2025-03-26 00:00:00 - Joint Committee on Public Health

2025-03-26 00:00:00 - Joint Committee on Public Health

REP DECKER - COMMITTEE CO-CHAIR - Good morning, everyone. It is so great to be here. Our first, introduction to the Joint Committee on Public Health in this new legislative session. I'm very excited to have this legislative briefing and to hear from so many of you who will be engaging, both with this committee and in with the issue of public health over the next two years legislatively. Welcome. This is a hybrid legislative briefing of the joint committee. This is a hybrid, legislative briefing of the joint committee. I'm Marjorie Decker. This is my third time chairing this committee. I feel very honored to be doing this. I'm also the state representative from Cambridge. You will hear from my co-chair, who was a very familiar person to those of us in the house as he abandoned us and is now over in the senate. So now we get to work together as co-chairs, Senator Driscoll who represents Norfolk, Plymouth, and Bristol. I also wanna say thank you to, committee members here. I think I see Sean Reed. Welcome. Representative Chicola, Representative Sangiola, Representative, Ayers. And so excited to be well, you're gonna introduce him, but I do have to shout out to my former co-chair and very, very good friend, Senator Julian Cyr. And then I also have, Representative Thurber who also was in the house.
Many of the house members, if not all, I think, except for my cochair, my cochair, my vice-chair who will be here are all, I85 think, new to the joint committee on public health. So, many of you will89 have the opportunity to get to know them as well.91 Today, this is93 a briefing to really help us understand from all of you what's on your mind as we think about the bills that come before us. What does the federal landscape look like? How does that impact your work? How do you want that to impact our thinking? We face a range of public health issues before us and threats and concerns, everything from looking at the impact on access to reproductive care, access to LGBTQ health care, our issues regarding mental health, behavioral health, infectious diseases, emergency preparedness, substance use disorders, environmental health, health insurance, hospital administration. These are just,133 some of the issues that will fall under135 the umbrella of public health. And so today, again, this is a briefing. It's an opportunity for you to highlight to us on the committee, what are you hoping that we keep in mind as we spend the next year thinking through the bills that have been sent to our committee filed by many of our colleagues. So with that, I just wanna say welcome. Thank you. And I'm gonna turn this over to my co-chair, Senator Driscoll.
SEN DRISCOLL - COMMITTEE CO-CHAIR - Thank you, Chair Decker. It's an honor to be here with you today at our introductory hearing. Thank you all for joining us. We look forward to hearing, from you today in the Joint Committee on Public Health as we get started in this new session. It provides an opportunity to get acquainted with, with all of you, the work that you do, the important work you do in across the Commonwealth, and the committee. I'd like to take a moment to just, mention my senate, members of the joint committee, Vice Chair Julian Cyr, Senator John Keenan, Senator Robin Kennedy, Senator Jason Lewis, and Senator and ranking minority member, Senator Dooner. Thank you, Rep Decker, to you and your staff, as we, get started here, in this new session, and, thank you for all the work that you've done in the past, in the public health space. I am really looking forward to hearing from all of you today as our members here. And, I know there's a lot of uncertainty in the world, and it's certainly coming down from the federal government, and we will do our best to hear what you are dealing with and, you know, chart a course ahead with all of us. So thank you.
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DECKER - At this time, I would like to invite and welcome, and thank Commissioner Robbie Goldstein. I'm gonna have you bring up your team and introduce them as well. We'll just start at the offset to say thank you and I'm sorry. But we really appreciate the work of so many people who work in the Department of Public Health and who play such critical roles in keeping our state safe, healthy, and resilient. So welcome.
ROBERT GOLDSTEIN - MASS DPH - Thank you. Good morning, everyone. Thank you, Chair Decker and Chair Driscoll, for the opportunity to testify today. As you just heard, I'm Doctor Robbie Goldstein. I'm the commissioner of the Department of Public Health, and I'm joined today by Deirdre Calvert, the director of the Bureau of Substance Addiction Services, and Karen Maleski, the director of the Office of Preparedness and Emergency Management. Together, we represent 3,200 dedicated employees at the department who work across eight bureaus, five offices, and four public health hospitals. Our staff play an essential role in maintaining the health and the the strength of individuals and communities all across Massachusetts. They work collaboratively with community-based organizations and health care providers, and they embody the values of public health and reflect the historic commitment this state has made to promoting the well-being of those we serve. I wanna start by saying that the past few months have brought uncertainty to the work that we do. I wanna take a moment to assure you that despite this uncertainty, the dedicated staff at the department remain unwavering in our commitments.
Just yesterday, we were told390 that several large CDC grants392 we receive are being terminated. And while we continue to analyze the impact of this announcement, I wanna be clear. This decision by the Trump administration is reckless and could have devastating impacts404 on public health. These funds support the core functions of public health, our laboratory testing, our surveillance and epidemiology, our vaccine infrastructure, and our community engagement efforts. Despite this, our staff remain resolute. We will not stop. We will not back down from our commitment to the people of Massachusetts. We are proudly one of the healthiest states in the nation. We have some of the highest rates of health insurance coverage, the best outcomes for children and families, the longest life expectancies, and still we have work to do. The department's vision statement calls for an equitable and just public health system that supports the optimal well-being for all people in Massachusetts.
And we hope to achieve this vision by following our mission, which452 is to promote and protect health and well-being454 and prevent injury and illness for all people, prioritizing racial equity and health by improving equitable access to quality public health and health care services and partnering with communities most impacted by health inequities and structural racism. We do this work with humility. We recognize that as healthy as we are as a state, we have unacceptable disparities in maternal morbidity and mortality. We're losing too many people to the opioid crisis. Too many youth and adolescents are dealing with depression and anxiety. We can and we must do better. Since joining the department, I've supported our programs to invest in the fundamentals of public health. We've committed to five strategic priorities, which can help us achieve our vision. These include a laser focus on health equity, centering racial equity, a commitment to emergency preparedness and our readiness to respond, a strong well-trained workforce, a public health infrastructure that's modern and accessible, and a culture518 of public service that recognizes our commitment and dedication to the people of Massachusetts.
Last winter, we took our vision, our mission, and these strategic priorities, and we created a department-wide strategy map, a one-page visualization of what we stand for. Our map calls out five key objectives to better serve Massachusetts, which include healthy long lives, quality public health and health care services, clear and trusted communication,546 actionable, reliable public health data, and community resilience to respond to, withstand, and recover from adverse situations. Along with our strategy map, we launched six major initiatives cutting across the entire department. Our first is implementation of the department's strategic plan to advance racial equity, a five-year plan that acknowledges the serious public health threat of racism and works to root out systemic and structural barriers to better health. Our second recognizes a major driver of decreased life expectancy, especially for black and brown women, maternal morbidity. By implementing a framework of levels of maternal care,589 we hope to create a system where591 birthing people and newborns are able593 to receive appropriate care in the right facility in their own community.
599 Our599 third initiative addresses the intersection of maternal child health and substance use disorder and acknowledge the courage and the action of the legislature in the last session.We now have made it clear that substance use alone is not a reason to report abuse and neglect. The department is now working with colleagues from the Department of Children and Families and the Office of the Child Advocate to develop a pathway for public health reporting that will link parents and infants with resources without627 perpetuating stigma. Our fourth initiative focuses on strengthening our emergency preparedness capabilities and fostering a culture of readiness and response637 across the agency. The DPH ready responder program will equip staff with the necessary skills to respond effectively to645 any public health crisis, even in the absence of ongoing federal649 support.
Our fifth651 initiative creating a DPH data library that will house our publicly available data and enhance data transparency and accessibility. And our sixth strengthens our public health hospital system by improving clinical standards and providing the highest quality of care for the most vulnerable residents of our state. These initiatives, while not comprehensive of the work of the department, represent our commitment to equity, preparedness, workforce, data infrastructure, and public service. So as we engage through the upcoming legislative session, we look forward to working with this committee and with our partners who are testifying today. I wanna thank you in advance for your partnership, and we look forward to answering any questions you may have. We're here to answer questions.
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SEN KEENAN - Thank you, folks, for coming up. Just a quick question. Just imagine the cost, certificate of.
GOLDSTEIN - So we are still going through all of the analysis, reviewing everything that's come into us. We think this is close to a hundred million dollars in726 cuts to the department. These were dollars that we are expecting to receive over the next six to 18 months.
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SEN CYR - Thank you so much. It's so good to be, back with this committee, and also it's so good to have the Department of Public Health here, the 3,200 members. I used to be among the 3,200 members who work for this agency, and it's essential work. Can you please just outline the from your funding, for the committee, what is the level of federal funding that you folks receive? My understanding is it's pretty substantial, perhaps not more than state funding, but what comes close. I think that'd be really helpful for the committee to sort of understand, how much this agency receives in federal dollars, maybe among, I think, the top among, state agencies probably after MassHealth. Should you expand that a little bit? Thanks.
GOLDSTEIN - Yeah. I'm happy to, and I will give you numbers as of two days ago because we're still analyzing what happened yesterday. Our budget at the Department of Public Health is around 1.7 to $1,800,000,000 annually. We receive about $700,000,000 from the federal government each year. It is a little bit less than 50% of our overall budget. Important to note in that funding is that we have a great diversity in funding that comes into the Department of Public Health, while much comes from CDC and other agencies in the Federal Health and Human Services. We receive money from EPA, from the Department of Education, from Housing and Urban Development, really all aspects of the federal government.
DECKER - Thank you. At this time, we don't have any questions. We're also fortunate as chairs and with our staff that we are in regular communication with you weekly and now maybe sometimes a little bit more than that. But really just to say, thank you, and please convey our thanks and gratitude to everybody who works with you in the Department of Public Health. We know how important the work always has been and now, continues to be really, really important and even harder. So thank you.
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DOMINIQUE LEE - PLANNED PARENTHOOD LEAGUE OF MASS - Good morning, Chairwoman Decker, Chairman Driscoll, and the rest of the committee. Thank you so much for having us here today. My name is Dominique Lee. I'm the president and CEO of Planned Parenthood League of Massachusetts, and I'm here with my colleagues to speak just plainly about what we're facing, which is real escalating threats to sexual and reproductive health care and what it means for the people of Massachusetts. We are the largest provider of this care in the state. In 2024, among our four health centers and telehealth services, we served over 45,000 patients, provided 65,000 STI tests, 20,000 birth control visits, and delivered abortion care to 9,000 patients. 55 percent of patients chose medication abortion. We are proud to serve937 the communities across Massachusetts, but increasingly, we're also941 caring for people forced to travel here from out of state.
As abortion bans take hold across our country, we have seen a 37 percent increase in out-of-state patients seeking abortion care, from 2023 to 2024. This is a national public health crisis. ProPublica has reported young women dying in Texas and Georgia after being denied care. Just a glimpse of the broader harm abortion bans are causing. That impact is being felt here. The surge in demand is stretching providers and making it harder to maintain timely access for Massachusetts residents. And at the same time, we're seeing renewed threats from the Trump administration to strip funding that doesn't align with its ideology. Planned Parenthood has been explicitly named as a target. Despite all, our mission has not changed. We provide trusted, compassionate care, and we fight for every person's right to make decisions around their bodies and futures. That won't change, but we must boldly act to protect all care for Massachusetts residents. Thank you.
MARY-ROSE MAZZOLA - PLANNED PARENTHOOD LEAGUE OF MASS - Good morning, Chair Decker, Chair Driscoll, members of the committee. My name is Mary-Rose Mazzola and I'm the chief external affairs officer for Planned Parenthood League of Massachusetts and executive director of our advocacy fund. We're here today to make it clear that our top priority is keeping our doors open and continuing to provide sexual and reproductive health care for wealth. In 2019, the Trump administration revised Title 10 regulations to prohibit recipients from referring or offering abortion services. Fortunately, planned parenthood did not have any interruptions in care, thanks1047 to the prompt efforts of this body to issue emergency funds through a family planning reserve fund in a supplemental budget. Yesterday, as I'm sure you've heard, the Trump administration announced a freeze on Title 10 while it investigates the program. We expect severe restrictions to be imposed again, and we hope that the legislature can provide support similar to the action that was taken in 2019. Planned Parenthood currently accesses discounted prices on many of our essential medications, including medication abortion through the 3 401077 b drug pricing program.
