%20Public%20Charts.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">recent poll we commissioned<\/a> found 40 percent of Massachusetts residents say they\u2019ve delayed getting care due to the cost. Many say they\u2019ve faced a choice between paying for medical care or housing, food, or gas.\u00a0<\/p>\n<p>Hospitals are short-staffed, paying more for people, devices, medications \u2013 everything it takes to provide our state\u2019s famously world-class care.\u00a0\u00a0<\/p>\n<p>Many not-for-profit health plans are experiencing unsustainable losses as they strain to cover rising costs for care. Last year, Blue Cross lost $400 million, the biggest loss in our history.\u00a0\u00a0<\/p>\n<p>There\u2019s never been a greater need for us to work together and do things differently. There\u2019s no better place, either.\u00a0<\/p>\n<p>We have an excellent track record in our state of collaboration between health plans, clinicians, business, labor, and policymakers.\u00a0<\/p>\n<p>Landmark health reform led to near-universal coverage here. And the value-based care model widely adopted in our state \u2014 largely replacing the old fee-for-service system \u2014 slowed cost increases, spurred innovation, and improved quality for many years.\u00a0<\/p>\n<p>But that\u2019s under threat now.\u00a0\u00a0<\/p>\n<p>So how do we build a more affordable system that can withstand old and new pressures?\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Enforce the state health care spending benchmark:<\/strong> It\u2019s intended to protect consumers from unaffordable annual cost increases. But the benchmark, established as part of health care reform legislation in 2012, has been breached for so many years it\u2019s been rendered nearly meaningless. Let\u2019s strengthen our regulators\u2019 enforcement capability with real penalties and performance improvement plans for health plans and health providers that exceed the benchmark.\u00a0\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Control what we can. <\/strong>Private insurers don\u2019t have to wait for state action. We can commit to keeping the average price increase we pay providers below the 3.6 percent state benchmark.\u00a0 This month, my company notified providers in our network that we intend to do exactly that.\u00a0\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Establish a pharmacy drug affordability board<\/strong> to review high-cost prescription drugs and set limits to how much the costs can grow.\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>\u00a0Explore ways to live within a budget <\/strong>for health care services. Some states have had success setting price controls, including Rhode Island and Maryland. We may choose another route, but evaluating innovative options, with curiosity and transparency, can help catalyze meaningful change.\u00a0\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Develop and require payment models that reward outcomes over volume <\/strong>to ensure patients are getting the right levels of care at the right time in the right setting. Value-based care has proven effective in primary care and offers potential in other areas as well.\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Expand independent lower-cost treatment options <\/strong>including primary care, urgent care, and ambulatory surgical centers to relieve the long wait times and overcrowded emergency rooms at our hospitals and doctors\u2019 offices.\u00a0<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Learn from the collapse of Steward Health Care<\/strong> to ensure for-profit health care organizations in our state enhance the quality of care and decrease the cost.\u00a0\u00a0<\/li>\n<\/ul>\n<p>In short: We need to ensure our system is as strong and resilient as possible today, before federal government and market forces exert even more pressure tomorrow.\u00a0<\/p>\n<p>Building that system will take deep collaboration between our state\u2019s hospitals, drug companies, not-for-profit health plans, policymakers, regulators, and employers.\u00a0\u00a0<\/p>\n<p>We can\u2019t just ride out this storm. The headwinds are too strong. But we can come together to harness the power of this moment for meaningful change.\u00a0\u00a0<\/p>\n<p>Sarah Iselin is president and CEO of Blue Cross Blue Shield of Massachusetts.\u00a0\u00a0<\/p>\n<p>\n\tRelated<\/p>\n","protected":false},"excerpt":{"rendered":"OUR STATE has a chance to make big changes in our health care system right now \u2013 the&hellip;\n","protected":false},"author":3,"featured_media":95445,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,1142,1269,67,132,68],"class_list":{"0":"post-95444","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-opinion","12":"tag-united-states","13":"tag-unitedstates","14":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/114922472241401536","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/95444","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=95444"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/95444\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/95445"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=95444"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=95444"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=95444"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}