2022-03-21 00:00:00 - Joint Committee on Health Care Financing

2022-03-21 00:00:00 - Joint Committee on Health Care Financing

SHOW NON-ESSENTIAL DIALOGUE


JASON ALUIA - MASS ASSOCIATION OF HEALTH PLANS - HB 4378 - Good afternoon, Chair Friedman, Chair Jehlen and members of the committee. My name is Jason Aluia, I'm the vice president of government and external affairs at the Massachusetts Association of Health Plans. MAHP as we are known in the building represents 16 health and dental plans and two behavioural health organizations that provide health care coverage to nearly three million Massachusetts residents. I join you today to voice our opposition and concerns to the initiative petition filed today and being heard today, House 4378, an act to implement medical loss ratios for dental health plans.

The bill would impose unprecedented requirements on dental252 plans that we253 fare will increase costs255 for families and256 small businesses in the commonwealth. Dental benefit plans are designed to provide Massachusetts, families and individuals with affordable access to oral health care. Affordable and accessible dental coverage improves not only oral health but is shown to benefit an individual's overall health and can lead to reduced healthcare concerns for the individual and costs for the commonwealth and their families and businesses. Typical dental plans are designed to promote preventive care289 while also providing290 coverage for common major oral health services.

The bill before you imposes medical loss ratio MLR requirements on dental plans. Dental loss ratio as it will become is a measure of expenditures to insurance premiums, not a measure of the value or quality of care. The coverage services and cost structure of these dental products are different from medical products and should not be treated in the same manner as this bill dictates. In fact, the affordable care Act excludes dental products from MLR requirements. Standalone dental plans are considered to be accepted benefit plans under the ACA as well as HIPA and therefore are exempt from many of the more costly requirements of the state statute and regulation.

The premium costs for dental plans are much lower than the premiums of medical insurance, but the fixed costs are very similar. Dental plans manage their cost by focusing on preventive and restorative services, encouraging regular visits that reduce the need363 for more costly and reactive treatments later on. Dental benefits plans still face the same fixed administrative costs, including vigorous customer service, such as staffing call centres, maintaining robust provider networks, language assistance in claims processing. There was little room for dental carriers to reduce costs without affecting these services and required consumer protections. They include anti-fraud efforts, timely access standards, grievance procedures and that's where the bulk collectively where the administrative expenses are found in those two buckets.

As a consequence of low-cost premiums, these administrative costs account for a higher percentage of dental plan budgets than they do for medical planned budgets and carriers. This is a fact also accepted by the National Association of Insurance Commissioners, who in their guidelines, recognize the need for these lower premium plans to dedicate a higher percentage of premium toward administration. Since the administration of benefits and regulatory requirements are not variable costs, the passage of this question would require dental plans to increase payments to dental providers in order to meet these strict MLR requirements resulting in increased premiums for consumers and increased costs with businesses offering dental coverage to employees receiving such benefits.

Finally, it is important to consider that an increase in premiums may result in many individuals, especially low-income adults for going coverage and dental care altogether. Those without coverage are far less likely to get the preventive and diagnostic care they need to head off more costly and painful dental and health conditions later. If low-cost plans cannot cover their administrative costs under the ballot questions mandated 83% loss ratio, these plans may no longer be often in the commonwealth and those plans that do remain will likely have to increase premium costs.

SHOW NON-ESSENTIAL DIALOGUE


REP ELUGARDO - HB 3781 - Hopefully, I just had some brief comments to make on H 3781. I wanted you to understand why I filed it and where it's coming from. It is a commission to study health insurance coverage in schools for medically necessary treatment for children. I discovered when I first started the job a few years back in my Brooklyn public school committee meeting that they were spending quite a bit of money on health care for children that would normally be provided by their medical insurance. But there is something going on that means that because it's being provided on the school premises, health insurance companies don't have to cover it.

I talked to the then interim superintendent, I've recently talked to our current mayor about this to just update that, it's still an issue. I talked to a couple of582 colleagues who are in areas that have strong health care services, medical services for children. Those school districts across the commonwealth tend to attract families with children that have in intense medical596 needs. And so what I want to know is what, how much money are school systems spending on this and are they really the best payers for treatments that are typically covered by medical insurance? And what the recommendations611 would be?

My hypothesis is that they're not the best players for that, that it should in fact be health insurance companies that are paying for the same care they paid for if it happened, you know, 100m down the road or whatever. I'm asking the committee to pass this favourably so we can set up a commission to take a look at this.

SEN FRIEDMAN - Thank you. Have you talked to insurers in terms of where there like what the reasoning is for this? Is it just a long time in statute643 Nobody's really paid attention to it. Is there any?

ELUGARDO - I have not, this is what I'm asking you to help me to do so, that's why I filed the655 commission versus a bill to fix it because I don't know whether it needs to be fixed or not. I want an official conversation that's mandated by the legislature, that will bring the right parties to the table. Myself not being as some of the people on the committee must be um, connected or knowledgeable at all about insurance. I just know what's happening in my districts and it seems to be happening in districts across679 the commonwealth. And so I would like the opportunity to have exactly that conversation and see if there is a good reason and if, and if there is maybe there's another fix.

SHOW NON-ESSENTIAL DIALOGUE


REP LAWN - I just have one. Thank you for your testimony. Do you have an example of some types of medical expenses that they're providing701 that are not covered?

ELUGARDO - Sure, there's a very long list and it's diverse but let's say you have like I met one child that has very severe cerebral palsy combined with some other complicating factors and so they need a nurse's care while they're in school to be present with them for certain types of medication that can't be provided by the school nurse, and so like that would be one example. But, you know, I filed this a while ago, I actually saw a list about 18 months ago just from Brooklyn public schools of six or seven different conditions that were quite serious, quite expensive and ranging from kids that have behavioural health, serious behavioural health issues to kids that have very serious physical impediments or multiple diagnoses.

You know, cancer patients, you know there's a broad range and I think that it seems to me again, I'm not a medical expert in any way or health trans expert but as a parent, as a legislator, it seems to me that the bar was the location of the child and not the type of service. So the schools are equipped to handle basic medical care for their nurse nurses when we do the job of making sure that we have enough nurses in the school. And so this is really talking about severe conditions that kids have to live with day today, but are still able to go to school because they are able to receive this medically necessary treatment that enables them to be present on the school premises and then they step onto that campus and the coverage stops.



SHOW NON-ESSENTIAL DIALOGUE
© InstaTrac 2025