Our access to this program and the $2,800,000 in annual savings1083 that results are dependent on the federal section 3 18 STD program. The section 3 18 STD program was explicitly named in the original OMB memo as one to eliminate. While that memo has been rescinded, the intention is clear. The Trump administration will use section 3 18 to deny PPLM funding as part of their pledge to defund planned parenthood. Another funding stream planned parenthood receives from the federal government is through the teen pregnancy prevention program grant. We receive $1,000,000 per year for a 5-year grant, and we are on year two. With this support, Planned Parenthood develops evidence-based sex ed curriculum and provides comprehensive sex education to 44 states across the country. This generates revenue for PPLM and allows us to keep our doors open. We expect this funding to be cut mid-grant as it was during the first Trump administration. We hope to collaborate with the Commonwealth in the coming months to address these issues the best we can, develop a strategy to supplement planned parenthood's funding, and maximize the impact of any additional support from the state. Thank you very much.
SHEILA RAMIREZ - PLANNED PARENTHOOD LEAGUE OF MASS - Chair Decker, Chair1152 Driscoll, it's really great to see you. Thank you for having1154 us. My name is Sheila Ramirez. I am the director of public affairs at the Affiliates, and I'm really happy to1160 be here today. True reproductive freedom means that everyone has control over their bodies and the choices that shape their futures, including young people. We are proud to support a bill expanding abortion access for young people, age 1991, and senate bill 1579. This bill eliminates parental consent and judicial bypass allowing all patients regardless of family circumstances the right to make their own reproductive health care decisions. Young people who have obtained parental consent or seek judicial bypass, core authorization for an abortion experience delays in care an average of 9 to 15 days, which can make care more expensive, time consuming, and completely inaccessible. Our remaining parental involvement law makes Massachusetts out of line with other high access states where young people can seek care without barriers or delays. In a state that is deeply committed to reproductive freedom, there is an inconsistency in policy when it comes to young people. Thank you for taking the time and thank you for your commitments on sexual and reproductive health care.
DECKER - Thank you all of you for the incredibly important1227 work that you do in providing important health care to the assault on our LGBTQ community is to, to erase their humanity and deny them and deny all of us our ability to actually thrive. So thank you. Do my colleagues have any questions?
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LEDA ANDERSON - MASS MEDICAL SOCIETY - Good morning, Chair Decker, Chair Driscoll, members of the committee. Thank you so much for the opportunity to be here this morning. My name is Leda Anderson. I'm the director of advocacy and government relations for the Mass Medical Society. We are a professional association of over 24,000 physicians, residents, medical students across all clinical disciplines, organizations, and practice settings. I just wanna start by saying, thank you, and I'm sorry. We greatly appreciate the work that this committee has done over the years, in particular, the landmark maternal health law that passed last year, this past summer. And we recognize that in this current moment, I think it goes without saying that the role of the state, the work of this committee, our department of public health, is more critical than ever to protect and advance public health, and to reduce health inequities. So our goal as an organization, is to offer the collective expertise of our physician leadership, our members, our staff to serve as a trusted resource on all healthcare matters.
You know, we encourage you to reach out to us, wherever we can provide insight or clinical expertise on issues related to state-level issues1365 or federal issues, especially things that impact your constituents. So with that said, the medical society is deeply committed1373 to improving public health, recognizing1375 the role that physicians can and must play in advancing policies that address the root causes of health disparities. Our members understand that health outcomes are shaped not just by access to affordable quality medical care, but also the social determinants of health such as access to nutritious food, safe water, clean air, which must be addressed in order to reduce health disparities and improve public health. We're also deeply committed to protecting access to reproductive and gender affirming care, particularly given the very hostile federal and national landscape that increasingly seeks to undermine access to this critical and life saving care.
Of course, the opioid epidemic remains, an urgent public health crisis and a significant priority for us, and we're very, very grateful for the comprehensive sub-law that passed, last year and for all the efforts that the Commonwealth has made over the years to stem the tide of this crisis. But as we know it's an incredibly complex, public health issue and there's there's still more to do and we will continue to advocate for harm reduction strategies that we know can save lives. But in addition to these important issues, there's one topic we'd like to focus on today, because of the growing threat that it poses to public health in the Commonwealth, and that is the rise in vaccine hesitancy and the resurgence of vaccine-preventable illness in the Commonwealth. So with that, I'd like to turn it over to Doctor Taylor.
HUGH TAYLOR - MASS MEDICAL SOCIETY - Thank you, Leda. And good morning, Chair Decker, Chair Driscoll, members of the committee. My name's Hugh Taylor. I am president of the Mass Medical Society, and I'm a family physician. I spend most of my career focusing on preventive care. As Leda mentioned, I'm gonna focus most of my comments on the vaccine policy, but I do wanna recognize that there's a primary care bill filed by my colleague, Greg Schwartz, before your committee. And I also wanna share the medical society is very committed to working with you to pass comprehensive primary care reform this session. We know that a robust equitable access to primary care improves overall population health, and that primary care in Massachusetts is under-resourced so that we currently have, significant primary care shortages, and we also have significant disparities in access to primary care. So we look forward to being part of the new primary care task force and bringing recommendations about this to the legislature. So now, about vaccine policy. Decades of scientific research have proven that vaccines save lives, prevent infections, and avoid public health crises. And we are now deeply alarmed by the rising cases of vaccine-preventable diseases, like measles, which pose serious health risks. Massachusetts has long benefited from our society's commitment to vaccination, but recent declines in immunization rates are putting us at risk.
There are now thousands of children attending schools across our state with vaccination rates well below the herd immunity threshold for all vaccine-preventable diseases. Vaccines are essential for protecting our patients and our communities, and that's why we continue to advocate for the removal of all nonmedical exemptions, particularly amidst this measles outbreak, which is spreading nationwide. There is a strong correlation between, getting a non medical between allowing non medical exemptions and lower vaccine coverage, and that's become a growing public health threat. Physicians, are seeing an increase in vaccine hesitancy among our patients in due hard in due to the spread of misinformation. We are committed to building public trust and addressing our patients' vaccine concerns with evidence-based science and data, but we also need strong state policy. The1597 CDC now reports over 3 50 cases of measles nationwide. Massachusetts has not reported a case yet, but some of our New England neighbors have, and we are definitely at risk here.
Measles is highly contagious, can result in serious health issues, and as you know, even death, particularly for individuals with compromised immune systems. In some parts of the Commonwealth, over 20 percent of students are unvaccinated or under-vaccinated. For measles, you need a 95 percent vaccination rate to maintain herd immunity. So, the MMS thanks this committee for favorably releasing legislation in the previous two sessions that aims to close the nonmedical exemption loophole in our school immunization law. We should not wait for the inevitable disease outbreak. We need strong policy that offers us1644 the best possible protection against preventable disease, which will1648 safeguard public health and protect our vulnerable populations. So thanks again for the opportunity to testify, and we look forward to working in partnership with this committee on this session addressing public health crisis, immunization policy, and other critical issues. Thank you very much. Happy to take any questions.
DECKER - Any questions for my colleagues? Yes. The one question I have for you, when you talk about so also this was reported in the Globe about the number of, communities where kindergartners were over 22 percent unvaccinated, and that herd immunity is that you need at least 95 percent.
TAYLOR - Correct.
DECKER - I think the challenges with that data as well is that we actually don't have that data based on all of our communities. Right? It is those communities that voluntarily provide that data.
TAYLOR - That's correct. So we actually don't know
DECKER - So how worried are you when you think about, you know, what it looks like potentially statewide?
TAYLOR - So, very worried. I mean, even certainly in my community, I practice in the North Shore for many years, seeing more vaccine hesitancy. There's no question that we have more kids who are unvaccinated there. Don't have the exact numbers, but, you know, my experience, my practice is that it's very concerning, that we don't have the herd immunity that we need.
DECKER - And my understanding from talking to some of your colleagues is that as adjacent states have actually eliminated what is non-medical exemptions, starting 5 or 6 years ago. We've seen some of those folks who would like a nonmedical exemption move to Massachusetts, which we're trying to look at the correlation between when that started to the uptick in what seems like more communities that we know of having nonmedical exemptions and less vaccines.
TAYLOR - I have seen data, chair Decker, that that in states that have gotten rid of the nonmedical exemptions, that their immunization rate has improved, and that's, I think, significant.
DRISCOLL - Thank you for being here. Just a question around if, you know, if and when we saw an outbreak here of of measles, in Massachusetts like we've seen in other parts of the country. Do you get a sense of folks that have had this vaccine, in their lifetime, you know, thinking they're already covered in terms of will we have to or we or can we expect that we will need to or see a an increased interest in getting, you know, up to date or or bringing their you know, topping off their level of, antibody, so to speak.
TAYLOR - So, the DPH has actually put out great recommendations as to, you know, who should be thinking about getting an additional immunization. Those you know, it depends on how old you are, whether you had measles when you were a kid, whether you got vaccinated during the window in the sixties when vaccines were not as effective, a number of factors there. But, yes, so I'm grateful to the DPH1819 for putting out very specific1821 recommendations about who should be getting an1823 additional vaccine in that case.
DRISCOLL - K. Thank you.
DECKER - Well, thank you both for your work, and, we will be hearing more from you throughout the session.
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DECKER - At this time, it is my pleasure to also welcome Doctor Ndidi Amaka Amatua Anugaka, who is the director and founder of the Center for Black Maternal Health and Reproductive Justice, which is located at the Tufts Center for Black Maternal Health and Reproductive Justice, which I believe was also founded by you. And I will also say, I believe is the only academic institution who is dedicated to doing academic research and providing data on maternal health outcomes for people of color and women of color, and who was an incredibly important partner, not only in the commission that we worked on together to examine racial inequities and maternal health, but also a really important partner with you and members of your team in helping us draft what has been landmark legislation on maternal health that centers racial equity. So I wanna say welcome.
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NDINDI ANUGAKA - TUFTS UNIVERSITY - HB 4999 - HB 1456 - SB 1199 - So good to see you as well. Thank you all. Good morning, everyone. Good morning, chairs Driscoll and Decker, Vice-Chair Cyr, Anne Kearns, and esteemed members of the committee. My name is Dr Ndidi Amaka Amatua Anugaka, and I'm the proud, professor of black maternal health at Tufts University School of Medicine. I also founded and direct the Center for Black Maternal Health and Reproductive Justice and the Maternal Outcomes of translational health equity research lab this committee in particular is well aware of the maternal health crisis that we're facing in our country. Black women in The United States are dying at two to three times the rate of white women. And here in Massachusetts, they experienced nearly twice the rate of severe maternal complications. What's even more troubling is that 84 percent of maternal deaths are actually preventable. So while awareness has grown, systemic barriers remain.
Today, I wanna focus on what must be done to advance meaningful solutions here in the Commonwealth. Number one, ensure effective implementation of House Bill 4999, Massachusetts maternal Health Omnibus Bill. The passage of this bill in August 2024 was a landmark achievement here, but policy alone is not enough. We must ensure its full and effective implementation. Some of the key priorities include equitable reimbursement models for midwives, doulas, and community health workers with a focus on ensuring integration within hospital systems. Passing a policy is one step. Ensuring it is implemented effectively and equitably here in the Commonwealth is another. Two, updating our birth center regulations that prioritize patient centered accessible care. Three, expanded maternal mental health services, ensuring all birthing individuals receive comprehensive and culturally responsive support. By focusing on accountability, enforcement, and accessibility, we can turn policy into real measurable change here.
My center has been instrumental in executing many of these policies. Through grants and foundational funding, we have developed an interactive toolkit to support doulas and MassHealth members in becoming Medicaid reimbursable. Designed with a community engagement framework, our robust community advisory board composed of doula stakeholders guides the toolkit's content, intuitive design, and information dissemination. We also need to do a better job of investing in our diverse maternal health workforce, supporting the funding and utilization of maternal health pipeline programs to recruit, train, and retain a diverse perinatal workforce here in Massachusetts. And we're doing some of that through my mother lab, where we work with students, graduate students, residents, OB GYNs, law students, etcetera. And we work on retaining them here in the Commonwealth so that they can be a part of the perinatal workforce.
Three, improving maternal health data collection and reporting, requiring real-time, race-specific maternal health data to better track and address disparities, and supporting community-based research models that center black and brown birthing individuals. I'd also like to call your attention to support for House Bill 1456 and Senate Bill 1199, an act ensuring access to full-spectrum pregnancy care. So I understand that this is an informational hearing, but I wanna highlight the fact that we should be doing a2099 job of requiring all Massachusetts private insurance to cover the full spectrum of pregnancy-related care, including prenatal care, childbirth, miscarriage management, abortion, and postpartum care.
As someone who's recently postpartum myself and sitting in that entire spectrum, I can attest the importance of those services. And also eliminating cost sharing, financial barriers to essential services. So I recently provided written testimony in support of those bills along with colleagues at Brandeis University, and I believe it is essential to reduce black maternal mortality and improve outcomes for all families here in the Commonwealth. Cost should never be a barrier to life-saving care. Massachusetts have the opportunity and partnering with my center to once again continue to lead the nation in maternal health equity, and I urge this committee in particular to make this work a priority. Thank you for your time and commitment to this critical work, and I'm happy to answer any questions. And so is my colleague, Sunday Daniels.
DECKER - Thank you. I'm happy to share with you that a lot of some of what you have asked us to start implementing, Department of Public Health has already been moving in that direction. That's great. But there is more work to be done, both in full implementation and, just in stuff that wasn't covered there. So excited for this session.
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MICHAEL LEVINE - MASSHEALTH - Thanks for having me. Good morning, chairs Driscoll and Decker and members of the committee. I appreciate the opportunity to come and speak on behalf of, MassHealth and the 2,000,000 members that, we serve in the Commonwealth. MassHealth covers both the state's Medicaid and CHIP program. We cover about, one in four Massachusetts residents, 45 percent of kids, and 70 percent of people who are in nursing facilities. We are committed to providing high-quality care to our members, and we are proud of the work we have done in partnership with many of the stakeholders in this room and many members of this committee to work across the state to achieve universal coverage, for residents of the Commonwealth. In my brief time this morning, I am gonna highlight 4 of MassHealth's programmatic priorities that I think dovetail nicely with the the charge of this committee. The first is health equity. And, following on the previous speaker's wonderful remarks, we're really proud of what we've done at MassHealth to expand access to doula services over the past year and a half. Over a thousand moms on MassHealth have received doula services from over 50 doulas who speak over 15 languages.
And if you think about closing gaps between moms of color, and white members of MassHealth, it's a really important initiative. We've also launched remote patient monitoring, particularly in the perinatal population, particularly for people at risk of hypertension, and are excited about that and other innovative approaches where we can partner with providers in the community to reduce bad outcomes. The second initiative is around shoring up behavioral health and primary care. You've already heard today, and I'm sure you'll hear more about the challenges that all residents of the Commonwealth experience accessing primary care and behavioral health. On the primary care side, I wanna highlight that we are about two years into a primary care subcapitation program, and what that means is that we have about a thousand practices across the state, every major health system in FQHC receiving monthly payments from MassHealth to take care of their members. We're out of the business of paying for 15-minute visits, and we are trying to support practices who are going to invest in expanded access and integrated behavioral health and primary care to take care of the people who they serve without worrying about, you know, how they bill for it.
We've invested over a hundred $50,000,000 on top of what we were previously paying for those services, and we've been really encouraged to see about 200 practices out of that thousand in just the past two years graduate into higher tiers of service offering more hours, more access to reproductive services, more access to integrated behavioral health. On the behavioral health side, we're also about two years into the behavioral health roadmap, where we've launched, over two dozen community behavioral health centers across the state that are offering 24/7 access to crisis care, and it's working. We've seen rates of psychiatric boarding in the emergency department fall by more than half over the past two years, and we're seeing crisis interventions shift from the hospital to the community where people, can access them and be safer and be well. The third initiative I wanna highlight is around promoting member independence. Massachusetts leads the nation in what's called rebalancing away from institutional settings of care towards community-based settings of care for individuals with disabilities.
And, there is always more work to be done. So we are, proud that under our Money Follows the Person program in 2024, we were able to pair 270 individuals in nursing facilities who wanted to move back to the community with services, with housing to get them to where they wanted to be. And we also are working hard to improve access to wheelchair repair. If any one of us broke our leg, we'd go to2439 the ED, we'd get it fixed, we'd be out that day. If you are relying on a wheelchair for mobility, it could take weeks or more to get that fixed, and that's simply unacceptable. And that's why we're working with2449 providers of, wheelchair equipment on a timely, faster, and more responsive services for members who need it. There's so much more work to do here, but I just highlight it as an example of a way where we're trying to promote independence for our members. And the last piece I'll highlight is, member experience and customer service, and customer service probably sounds like a strange thing to raise at a public health2472 meeting. But, if you can't understand what your benefits get you can't use it to navigate to care, you can't even understand the mail you get from us, then all MassHealth is just a piece of plastic in your pocket.
What we've done over the past couple years is translated our notices into the top 6 languages that our members speak. We've worked really hard to get our call center to a place where they're picking up the phone quickly. And in partnership with organizations like Mass Law Reform, we are doing a better job and have more to do on, making sure that non-English speakers can use the call center and use it well. And we're also increasing self-service. So you don't have to wait for a piece of paper mail. It's 2025. You ought to be able to go online and update your info and find a doctor through a self-service platform. So, we've launched that. We have the My Services platform with over 25,000 users who are much more engaged and able to use their insurance to access care. So those are just a sample of a couple things going on at the agency. Again, health equity, primary care and behavioral health, promoting member experience member independence, and improving customer service are, just four of the many areas where we'd like to partner with your committee. So thanks for having me.
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DECKER - I just wanna say, thank you to you and your team. For 122558 years, I have been so impressed with everybody who works at MassHealth and knowing that MassHealth actually is a model of care and coverage that our private insurers actually should aspire to. Often they eventually get there, but MassHealth is where we have to initiate it and innovate it. And the largest portion of our budget our state budget goes to those that you are providing care to. And this speaks to why we're here in public health. Public2582 health is about looking at what are the social determinants2584 that allow people to not only survive, but to thrive. And when people have access to shelter, access to2590 food, access to education, access to employment, access to behavioral health care, substance use, clean air to breathe and drink, then it will cost us less money, and you will have less cost, in the customers, that you are serving. So, cannot thank you enough for all of the incredible innovative work that continues to happen through MassHealth. We should also be very, very proud of, the state agency and the work that they do and that they're a model nationally. So thank you.
LEVINE - Thank you.
DRISCOLL - On the sub, capitation program, what kind of a back loop do you have? You said you're two years into the number you the start of in terms of, like, how it's going with providers.
LEVINE - So, next week, April 12636 will be the two-year anniversary. So I think, two signs of success and one area where, clearly, we have more work2644 to do. The two signs of success are one,2646 you know, the thousand practices have stuck with it. I think they took a pretty big leap of faith with us two years ago that this was gonna work, and we still have every FQHC participating. We still have every major health system. We still have a thousand practices in, and so I think, that in and of itself is a good sign. And then again, the fact that about 20% of practices have actually raised their hand to level up and say, you know, I don't wanna be a tier 1 provider. I wanna be a tier 3 provider, which means I have to do more, but I get paid more. Means that just on the ground, MassHealth patients are getting access to better care. So that's a good sign. I think it's really hard if you're a primary care practice to have one foot in the MassHealth monthly payment canoe and the other foot in the 15-minute fee-for-service treadmill canoe because that's how Medicare and commercial pays.
And so I think one of the topics that, I expect the the, the committee, the the task force that's taking on primary care in the coming months co chaired by HHS and HPC, I I expect there will be discussion around, okay, how do we how do we just make it easier for primary care practices to, you know, do the right thing, take care of patients, and not worry quite so much about the fee for service churn. And whenever I go visit a practice, that's most of what I hear. As, you know, this is great. If we if we had this for everyone, then we could really redesign our care teams. We could really get the people with the, you know, chronic conditions who need the most management in and manage others with lighter touch community health workers, like, the whole thing. So I think it's still in progress, but we're feeling good two years in about, some momentum. Thank you very much.
DRISCOLL - Thank you.
CYR - Thank you so much, and thank you to MassHealth for, just being exceptional partners in innovating on health care delivery. When we look at the reforms and work we've done on mental health and behavioral health, you folks have been in the lead. Now we're looking to primary care, as well, and it's really nice to point to our Medicaid agency, especially to the other players, in the payer market and saying, hey. Look. You gotta level up to MassHealth. If you could just could, for the committee, outline just briefly, certainly the various substantial level of federal resources you receive, outline your budget, and if you could just hazard a guess of what you know, if an $800,000,000,000 cut in Medicaid funding occurs through a reconciliation process in Congress, assign it to law, what that could mean for MassHealth and your services. Thank you.
LEVINE - I appreciate the question, and, certainly, there's a lot coming out of DC right now, both the Hill and the executive branch. So our budget is about $21,000,000,000 that we spend, but we get around 14 of that from the federal government. So the net spending from the state general fund is, you know, call it around $8,000,000,000. And, so we are heavily reliant on federal revenue, and there's a lot of interest at the federal level around reducing Medicaid, revenues, from the federal government. You know, I'd offer a little bit of good news, which is that there there's not a lot we do that red, blue, and purple states don't do. And I think there is going to be, it will be difficult at the federal level to take some of the steps that are being described. I mean, obviously, if you're going down a path where you're trying to pull hundreds of billions of dollars out of safety net health care across the state, we're gonna have a lot to talk about because at our core, we're all here for our members and if there are 2,000,000 people who need access to primary care, behavioral health, hospital services, pharmacy, dental services, you name it, up and down the chain, personal care attendants, home and community based services.
We're gonna need to figure out a way to continue to provide services. You know, I'll also point out, we have about 200 to 250,000 more people on MassHealth than we did before the pandemic. Those are people who used to be privately insured, and I think, you know, part of any whether it's driven by changes at the federal level or it's just, you know, how do we make this program work, you know, I think we need to make sure that no matter what happens, we can preserve universal coverage and some of that may involve, you know, making sure that people are able to get coverage if they're no longer eligible for MassHealth on a different plan. So long way of saying, it's hard to say. There's a lot of uncertainty. There are all the same concerns we have are playing out in 49 other state capitals, and, we will be working closely together in the event that some of these changes come.
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KERANS - [INAUDIBLE]
LEVINE - Yeah. So in February of 2020, there were 1,750,000 people on MassHealth. In April of 2023, at the end of the public health emergency, right before we started redeterminations, we had about 2,400,000. So that's a 650,000 growth over the course of, three and a half years. We went through redeterminations, very proud of how we did it here in partnership with the legislature. And the caseload has since reduced from about 2,400,000 to a little north of 2,000,000. But that's still 250,000 more than we had beforehand.
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BETSY LEHMAN - BETSY LEHMAN CENTER - Welcome. Thank you, and good morning, Chairman Driscoll, members of the committee. And, really, appreciate the opportunity to testify about the current state of health care safety in Massachusetts, how challenges and safety impact public health and the health care system, and a key step we can take right now, to improve. As you know, the Betsy Lehman Center is a non regulatory state agency established by the legislature to support efforts to reduce patient harm in the Commonwealth. Patient harm is often thought of as headline-grabbing events like surgery on the wrong patient or wrong body part. And while these things do happen, it's errors during routine care like medication errors, delays in diagnosis that drive the high rates of patient harm in all settings where health care is delivered. These events hit patients and families first, but the consequences ripple across the health care system, raising costs and straining capacity. And the system-level impacts are big because the incidence of patient harm is so high.
Recent research reveals that one in four Massachusetts patients will experience at least one harm event during a hospital admission. That's almost 80,000 harm events each year in hospitals alone. And because an additional $10,000 in costs will be incurred for each of these events on average, that amounts to $1,800,000,000 in claims that potentially could be avoided each year, about a which are paid by MassHealth. These figures don't include out-of-pocket costs and lost wages to patients and families, and nor do they include the hospital's own lost revenues, from lengths of stay that increase by almost a week on average when a patient is harmed. At a time when Massachusetts hospitals are operating at capacity, routine harm events slow patient throughput, leaving patients, leaving people stacked up in emergency departments waiting for open beds where they're more prone to injury. A persistent barrier to safety improvement has been the lack of timely, reliable data about safety outcomes. For complex reasons that we've explained in our recent annual report to the legislature, hospitals' own reporting systems currently detect less than 15 percent of the harm happening to their patients. That's a lot of bad news. The good news is that there is a way forward.
It's now possible to identify harm events in near real time using automated adverse event monitoring. These systems continuously scan every patient's EHR and can detect3180 well over a hundred types of harm events as they are occurring. This approach has been a game changer for several hundred early adopter hospitals outside of Massachusetts. These hospitals are uncovering about 10 times more harm events. They're using this information to reduce patient harm by 25 percent on average and in many cases more, and they're achieving high returns on their investment largely by reducing length of stay. The Betsy Lehman Center is well into the preliminary stages of a pilot3207 that will test automated monitoring in 6 to 8 hospitals, but will need3211 additional state investment to, see this work through. Preventing the physical and emotional impacts3217 of harmful care on patients and families is an urgent public health goal in and of itself. The opportunity to make inroads on the cost and capacity issues facing the state by improving patient safety is one that shouldn't be missed. Over time, so I will just thank you again and stop right there. And happy to take any questions.
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LYV NORRIS - REPRODUCTIVE EQUITY NOW - Good morning, Chair Decker, Chair Driscoll, and members of the committee. My name is Lyv Norris, and I'm grateful for the opportunity to testify this morning with my colleague, Claire Teylouni, to share reproductive equity now's perspective on the current landscape of reproductive health, rights, and justice in the Commonwealth. Today, in nearly three years since the US Supreme Court issued a decision in Dobbs V. Jackson, 19 states have taken action to severely restrict abortion and entirely ban as well. As a result of this legislature's actions to expand care and increasing restrictions in other states, Massachusetts continues to see a high demand for reproductive health care services. In 2023, Massachusetts experienced a 37.2 percent increase in total abortions, a 70.2 percent rise in medication abortions, and saw a 565 percent increase in out-of-state patients compared to 2022. In 2024, reproductive equity now received over 200 calls to our abortion legal hotline and about 15,000 visits to our New England abortion care guide.
Together, these data and the surge in demand for legal guidance and resources highlight the critical need for ongoing action to ensure that everyone has access to the reproductive care that they need and want and reflects the growing fear and uncertainty surrounding abortion access, especially as states impose restrictive bans and federal threats to care loom. While our written testimony will go into far more detail for the committee on the current landscape of care and the wide-ranging threats, we wish to focus our testimony this morning on two critical areas that we are closely monitoring in this post-Roe era. First, efforts to criminalize abortion care are ever evolving. And while the new hostile federal administration is undoubtedly a threat to abortion access, it is threats from other states that may also test the ability of our state to do everything within our power to protect our reproductive health care providers. We are seeing now perhaps only the beginning of an escalated effort by hostile government actors to criminalize pregnancy and providers, including in protected states.
Last month, a grand jury in Louisiana indicted Doctor Margaret Carpenter, a New York-based provider, for allegedly sending abortion medication pills to a teenager in Louisiana where abortion abortion is banned. This follows Texas Attorney General Paxton's civil lawsuit against Carpenter for allegedly sending pills to Texas. New York governor Hochul has refused to honor Louisiana's extradition request for doctor Carpenter, relying on New York shield law similar to ours here in the Commonwealth. Meanwhile, Texas has also arrested multiple in state providers further entrenching fear and uncertainty. The civil and criminal charges against doctor Carpenter are first test of shield laws like our own, which have been enacted in 18 states and Washington DC. These laws, specifically a subset of shield laws in 8 states, including Massachusetts with telehealth shield protections, allow providers to send nearly 10,000 medication abortion pills to patients across the country every month and contribute to medication abortion via telehealth, accounting for nearly 20 percent of all abortions in the country.
The Massachusetts medication abortion access project known as the MAP, which launched in October 2023, has seen demand for its3468 asynchronous telehealth model of medication abortion care skyrocket in recent months. Specifically, they recently lower lowered their minimum payment to $5 and immediately saw demand increase sixfold. While our providers are not deterred by these attacks, they must have our continued support and defense. These attacks underscore the urgent need to ensure that our shield law provisions are as robust as possible. It is up to us to protect provider and patient privacy to the greatest degree possible, both by allowing anonymity on prescription labels and by keeping their cell phone location information from being weaponized against them. Secondly, we are very proud, of the progress that Massachusetts has made in expanding access to abortion later in pregnancy. Current law now allows for abortion care after 24 weeks when it is necessary to preserve the life of the patient, necessary to preserve the patient's physical or mental health warranted because of a lethal fetal anomaly or diagnosis or warranted because of a grave fetal diagnosis.
Despite this progress, barriers to accessing abortion care later in pregnancy still remain. Patients who should be able to receive exceptions that our statute allows. Many providers, including dedicated maternal fetal medicine specialists and complex family planning specialists, specialists, believe that our current framework is still too restrictive and overly complicated to meet the needs of their patients, and hinders providers from being able to offer compassionate care. Even one patient who's denied care in Massachusetts and sent to seek later abortion care out of state is one too many. In this travel, we're concerned is simply unsafe in our post to our reality, given the threats that patients face from hostile states and from a hostile Trump administration. To ensure that we are not compromising on reproductive freedom, but rather living up to our long standing legacy of leading on it, we hope Massachusetts will address our statute governing abortion later in pregnancy, and ensure that patients and doctors who, carefully consider these decisions regarding this care can prioritize health, safety, and compassion when making decisions in the most challenging circumstances. In, closing, we thank the committee for its very long-standing and steadfast commitment to protecting and expanding reproductive freedom, equity, and justice in Massachusetts, as we continue to see equity nationwide. Your leadership remains extremely important, and we look forward to the opportunity to be a resource and a partner to you throughout this session as you deliberate on many of these issues. Thank you.
DRISCOLL - Great. Thank you for, being here today and for your work and vigilance to protect providers and work with us, collaborating this session. Any questions from the committee members? Just fine. Thank you.
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JESSICA LAROCHELLE - MAMH - SB 1394 - Yeah. She sends her regrets. She's there's folks in our conference room from overseas. She's inviting advising them on how to provide better crisis services. So she sends her regrets. Thank you so much Chair Decker, Chair Driscoll, honorable members of the committee. My name is Jessica LaRochelle and I'm here with my colleague Kate Alicante and we're from the Massachusetts Association for Mental Health or MAMH. MAMH is the second oldest mental health association in the country. Much of our work focuses on access and reform of the behavioral health treatment system, but we're also unique in the sense that we go upstream and also work on promotion and prevention activities. We do a lot of intersectional work. For instance, the intersection of behavioral health and the educational system. The intersection of behavioral health and housing. The intersection of behavioral health and the criminal justice system. We take a step back and think about what it means to be healthy, and that all of these systems and determinants contribute to overall well-being.
As an organization, we do public education, we do public policy, and we do convening, bringing together diverse stakeholders to help achieve consensus and work for change. Kate and I are going to give some examples of MAMH's work in the promotion and prevention space. The first one is child and adolescent mental health. MAMH is proud to be a member of the Children's Mental Health Campaign. You're gonna hear from them in a minute, but we wanted to say that we share the campaign's deep concerns about the governor's proposed cuts to the Department of Mental Health. These cuts on both the child and the adult side largely affect community-based services. If we cut community-based services, people aren't gonna be able to get the care that they need, and we're gonna further strain our emergency rooms and our hospitals. The second thing I'd like to mention is full implementation of the road map for behavioral health reform. The road map, of course, is the commonwealth's blueprint to help people get the care they need when and where they need it. Much progress has been made in the first two years of implementation, but like any major reform effort, we still have a long way to go.
We specifically wanna thank, chair member Cyr, of filing S 1394, towards the end of effective and efficient implementation of the road map. MAMH is also working to foster partnerships between the community behavioral health centers and schools. Their schools and CBHCs are providing urgent care to students on-site, and the goal again is to go upstream, is to prevent calls to 911, is to prevent calls for mobile crisis, is to prevent suspensions and expulsions. And finally, I wanted to emphasize that we're working to towards the widespread adoption of collaborative care. The psychiatric collaborative care model is an evidence-based model of integrating behavioral health and primary care settings. The whole goal is early identification. There's actually an 11 delay between the onset of mental health conditions and getting treatment. This is far too long. The collaborative care model has been shown to reduce total health care costs and by going upstream, preventing suffering, preventing disability, and preventing acute and emergency services. And now, I'll turn it over to Kate to talk about some of our other work.
KATE ALICANTE - MAMH - Thanks, Jess. So like Jess said, in addition to our efforts to transform the behavioral health system, the MAMH is also engaged in advocacy to reform the housing and criminal justice systems. Access to affordable, quality, and safe housing is one of the most fundamental social determinants of health. That is why we must prioritize investments in supportive housing to ensure that individuals with behavioral health conditions have stable living environments. MAMH supports the housing first approach, which means providing housing without requiring treatment or sobriety as a prerequisite. For example, we've worked to expand the safe havens program, which is an alternative to shelter placement for hard-to-reach individuals who are chronically unhoused. Additionally, MAMH has advocated for their Department of Mental Health rental subsidy program, which currently assist over 2,500 individuals every year. Last year, MAMH also helped successfully advocate for the inclusion of the supportive housing pool fund in the affordable homes act. Thank you, by the way. In regard to the criminal justice system, people with mental health and substance use deserve care in therapeutic settings approved by DPH or DMH, not correctional facilities.
However, Massachusetts remains the only state in the nation that commits men with a substance3981 use condition to prison. Substance use is not a crime. It is a public health issue. Last year, the substance use omnibus bill shifted section 35 commitments out of the Department of Corrections Alcohol and Substance Abuse Center, but the Hampton County Sheriff's Department continues to operate a section 35 program. This must change. Furthermore, Massachusetts is also the only state in the nation whose secure psychiatric facility is run by the state's Department of correction. Despite its name, Bridgewater State Hospital is not an accredited hospital. Issues include excessive or inappropriate use of chemical and physical restraints, prison-like conditions, and lack of access to mental health care. To truly support those with mental health needs, Bridgewater should be transferred to the Department of Mental Health, ensuring trauma-informed, person-centered care with proper oversight and accountability. In conclusion, as just said, MAMH envisions a day when all Massachusetts residents have access to the social economic opportunities that promote overall health and protect resilience. Thank you for your time, and we welcome any questions. Thank you.
DECKER - I wanna say thank you to both of you and to Donna Mausch as well. MAMH is an important partner, to many of us in the legislature and have helped us pass really, important, legislation. I also would be remiss if I did not acknowledge that Kate was a key author in the maternal health report that the commission put out a couple of years ago as she was also a member of the, house committee, public health staff. So, really just, hard not to say how exciting it is to see you to continue to just soar and do really important work that benefits the people of the commonwealth. So at this time, I just wanna thank you all for your work. And any house members, any questions on that? Nope. Oh, actually, I think our vice, chair has a question.
KERANS - [ INAUDIBLE ]
LAROCHELLE - I'd say that the problem of behavioral health clinicians, inclusive of of child psychiatrists, not accepting any type of insurance, whether public or private, persists. I think the latest data I've seen is about 50%. And that's a huge access barrier. I mean, most people and families cannot afford the full cost of an appointment, whether it's therapy or prescribing. And so I think it's an incredibly significant barrier when we think about access and when we think about the workforce. I know some work has been done in the commonwealth to try to address the barriers, which include, barriers to licensing, barriers to credentialing, just complications with billing and reimbursement, but also rates. If, you know, looking at the parity reports, behavioral health has long been, underfunded compared to the medical surgical side. And, insurance doesn't reimburse as well. And so there's also, a financial incentive to not accept, to not be part of plan networks. It's a great question. It's a huge barrier. Thank you.
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SEN DOONER - Thank you, Mr. Chair. Through you, first off, thank you guys, for all the incredible work that you're doing. I have a couple questions, and I'm gonna try and sum them up and make it brief. Just under a month ago, one of my communities there, a grant that they had in the school system, that was to help students with mental health services and provide those services did get pulled. We were able to get it reinstated myself, Rep, Lenatra, Rep Orel, and, Rep Gasky. Thanks to the Lieutenant Governor stepping in. But if that happens in the future, is there anybody we can turn to through your department to help with that? I would just hate to see, you know, one of my communities lose a grant, especially when it pertains to mental health given the state that our commonwealth is currently in, and with children right now, making them feel okay, and having those conversations with them is so important. Is there any anywhere that we can turn to in the future if that happens again, with you guys?
LAROCHELLE - I'd say that I'm so sorry to hear that happen. And one of our priorities with the children's mental health campaign is building these comprehensive systems of school-based supports. So, we are a private nonprofit agency, but we do have very good relationships with a lot of, staff and leadership in various state agencies. So, for instance, if you're welcome at any time to reach out to us, and we can connect you to the best contact person that we know of. I'm not sure, but we'd have to, you know, do some digging on where was that grant issued from, what department, and, chances are we might have a good contact for you at that department. Perfect.
DOONER - And then one other question, and I'm not sure if you guys can answer, or if you can get back to me. Great. So when I first kind of got involved and I ran for city council, somebody within the local court system reached out to me, due to something you guys referenced. So a lot of the, like criminals that they would say, it is substance abuse issues. It's not necessarily, you know, it's different now. A lot of them are dealing with those challenges, and when I was talking with him, one of his struggles, he actually ended up leaving the job because it took such a mental toll on him. He couldn't, you know, he was able to find, these people who had substance abuse issues, a bed for 30 days, and then after the 30 days, it was kinda just like, see you later. And I know insurance4395 obviously plays a role in that as4397 well. But are there any resources out there, or is4401 there anything the legislature can do on our end to try and help, prevent these people who are looking for help and are seeking help in 30 days, you know, maybe just isn't enough for them. Is there anything that help in 30 days, you know, maybe just isn't enough for them. Is there anything that we can do on the legislature and to try and, help eliminate that that time frame or that limit that they're allowed to be there, just to be able to give them, you know, the services that they need and they're looking for. Sorry to throw it on4427 you. And if you want to get back to me, feel free. I just wanna
LAROCHELLE - This is a fantastic question, and, we get questions like this often. I'd say to answer the question on maybe two fronts. First, like, a helping a constituent front, and then your second question about what might the legislature do. The first thing I'd say is, the help line, behavioral help line, and substance use help line. For a lot of times when we get, it's we don't have constituents, but, like, just individuals and families calling, the two places that we direct them, especially in substance use, so the behavioral health help line, which is part of the road map for behavioral health reform, it's open 24/7-365. And people talk to a trained clinician who will actually, triage to determine exactly what services they need and do warm hands offs. They're use helpline, which is also extraordinary and has trained clinicians. Everything's free and confidential. In terms shortly gonna drop its, FY 26 budget proposal.
And in the, governor's H FY 26 budget proposal, there's $83,000,000 in cuts to mental health services and programs, and there's $19,000,000 in cuts to the bureau of substance addiction services. At the top of our priority list is, and it it it doesn't make sense to us. I mean, the newest data out of the Department of Public Health is one in two adults is suffering. One in three adults is suffering from psychological distress. One in two children and youth are suffering from psychological distress. There's never a time to cut mental health and substance use, but it's certainly not now. And we need to make sure that the fabric of community services is strong, so that people who need to transition from one level of care to another have options and there's openings. And so I would say the most immediate thing to do is, you know, really working with Ways and Means and leadership to shore up, funding for DMH4573 and DPH, especially BSES.4575
DOONER - Thank you. I4577 actually serve on Ways and Means as well, and I will definitely help advocating. I just think with the state of of the Commonwealth currently and all the people struggling, this shouldn't even be on the table to be cutting any mental health services or substance abuse. So anything I can do, please reach out to my office anytime, and I'll help in any capacity I can. Thank you.
LAROCHELLE - Thank you for your leadership.
DECKER - Senator, I just wanna say welcome to the committee. Really happy to have, another legislator who wants to lean into advocacy around mental health and behavioral health. And, I just wanna offer to you both, my time, my co-chair's time, and, we also have my former co-chair, but also partner in a lot of, legislation around mental health, legislation. So there's a lot that you can do, and we're happy to provide you with a list of bills that have been prioritized. The governor's budget does, seek to cut half the DMH caseworkers right now, and also potentially closing two hospitals, including the only hospital that serves LGBTQ youth that are in crisis and need inpatient care. So really look forward to having you as an ally and advocate on these issues.
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NANCY ALLEN SCANNELL - MSPCC - I think I'm versed. You are. Alright. Good morning. My name is Nancy Allen Scannell. I'm the executive director of MSPCC, and it's so nice to see so many of you that we have worked alongside with, to make really great advances around children's behavioral health and child welfare, generally speaking. Thank you for, inviting us to4701 be, part of this important hearing. I think that everyone knows that MSPCC, is about 147-ish years old, at this point in time. And during our history, we have been both a direct service provider and have done advocacy. And so I'm here with my colleague, Courtney Cello, who leads our advocacy efforts, and I'm gonna spend, my few minutes, talking to you about our direct services because they really are focused on prevention. So MSPCC is probably best known for a focus on foster4738 care.
We provide a range of services and supports to foster families for a couple of, with a couple of main goals. The first is, to ensure that, we get the best possible outcomes from a very difficult situation. As you all know, foster care does not necessarily in and of itself lead to positive outcomes. However, it is our role that when it's necessary that we seek the best possible outcomes in, particularly by focusing on placement stability, which is really disruptive to kids' education, to their ability to make and keep friends, and, to their overall behavioral health and kind of a vicious cycle. In addition, we have a folk we have services that focus on infant, mental health, consultation. We have a, focus on, survivor services. So we have services that are focused on, children who have been, the victims of, child sexual abuse, and, we have a big focus on home visiting services, all of which have huge implications, for prevention.
We can tell you lots and lots, and I think we have about these services, but I think that my final comment to you, is that we are hugely reliant in all of these services on federal funding. And so some of them are direct, funding allocations made to the state agencies. So in the case of, DCF, for example, much of the resource, that comes to the state for child welfare services is federal funding. And in the case of other services, there is a and in the case of other services, there is a federal match. And so the question that that you're all asking about what would happen, it would be devastating to these services, and the in the, outcomes that we would see would be, really, really devastating for kids and families. And so with that, Court, I think I was pretty close. You did.
COURTNEY CHELO - MSPCC - Hi. Thank you so much for having us. I am Courtney Chelo. I am the director of government relations at the MSPCC. And in that role, I have the pleasure of kinda guiding the day-to-day of the children's mental health campaign. So we are joined in leading the campaign by, MAMH, who you just heard from, Boston Children's Hospital, Health Law Advocates, Health Care for All, and the Parent Professional Advocacy League with about 250 supporting organizations across the state. And we are coming up on our twentieth anniversary next year, which is very exciting. We look forward to celebrating with you all. The campaign seeks to ensure that kids and families have access to the behavioral supports that they need where and when they need them, and we really think about that in terms of home, school, and community. While we've seen significant improvements in the behavioral health system over the last two decades, there is still a stark gap between needs and access.
You just heard Jess highlight that data point, right, that one in two kids in the Commonwealth in 2023 reported, significant psychological distress. There's another data point from that same year from CHIA. Only a quarter of our kids had a behavioral health visit. So, you know, not a perfect one for one comparison, but that does highlight, what any parent, historically, much of the investment in our behavioral health infrastructure has been in the home and community4960 spaces, But we do know that schools are where behavioral health needs are often first identified. So, we have been doing a lot of work in this space over the last few years, and had a number of successes last session, including codifying the school based behavioral health technical assistance center, which provides direct support to our school districts so that they can better support kids, and ensuring that there are state resources dedicated to the development of a statewide birth through higher education school based behavioral health framework. And thank you to Chair Decker for leading the charge on both of those.
We look forward to building on that work moving forward. There's so much ground that we could cover in the kids' behavioral health system, but with under a5003 minute left, just want to draw attention to the $24,000,000, being proposed to be cut from the DMH child and adolescent line. Our commonwealth is frequently lauded for having a children's mental health system that sets a national example, and it is true that we are relatively well resourced compared to other states. But again, we still see need outstripping demand. Despite our progress, our systems are simply under-resourced and not equipped to meet the unrelenting demand that exists. So it is hard to believe that there aren't other places in our massive state budget that we could cut aside from DMH, which serves both adults and children with the most serious and complex behavioral health needs in our state.
So just to wrap up, I just wanna highlight that the rationale that you will hear for cutting kids services, is that they are being underutilized. That beds are left empty and their openings in community-based programs aren't used. But a closer look does reveal that this is an oversimplification. A number of factors contribute to the complexity of navigating the system and leads to beds sitting empty, but it is not for a lack of need. We've been talking with many of you and your colleagues about the complexity of these cuts and what the impact will be. We look forward to meeting with the rest of you ahead of the house and senate budget releases, and I will conclude there. Thank you.
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SCANNELL - So, it's a very good question. I don't know that5122 we have exact numbers. I think we always point to the5126 canary in the coal mine, which is the number of kids that are boarding an emergency department to any given point in time. And so, understanding that the open bed someplace, right, may not be the exact fit for a kid that's boarding. It's still a really good litmus test for whether or not the system is sufficient. In fact, I would say that boarding overall indicates an insufficiency in community-based services, that would and should prevent a child, or any person, really, from arriving in an emergency department and not being able to move on to, an appropriate level of care in a fairly rapid time frame. And so, that number, as you know, goes up and down. We are grateful to our friends at the Mass Hospital Association who track that on a very regular basis. If you don't get that from them, you can, and, I would urge you to. But the fact is that there isn't a sufficient supply certainly of, the types of beds that we are talking about right now. In particular, as was mentioned, kids, beds that are appropriate, for, youth who are trans. Right? Because, of the situation in terms of the setup in most residential programs, most programs are not appropriate, in terms of the safety and privacy of youth who identify as trans. There is a program, though, that is appropriate, and it is on the chopping block.
DECKER - And oh, can you actually so just thank thank you, Nancy. I was gonna ask you to talk more about that. We know that there's two hospitals that the governors proposed closing. My understanding is one of them is really where it is the only, inpatient care for many of our LGBTQ adolescents. And at a time when our president is, both criminalizing care to the LGBT community, adolescent community specifically, and punishing states by taking away hundreds of millions of dollars in access to care. Can you talk more about what your concern is, with the closure of this hospital if it were to move forward?
CHELO - Yeah. Thank you, Madam Chair. But I'm gonna let you. Sure thing. So, just really quickly on that point too, just wanna add that I think the issues within the kids' behavioral health system are as complex as the complexity of the system. I think it's not as simple as adding beds. I think that there's one silver lining that can come from this proposed cut. It's that perhaps we have the political will to really take a serious look at those issues with flow and how kids are able to move through the system so that we're able to better utilize the beds that we do have before we add more, to make sure, again, that we're kind of addressing, the resources that we have available to us. And we can absolutely talk more about that as the session goes on. In terms of the unit that we're particularly concerned about, there are actually two. So I'll start with the LGBTQ youth piece. There was a report Westboro. Yes. Run by NFI. So, back we saw right after, the marriage equality decision, a report in JAMA Pediatrics that highlighted that when there are positive, national movements around LGBTQ rights, that that has a significant impact on youth mental health in a positive way. We also know that the opposite is true.
And so as we see these continued attacks on LGBTQ folks, and in particular, trans youth who just want to play sports, go to school, have the same public accommodations afforded to everybody else, we know that that is going to have a significant impact. The unit in Westborough is, in addition to being the most centrally located, inpatient unit in the state for kids, is the only one that is equipped, as Nancy highlighted, to provide private accommodations for trans youth, and gender diverse youth. The team there has also developed a specialty in working with this population. No one is gonna tell you faster than an LGBTQ youth that you're getting it wrong. Even I have a, you know, a learning curve at times trying to make sure that I'm using the right language as things, you know, just evolve so rapidly, which is fantastic to see. But it really is meaningful that the staff at this program have developed that expertise and are able to work with sensitivity with this population, who are there because they are already in crisis. And so losing that capacity would really be a significant loss, not just in terms of the actual space, but also in terms of the incredible staff that are working with these young people.
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REP SOUSA - [ INAUDIBLE ]
CHELO - How the impacts of mixed immigration status families is what we're seeing in our work. So from a broad, like, policy level with the campaign's work, and Nancy, I don't know if there's anything from the Elliott side that you wanna add, but, not seeing specific data yet. But I think anecdotally hearing the same things that you are hearing, I think we share your concern that, again, right, everything that we are kind of consuming daily as grown-ups that's making us feel a bit dysregulated is having a really big impact on our kids. And we're gonna continue to see sort of a disproportionate effect, you know, LGBTQ youth, youth of color, immigrant youth concerned about what the news means for them and for their families. Nancy, I don't know if there's anything you wanna add for that.
SCANELL - I think. So this may be nothing that you know, but I, will support what you maybe you already know, which is that at the programmatic level, there is a very fine line between the folks that we serve and the people who serve them, the rest of us. Right? And so we are hearing, tremendous, amount of, distress from folks who are coming into our programs. We're looking, we're working really hard with them to ensure that they are prepared, to demonstrate, whatever they need to or to answer questions or not as they, feel that they need to. People are scared, though. Are they are not going to school. They are not going we worry about the long-term effects of something like that of that trend, increasing child welfare involvement, increasing, deepening of poverty, etcetera. And that is true among our staff as well. They are very, very worried for family members, and so it has an impact on everything on a daily basis. I think that's what you know. But yeah. So thank you for asking the question, though. Great. Thank you for being here.
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KATIE MURPHY - MNA - Good morning, chairs Decker and Driscoll. Thank you very much for the invitation to be here5622 today. My name is Katie Murphy. I'm5624 the president of the Massachusetts Nurses Association, representing over 25,000 frontline nurses and5630 health care professionals. I'm also an ICU nurse at the Brigham and Women's Hospital. I'd like to focus my remarks today on two things, working conditions for frontline staff, and access issues for patients. Our members were on the frontline of health care, and every single day, we see how the system works and doesn't work for patients and staff. Simply stated, these conditions in our health care facilities are driving nurses and health care professionals away and endangering patients. Independent studies have consistently found the quality of care decreases dramatically when nurses are forced to care for too many patients at once. This research has also directly linked excessive patient assignments to a marked increase in nurse dissatisfaction and burnout resulting in costly turnover in nursing staff.
Nurses are leaving the bedside, consistently citing caring for too many patients at one time as the reason they're leaving. This has created a staffing crisis that is juxtaposed against an increase in the actual number of licensed registered nurses in the Commonwealth. As we have said time and time again, we don't have a nursing shortage in Massachusetts. We have a nursing crisis. This was confirmed by the Health Policy Commission in their 2023 health care workforce report. The problem is not a lack of nurses, but an increasingly difficult work environment. Working conditions can and also should be improved by addressing workplace violence, which everyone agrees is a significant problem. Violence in health care facilities has been on the rise since COVID with some type of assault occurring every 38 minutes. Patient access to services or lack thereof is also a top concern for health care workers. Thank you for your work in the legislature that you did last session to prevent another steward5738 crisis and to address maternal health access.
Unfortunately, we continue to see the loss of essential services in communities across the Commonwealth, and it is a crisis. For years, we've seen hospitals and health care corporations eliminating essential health services, things like pediatric units, emergency departments, and in some cases, full-scale hospitals or hospital systems. These closures happen over the objections of the communities. And in most cases, despite the determination of the DPH that the services proposed for closure are necessary for preserving access and health status within the service area. We're seeing this trend accelerate, leaving pockets of the state without access to basic health services like maternity care and inpatient behavioral health. As we sit here today, Texas-based for-profit Tenet Healthcare is proposing to eliminate the level two special care nursery at met MetroWest Medical Center. I could go on, but the seconds are ticking away. Thank you very much, and I'm happy to answer any questions.
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DAVID SALTZ - HPC - Good morning, Madam Chair. Chair Driscoll, through you to the members of this committee, it is great to be able5844 to, talk with you this morning, and to5848 share a little bit of what I think5850 is some exciting news and work ahead for the Health Policy Commission. The Health Policy Commission is an independent state agency that is focused on improving the affordability, accessibility, and health equity of health care in this commonwealth. Our vision and goal for health care is better care at a better health at a price that our residents5870 can afford. There are some significant challenges, facing our health care system right now. But I'm excited that there are a few areas where I think we're gonna be able to make some important progress this year, thanks to the work that you have done. First, I wanna talk about maternal health. This has been a big priority for the Health Policy Commission over the years, both in our research work and in our investment work where we provide grants to different health care provider organizations.
Last year, through this committee, the legislature advanced a very significant maternal health bill, that made a huge leap forward in some of our policies. Included within that bill is also a new important maternal health access and patient safety task force. Force. That new task force, is gonna be co chaired by the Health Policy Commission, and the Department of Public Health. And we're gonna be looking at the avail availability of maternal health services in Massachusetts. We're gonna be making an assessment of the maternal health workforce. And we're also gonna be looking at some of the past closures that we've experienced in maternal health services, so we can understand what those impacts have been for different patient populations, but also to help us prepare for the future and put in place the right types of policies that may prevent future closures. So I'm really excited about this work of this task force, and to be able to report back to this committee our recommendations.
The second area of challenge that I'm excited to work on this year is primary care. Primary care is in a dire situation in Massachusetts. We are spending a declining amount of our health care dollar on primary care, and 40% of our5974 residents say that they are unable to get the5976 primary care visit they need due to the cost or wait times of that care. Included in the legislation that passed just at5984 the beginning of this year is a new primary care task force, which is gonna, again, be co-chaired by the Health Policy Commission and the Secretary of Health and Human Services. This task force is gonna be looking at making recommendations about how we can strengthen and stabilize our primary care workforce, invest more into primary care over time, and ensure that we're, reducing some of the administrative burden that we know is leading a lot of burnout within our primary care setting.
So that task force is also gonna be meeting, starting just in about two weeks. The maternal health task force is beginning next week. And with both of these task forces, you have charged HPC and a whole group of experts to really come back with some policy recommendations that can help move these6030 issues forward. When I6032 think of task forces, I think you get out of it what you put into it. And the Health Policy Commission, we6038 are committed to making these task forces something that is gonna really dive deep urgently into these issues and provide actionable insights and recommendations to you in the legislature. So thank you for your support, and I look forward to working with you in the year ahead.
DRISCOLL - Thank you very much. We look forward to those insights and, actionable, information and guidance. Any questions from committee members? Thank you very much.
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GENA FRANK - 1199SEIU MASSACHUSETTS - Hi. Thank you, Chairs Decker, Driscoll, and members of the committee. I see so many longstanding supporters of frontline healthcare workers here today and the people we serve. I'm Gena Frank. I'm political director for 1199 SEIU. 1199 SEIU is made up of approximately 80,000 healthcare workers in hospitals, nursing homes, and home care agencies across the common and, excuse me, home care across the Commonwealth. I would say that we are also the backbone of our healthcare system. We have several bills before the committee this session. They include legislation addressing conflict of interest in nursing homes, filed by Rep. Mendez and Senator Fernandez, and several bills which seek to address the continued closures of programs and hospitals as President Murphy mentioned. However, I'd like to use my limited time today to talk about what we at 1199 see as the top public health concerns facing the Commonwealth. Our biggest concern for a long time, particularly post-pandemic, has been workforce shortages.
We are in desperate need of qualified staff in hospitals, nursing homes, and home care. Understaffing is contributing to delayed care, more emergency department visits, and hospital boarding, and by extension, worse health outcomes. Understaffing is driven by a combination of low particularly for frontline staff, not just nurses, is driven by the combination of low wages and the high cost of living here in Massachusetts. That was the finding in the same health policy commission report. They were like, low wages are a key part of this. And it's driven by the high cost of housing. Far too many health care workers, and the people they serve cannot afford to live, work, and raise a family here in Massachusetts, and that is a public health crisis. So those are the major issues already facing us today, but there are two enormous threats on the horizon that would exacerbate our healthcare staffing crisis, and by extension, the public health of our communities. The first one is, of course, what's already been mentioned, the possibility of significant Medicaid cuts, which could result in billions of billions of dollars lost here in Massachusetts.
This would mean a reduction. I don't need to tell you all of the threat that it poses to the reduction in services. I mean, our health care system is already plagued by unfair and inadequate reimbursement rates. If the federal government slashes Medicaid, state government must be prepared, and this is where I need all of your help, must be prepared to utilize new revenue sources and consider judicious use of the rainy day fund to prevent destabilizing our healthcare system and preserve our public health. The second major threat to our healthcare system comes from the Trump administration and their relentless attacks on both undocumented and legally present immigrants. Recent immigrants, here working legally, make up a substantial portion of the direct care workforce in our healthcare system. Yet, the Trump administration has already announced the imminent termination of both temporary protective status for patients and Venezuelans, and the entire humanitarian parole program. Healthcare providers, particularly our nursing homes and home care consumers, employ a significant of those folks who are legally present under those two programs. State government must act urgently and do all in its power to help protect the thousands of immigrants who keep our health care system running. On behalf of our members, I look forward to working with you to address these and mitigate these threats. Thank you.
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SOUSA - Thank you so much. I feel like between6310 you and President Murphy Framingham's in the6312 house. It's very exciting. I wanted, to know if you could, if could you share some more information, about who these TPS and human, humanitarian parole, impacted workers are, and if you know what's gonna happen to them, or is there a plan?
FRANK - Yeah. So we have a lot of Haitian workers in our union and providing essential health care. These are folks who have been here oftentimes for, like, 15 years. They have had this legal status, and they were just informed that it's gonna go away August 3. Now, all of our health care providers are right now asking themselves the question, what do we do? Because you have to have legal status. You have to submit an I-9 in order to work in a health care setting. So they have legal status, but then they won't after that time. So you're facing all these shortages, so what do you do? I mean, we don't know exact numbers of TPS holders, but I can tell you that 40% of nursing home workers are migrants are immigrants, excuse me. And a significant portion, like, I went into one nursing home the other day to try to find folks to join in on a lawsuit challenging this, and we immediately identified 7 TPS holders in that one nursing home.
And nursing homes already have vacancy rate, one in seven positions they can't fill. Like, that's the status quo of where we're at right now. So employers are gonna do the hard work of having to make really hard decisions. Like, they could be putting their Medicaid funding at risk, their Medicare and Medicaid funding at risk by continuing to hold these these employees. Medicare and Medicaid funding at risk by continuing to hold these employees. So that's who they are in the nursing home. In home care settings for private pay home care, we have lots of folks who are undocumented. That's who's doing that work in private pay home care settings. Similar deal with public pay home care is folks who have to fill out an I-9 have largely came here legally because they were leaving humanitarian crisis countries, and now are being told, actually, in the case of humanitarian parole, it's gonna be disappearing at the April. Like, sorry, bygone.
DECKER - Just wanna say thank you for the work that you do, and to, make no mistake that what this Trump administration is doing is to take people who are legally here, create an illegal status, and as they transparently showed us, they are taking a chainsaw to many parts of our society, including health care and anyone who's needed a home health aide for, anyone who's gone into a nursing home or a long term care. We can absolutely expect, a very fragile workforce to already just collapse, and it will be much harder to care for people, in each of our communities, as a direct result of the federal government's chainsaw approach to what? I'm not sure. But thank you for your work, and we will continue to rely on you as an important partner to inform us on what you're seeing, at the ground level. Thank you. Thank you.
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CHARLES ANDERSON - THE DIMOCK CENTER - I'm Doctor Charles Anderson, president and CEO of the Dimock Center, where our mission is to heal and uplift individuals and families in our community. Our services range from early intervention and early education and care to crisis support with roughly a hundred beds of substance use disorder and one of the few family shelters in the state. And while all of this is public health, today I wanna focus on our embedded federally qualified health center or community health center providing over 75,000 visits per year. I think we would all agree that post-COVID, our system of health care in the Commonwealth is wobbly at best and collapsing at worst, and this represents a significant public health crisis. As we work together to address this situation, I hope that we can also agree that a focus on primary care and prevention is critical to any long-term public health strategy. With that understanding, let's consider the fact that the largest primary care network in the Commonwealth are the 52 community health centers that care for one in six people in the state and every other person in the city of Boston.
Without our community health centers, patients like the young woman who came to our clinic recently with a child with special needs and dealing with the trauma of housing instability and food insecurity would have ended up in an emergency room that was not equipped to provide the holistic and highly coordinated care that she required. Unfortunately, this important thread in the fabric of our local health care system has experienced the same increases in labor costs without a reciprocal increase in revenue resulting in the same operational deficits that are impacting our hospitals. Community health centers, however, caught in an even more challenging situation. We don't have the cash reserves to steer through the current fiscal turbulence, let alone prepare for the impending tsunami of federal budget cuts on the horizon. Despite this economic reality, as pharmacies and critical access hospitals like Kearney have closed, community health centers are standing in the gap to provide access to fundamental health resources like urgent care and medications. Nearly one half of community health centers nationally are experiencing negative margins.
It has been predicted that6644 as many as one in four community health centers sites across the country are at risk6648 of losing and closing their services. This is before laying on any federal cuts in funding. Although our state is not immune to this, we have always been forward-thinking in our approach to health care and public health. Now is the time for us to stabilize our community health centers by one coming together with a shared understanding of the critical role that community health centers play in this system. Two, by providing needed financial support to our most impacted community health centers. The master league requested $75,000,000 from the state, and while 12,500,000,000.0 was greatly appreciated, we're asking that the state extend that support to providing another 65,000,000. And third, we must stand together against threats of funding cuts that would further destabilize our system and leave many of our residents without care. I leave you this morning with one adaptation of the model for my favorite children's book character, Dr. Dee Dee Dynamo. There is no problem too big or too small, and like Dr. Dee Dee Dynamo, we can tackle them all. Thank you.
DECKER - Any questions? I also wanted to say thank you for your work on the Commission on Maternal Health and Racial Inequities. Thank you for being an important partner in the legislation that came out of that and for all the work that you do.
ANDERSON - Thank you for what you do as well.
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NAHID BHADELIA - BU CENTER ON EMERGING INFECTIOUS DISEASES - HB 2385 - Thank you so much, Chair Driscoll, and Chair Decker. Honorable chairs and distinguished members, I thank you for the opportunity to address you today on this incredible work that you're doing. As Chair Decker said, I am an infectious diseases physician, and I'm the founding director of Boston University Center on Emerging Infectious Diseases. We're a research center that focuses on public health, data science, and policy research as it relates to global health security and pandemic preparedness both here at home and abroad. I will focus my very brief remarks on four main issues related to infectious diseases, which I believe are of the utmost importance to the6786 Commonwealth. First, we're coming out of a prolonged pandemic. Just because we had one threat, overwhelm us, does not mean new threats are not on the horizon. Even as we ensure that our healthcare facility and delivery systems remains resilient and ready against new infectious diseases by addressing significant workforce shortages, ensuring healthcare worker training and safety, and facility readiness to care for patients with highly communicable infections, I believe we need a little bit more to catch that first patient.
We have found a significant gap in resources that provide real-time awareness of new threats to clinicians, emergency rooms, and hospitals. What our clinicians need is timely information about whether the person in front of them in the emergency room who has just traveled abroad may have an infection they need to worry about and if there's an outbreak going on. To supplement the excellent alerts and educational materials from our federal, state, and public health partners, we at SEED are launching Beacon, BioThreat's emergence analysis and communications network. It's open source, free, it's available in seven languages, and it merges AI, large language models, and a globally based network of subject matter experts who provide regional and technical context which clinicians, public health experts, committee members such as yourselves, as well as journalists and general public can use. Like any early alert systems with fires and hurricanes, Beacon's job is to analyze and broadcast the rise of new threats. It is a globe-spanning, open source, near real-time disease alert system that you will keep in your pocket or on your desktop and you will rely on.
The program will launch at beaconbio.org next month, April 24. And we have already been in close communications with Mass DPH, as well as global partners such as WHO and the Africa CDC, and we welcome further partnership with this committee and local departments of public health. Second, I want to underscore the public health significance of the current H5N1 influenza outbreak. As you know, this is a virus we've known for a while, but it has now behaved in ways that we don't expect. It's infected over 40 mammalian species, has infected our farm animals and domestic animals, and caused over 70 human sporadic infections, and over a hundred and 70000000 wild and commercial bird infections here in Massachusetts. And although we have not seen a human infection yet, and infection yet,6924 and thank6925 God there's no evidence of sustained human-to-human transmission, given the amount of virus in our environment, this is only a matter of time. We are ahead of the curve6931 in the Commonwealth with the6933 proactiveness of our Department of Public Health.
And hence, I would like to suggest that what we need at this point is a systemic and coordinated approach to assess our readiness against this threat in animal health and human health. I had the pleasure to speak with representative Lee Davis about House Bill 2385, an act establishing a special commission on aviod influenza, which will do justice. I strongly support this action to assess risks, develop, prevention policies, and coordinate efforts among government agencies, agricultural stakeholders, and public health entities. And the last two words I wanna say is there's a planned reduction in federal funding for infectious diseases research at a time when we do not withdrawn our federal funding for global support for programs that help us stop outbreaks where they start. We are more vulnerable.
And we here in Massachusetts with our strong, vibrant academic, you know, biotech and pharmaceutical sectors, we will suffer not just the human cost, but also to our economy, and we will lose experts to other countries. I urge this committee and the state to look at the impact of the withdrawal of infectious diseases funding and also how we can mitigate by being more coordinated by synergizing in this future limited resources here in The United States. Lastly, I will be remiss as an infectious diseases physician to not underscore what my colleagues earlier this morning already said about vaccine confidence. What we have found is that that is eroding nationally, and we are not immune to that. And with the measles outbreaks happening everywhere, none of our communities are safe. And I would just underline everything they said this morning. Thank you so much. And I offer myself, my faculty, and the BU seed as a both a resource to you as well as a partner for some of these complicated infectious diseases, problems. Thank you. Any questions?
DRISCOLL - Thank you for being here. It's good to have you, testifying here again at the state house. Just a question around H5 N1, the measles threat. If this were to show up in the Commonwealth, how quickly you know, again, I guess it may depend on scale, but how quickly do we have to move and, you know, what do you see kind of playing out if and when?
BADALIA - Yeah. For measles, you know, as was mentioned this morning, we rank around 1.3 for, I think, kindergarten exemption rates, which is much lower than I think the overall rate, which is three and change nationally for kindergartners exempt for any child and parental exemptions. But that range is 0.6 in Suffolk County to 4.6, I think, in, like, Dukes County. Right? What we found from our own research and a publication that we had last year was that aggregation happens at community levels. Communities aggregate together who have similar feelings of hesitancy, and that's what increases our risk is that it's not that it's 4% in different blocks. A lot of times it's in the same neighborhood. So if measles finds those communities, that's when it's high at risk, particularly because the incubation period is so long.
So you may miss people who are exposed. They may go to other areas and potentially the risk of transmission continues. For H5N1, until there's a human-to-human transmission risk, the bigger risk is that you might have backyard bird deaths and illnesses. You might have dead birds in pools at schools. How do we advise all our different communities? Because we've seen now a very severe infection and a death from h 500 in Louisiana from a case of, backyard poultry. So for now, our goal should be to strengthen, to double down our ability to surveil the infection in animals and humans, but to have a plan that if this becomes a human-to-human transmission, what is our vaccination plan? How will we quickly get diagnostics on tap to ensure that we can diagnose specifically H5N1? Because you can miss that among influenza A, which is the type of general class of, virus that H5N1 is part of.
DECKER - I just wanna say thank you. It's always alarming to hear you speak.
BADALIA - Sorry. I always bring bad news.
DECKER - You know, great great dinner party. But it's important. Right? And I think what's important and I can't believe that I sit here as chair of the joint committee on public health to say that we are really experiencing a time in which our federal government is absolutely creating a circumstance where we are more vulnerable and we have less tools and less resources to protect each other. Whether it's the withdrawal from the WHO, the hatchet job that's being done at the CDC, the NIH. Thankfully, the, folks at the CDC were still able to gather and look at what the next flu vaccine should be like, and this may be the last time. But as they will tell you, it was done in the dark of night, and it's not an official meeting. So for those who are wondering, there will be a flu vaccine, based on, science, and that, science and public health, to be clear, was always a nonpartisan thing. It didn't matter your party affiliation.
And in fact, there are many Republican leaders who in fact, were the leaders of public health in this country nationally. So it is an alarming time, and as a state government, we're being asked to do more with more being taken away from us, and we're not an island as a state, and we're not an island as a country. So we will continue to rely on you, but to those who are listening to this hearing, please know that the leaders in the legislature, both as committee chairs, both the speaker, the senate president, our, commissioner of public health, and our NGO partners. There's a lot of7253 conversation that has been taking place since November that is talking about what does collaboration and partnership look like.
And, what you're hearing today, we have the commissioner here saying just yesterday at noon, that we fair to lose a hundred million dollars towards infectious disease work, which is the Department of Public Health alone. And that's not all the cuts. But so it's happening very quickly, and we are all scrambling to keep up with the news that's coming in and to understand the rationale behind that, but please note that, your leaders in state government and, our partners are doing everything we can to stay in partnership. And I just wanna say a very special thank you to the, BU School of Public Health, which I have found in my, last six years, chairing committees have been an invaluable apartment as a, partner as a state, as a legislative leader in helping us, both learn and navigate and need. So thank you.
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SEAN CAHILL - FENWAY HEALTH - So thank you, Chair Decker, Chair Driscoll, vice chairs, and committee members for this opportunity and your leadership. I'm Sean Cahill, director of health policy research at the Fenway Institute at Fenway Community Health Center in Boston. We provide care to everyone, but about half of our 33000 patients are LGBTQ. We have 6000 trans and non-binary patients, 2300 HIV patients, and 3500 patients on PrEP for HIV prevention. Our research institute conducts work in The US and around the world on HIV and STI prevention, disease prevention, and care. According to the Massachusetts Behavioral Risk Factor Surveillance System survey and the mass risk, youth risk behavior survey, 9 percent of adults in Massachusetts identify as LGBT, and 23 percent of high school students and young adults identify as LGBT or unsure of their identity. LGBT adults report high rates of fair higher rates of fair or poor health than straight cisgender adults.
LGBT adults and youth report higher rates of experiencing sexual violence, smoking and vape vaping tobacco products, and binge drinking. LGBT adults are twice as likely to report not seeing a doctor in the past year due to cost. Providing culturally responsive affirming care to LGBT patients can improve their ability to access health care and support their health and well-being. And this is why since 2011, we have trained health centers, hospitals, and private practices around the country in how to provide such care. Unfortunately, recent actions by the Trump administration and Elon Musk threaten our ability to serve our patients and communities. In recent weeks, the Fenway Institute has lost six research grants worth several million dollars. These include HIV prevention research with cisgender women, smoking cessation intervention research with transgender people, a study of the effects of race and age discrimination in health care, and four adolescent, HIV vaccine and prevention clinical trials. And as, for your information, adolescents are about one fifth of new HIV infections. We also face threats to our ability to provide gender affirming care from the president's anti transgender executive orders.
We're concerned about looming cuts to HIV and STI prevention and Medicaid. So we ask the legislature to protect safety net care funding by passing an act prohibiting discrimination against 3 40 b drug discount program participants. We also ask you to require that commercial insurance reimbursement match the rates paid by MassHealth by passing an act relative to rate equity for community health centers. These bills would not cost the state a dime, but they would help our state's health centers, half of which are currently running deficits due to these structural problems. Because the Trump administration is rolling back sexual orientation and gender identity data collection in health care, we also ask you to, please pass an act relative to LGBTQ health disparities, which would increase which would increase the collection of voluntary confidential SOGI data to help in reducing health disparities. We also asked the legislature to create a Massachusetts LGBTQ health research and education fund to support critically needed research and education, which is being cut by this administration. So thank you.
DECKER - Thank you, Sean. Could you also just tell us a little bit my understanding is, Ezona, as of Friday, you were informed of major millions of dollars that you are losing. Fenway has always, and even now more than ever, plays an important role in providing, appropriate, health care to our LGBTQ community. We also know that in states even like New York, even though at the moment, the orders coming out of the president's office, prohibiting gender affirming, care to minors is not actually law7566 at the moment. So we in Massachusetts, our hospitals have not stopped denying that care. But my understanding is even places like New York, there are hospitals that have stopped providing that care, as well as other states. And Fenway is seeing an uptick in people who are coming to Fenway for care. So you're seeing an increase in demand because of what's happening, and now you're looking at the no. Not looking. You will have less money to do this care.
CAHILL - Yeah. Absolutely. The budget for our institute is about 10,000,000 a year. And just on Friday, we lost several million dollars in grants. So we're gonna, appeal administratively, and then hopefully, that'll work. But if it doesn't, we'll consider other options. But I personally was the multiple principal investigator on a, grant that was 450,000 over two years to, develop, an intervention with older gay and bisexual men living with HIV to reduce social isolation, depression, and, loneliness. But, yeah, you're right. Like, in, I think it's NYU Medical Center, Langone Medical Center, that has stopped providing gender affirming care to youth, and, that care is still legal in New York State. The president's executive order does not have teeth yet. It's gonna take the, federal agencies months or even years to develop regulations, and those will be challenged. So, what we're seeing, unfortunately, is a lot of over-compliance, happening in federal agencies and in some private institutions as well.
DECKER - And, again, because this is an informational briefing, we're talking more than we would usually, but we wanna make sure the public continues to understand what's at stake as we in the public health committee look at bills over the next two years. We also I can tell you I have a constituent who's, works for a large hospital who focuses on both providing and doing research on LGBTQ health. Half a million dollar grant was just, taken from them, not renewed, and, people have lost their7678 jobs. And just as importantly, that means7680 that at a major hospital that provides a significant amount of care to the LGBTQ community and particularly adolescents, that care is actually now at risk of not being, replaced. I also want people to know that in Massachusetts, the conversations that we are having, in the legislature and with, the administration and with our partners is to think about.
We don't have the answers at the moment, but we are looking what does it mean to continue to provide care, even if our hospitals, because what's at stake and why New York7709 has, that hospital stopped giving7711 care is that they are threatening our hospitals with a loss of other dollars if they continue to provide care for, the the LGBTQ community that is specific to gender affirming care. And so the challenges of state governments around the country will be the risk that our hospitals will have in losing hundreds of millions of dollars versus continuing to provide that care. Well, we have to do both. And so there are lots of conversations in which we are thinking about, what does it think to innovatively and out of the box, think about how to ensure that care continues and not lose hundreds of millions of dollars. We don't have the answers, but for those who are watching to know that those conversations are happening, every day. And Fenway continues to be a really important partner in the conversation.
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TANYA NESLUSAN - MASS EQUALITY - Thank you, Chair Decker. It's actually Neslusan. Thank you, Chair Decker. Thank you, Chair Driscoll. To the honorable members of the committee, I appreciate you taking the time to hear us out today. As you know, the federal government has, you know, declared war on health care. We are particularly concerned, and I will keep this brief because most points have been covered. We are particularly concerned with the loss of data at the federal level around healthcare. As we know, determining who is at high risk and what, and, what populations are being impacted is extremely critical to understanding the impact of, you know, how we allocate funds and services. We are also very concerned about the attack on transgender health care.
We need to make sure that not only do we have transgender health care services protected in our state, which we do, but we also need to make sure that the funding is there. We have seen directly, we have seen a large number of what we're calling refugees to Massachusetts, looking for health care coming from other states where they have preemptively complied. However, we also have hospitals closing and consolidating and a lack of services, especially in more rural areas across the common Commonwealth. This is particularly concerning when it comes to behavioral healthcare and substance abuse care across the board where we already have a struggling population and are at higher risk. Beyond that, we are also very concerned about the impacts with HIV prevention programs and also some of the impacts of services around, accessibility in the disability community and the immigrant population. So thank you.
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ELIZABETH GANZ - ABH - SB 1392 - SB 1551 - HB 2535 - SB 874 - HB 1396 - Thank you, Chair Decker. So good morning, Chair Decker, Chair Driscoll, members of the committee, staff. My name is Liz Ganz. I am the vice president for government affairs and public policy for the Association for Behavioral Healthcare or ABH. On behalf of ABH and our members, thank you for this opportunity to introduce ourselves. ABH is a membership association of community-based mental health and substance use disorder treatment provider organizations. By community-based, I mean services provided in settings other than a hospital. To share a few statistics, ABH represents over 80 provider organizations. Our members serve approximately 81,000 Massachusetts residents daily, 1,500,000 Massachusetts residents annually, and employ over 46,500 people. Many ABH members deliver services through contracts with the Department of Mental Health, the Department of Children and Families, and the Bureau of Substance Addiction Services. ABH members also provide insurance-based, services.
Notably, ABH members are the primary providers of behavioral health care for people covered by public insurance in the Commonwealth, but our members also serve people who have private health insurance. While it's not part of my focus remarks8012 today, I'd be remiss to just say that I reiterate my colleagues have said about, budget8018 cuts to mental health and substance use, on the state level, the importance for community based services, and also, Representative Kerans, we have a bill that addresses some of the, children behavior health services at senate 1392. That's gonna take me off time. But I thought I would highlight on the, some of the bills of the several bills that8040 you have before the Joint Committee on Public Health, and, I know there are many. And what I would like8046 to highlight is Senate 1551,8048 House 2535, an act establishing a naloxone purchase trust fund. This legislation could address some issues that, caused by technicalities that are in the current law. As context, ABH strongly supported the SUD omnibus bill passed last session and signed into law. That law sets forth a requirement that SUD treatment facilities dispense not less than two doses of an opioid antagonist to patients with a history of opioid use disorder, opioid use upon discharge.
The law indicates an intent for the cost of the opioid antagonist to be covered by insurance through either a medical or pharmacy benefit. Our concern is that SUD treatment facilities can't bill insurance through a medical or pharmacy benefit and often don't have prescribers. Therefore, it's not clear how they would be able to cover the cost of this requirement. A dedicated naloxone purchase trust fund could resolve these challenges. And though although not, specifically assigned to this committee, given its public health implications, we felt it important to raise one of our priority bills this session, senate 874, house 1396, enact strengthening mental health centers. Primarily, this bill would mandate an increase in mass health rates paid to outpatient mental health centers. Understanding there are fiscal realities, mental health centers need higher reimbursement rates to be able to pay salaries, to retain and recruit clinicians, reduce wait times, and ensure workforce of providers prepared to deliver quality care. We greatly appreciate the work this committee does to advance public health. We view accessible, affordable, and equitable access to behavioral health services as critical to that goal, and we're happy to help you in your efforts.
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OAMI AMARASINGHAM - MPHA - You did great on the last name. Thank you. Good morning, Chair Decker, Chair Driscoll, members of the public health committee, and staff. My name is Oami Amarasingham, and I'm the deputy director of the Massachusetts Public Health Alliance or MPHA. We are a nonprofit advocacy organization focused on advancing policies that create the conditions for people to be at their healthiest in Massachusetts. Our organization has been around for almost 150 years, and for most of that time, we were known as the Massachusetts Public Health Association. But this past fall, we changed our name to better reflect the work that we do. We are not a trade association, but we are an organization that works in coalition with, almost everyone you have heard from today to advance public health policy, and funding in the state. As this committee knows well,8227 health does not start or end in the8229 doctor's office, and in fact, health is created 80% of health is created in the conditions where we all live, work, and play. For that reason, we are a multi-issue organization, and we have many bills in front of your committee.
But, of course, all the committees in the legislature really see bills that will impact public health in the state. Our top focus areas for this legislative session are public health infrastructure, housing justice, environmental justice, equity through health care, transportation, and sustainable food systems. With respect to public health infrastructure, we advocate for strong governmental systems that provide services, preventing disease and illness, and ensuring safe and healthy communities regardless of race, income, or ZIP code. Like many others this morning and your committee, we are deeply concerned about the federal picture, specifically funding cuts to public health and healthcare services, as well as the dismantling of the federal health workforce. With that in mind, we are very focused on the state budget process this session. We know that because of dismantling of the federal public health infrastructure, there8300 is gonna be even more demand on state and local public health. We are concerned about proposed cuts in H1 to the Department of Public Health and many of their programs, including cuts already mentioned to the Bureau of Substance Addiction Services or BSAS.
Specifically with respect to BSAS, we are very concerned, that these cuts will impact low threshold housing, and we know that in 2023, for the first time in many years, we saw a reduction in overdose deaths in this state, and we're very concerned about backsliding. I see my time is ticking down. I want to, also mention that we are very grateful for this committee's support in transformational work around our local public health system over the last several years, including, the passage of major legislation last session. In the state budget, we are very supportive of funding for local boards of health who are on the front lines of many of the issues you've already heard about today, but including vaccine delivery, food safety regulation, inspections, water quality, and much, much more. So we will be in front of your committee on several issues, specifically related to environmental health, but also look forward to working with all of you on many other issues in front of other committees this session.
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MARISOL GARCIA - HEALTH LAW ADVOCATES INC. - Thank you so much. Dear, thank you Chair, Decker, Chair Driscoll, members of the Joint Committee on Public Health. As was stated, I'm Marisol Garcia. I'm deputy director at HLA. I lead the work of our largest initiative, the mental health advocacy program for kids or MAP for kids as we call it. This statewide legal services program ensures access to mental health care for young people with unmet mental health needs. MAP for Kids attorneys provide free legal representation to income eligible families and operate from the Department of Children and Family, family resource centers that were created by this legislature to divert children from juvenile justice and child welfare to health and social services. If I might say, it's one of the best things you guys have done. Our program collaborates closely with the centers to ensure that family receive mental health services in their homes, in their schools, in their community.8444 I supervise the MAP for8446 Kids attorneys statewide, and as 27 years as a child advocate, I'm here to testify that timely access to mental health services, it saves lives.
Over 94% of the families served by MAP for Kids report at least one barrier to mental health care, with the most common barriers being bureaucratic delay and incomplete information. Hundreds of callers on our intake line describe children whose mental health worsens and symptoms exacerbate, while insurance companies deny claims. State agencies shirk their responsibilities, and school districts hire attorneys to fight parents' requests for services. Juvenile court and child welfare involvement is almost inevitable when we force children to shoulder the burden as they struggle due to their mental health. Caregivers are terrified of losing their parental rights and losing physical custody of their children as they navigate these multiple complex systems to secure mental health services. And tragically, families are often advised by health care providers to turn to the juvenile court to relinquish physical and legal custody of their children in exchange for intensive mental health services. A middle school student struggling with severe trauma, anxiety, and depression, known to the juvenile court, state agencies, the school district, and the top treatment providers in our state ran away from home and was sexually assaulted by an adult at an MBTA station.
When the police found them and brought them to the emergency department, the child remained there for months without receiving any emergency, receiving any therapeutic care. Everyone agreed that the child was at enormous risk, yet no one would take responsibility for providing the necessary mental health treatment. Finally, America Kids' attorney secured a safe therapeutic environment for the child. The result8555 was immediate. Both their physical and mental health began to improve timely access to mental health services. It saves lives. Since 2015, we've, MAP for Kids attorneys have decreased costly Medicaid services like emergency department boarding, crisis team intervention, and inpatient psychiatric treatment. On conclusion, persistent legal advocacy MAP for Kids improves the physical and mental health of kids and their caregivers, stabilizes8582 family, and reduces involvement in juvenile court and child welfare systems. I'm happy to answer any questions you might8588 have.
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GARCIA - I'm gonna be submitting the latest report from Boston University School of Public Health, along with my written testimony, just about how acute the mental health need is of kids and families in our state, and also the financial impact of untreated mental illness. And I just wanna take one second to really thank this committee for your courage because you've invited us all here to face the many challenges ahead of us. And these conversations, though alarming, are also have given me8619 hope today, not only for our commonwealth, but for our country. So thank you so much.
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AUDREY MORSE GASTEYER - MASS HEALTH CONNECTOR - Good morning. Madam Chairman, Mr. Chairman, members of the committee, and staff, thank you for the opportunity to discuss the Massachusetts Health Connector, and the work we do to provide affordable health coverage to everyone who needs it here in the Commonwealth. My name is Audrey Morse Gasteyer. I'm the executive director of the Massachusetts Health Connector. More Massachusetts residents than8668 ever before are in health connector coverage. With more than 366,000 people getting health insurance through our state's marketplace, which is the first in the nation. Created by this legislature through state8680 law in 02/2006. The vast majority of these people, more than 85% of our membership, get help paying for their health insurance. For most people, that coverage comes through our Hallmark Connector Care program, which uses Federal Affordable Care Act and state subsidies to deliver help paying for health insurance. Connector Care plans deliver lower monthly premiums, in some cases, no premiums, reduced co-pays, and eliminates deductibles.
This ensures that people in Connector Care don't just have a health insurance card, but have coverage they can actually afford to use when they're sick or injured, or to manage chronic conditions that require continual treatment, or to stay healthy with preventive care and screenings. More than 311,000 members in connector care have access to these enhanced benefits, and this includes more than 61,000 individuals who are8727 now in connector care, thanks to the 2-year connector care expansion pilot included in the FY 24 budget. We're very grateful to the legislature for your support of the connector care expansion pilot, which makes healthcare, not just health insurance, more affordable to more Massachusetts residents than ever. As we look ahead to this in the coming years, our fundamental mission remains the same. Deliver affordable healthcare to everyone in Massachusetts who needs it. This remains true as we actively review and prepare to comment on a newly proposed rule from the federal government as it relates to marketplace operations, and we will continue to monitor and anticipate potential changes to rules and policies related to the Affordable Care Act.
We will work to preserve Massachusetts' nation-leading health insurance coverage gains and ensure that our members and applicants continue to be able to depend on the health insurance coverage and access to health care we've worked so hard to establish here in the Commonwealth. The ACA has helped Massachusetts remain the national leader in health coverage rates with more than 98% of our residents in coverage, according to The US Census. Our individual mandate provides financial disincentives to go without coverage and creates a framework and standards for coverage that delivers key benefits and services to residents. Like this committee and other partner state agencies, affordability remains a top concern, including for small businesses in Massachusetts. To provide cost savings opportunities for employers while empowering employees to provide cost savings opportunities for employers, while empowering employees in their plan selection process. For the small businesses8827 we serve this year, we also created the premium value plan designation. During their shopping experience, employers can filter and view8834 plans that beat the average market premium, while providing the same level of benefits and services as more expensive plans.
This is really our first pass at identifying premium value that already exists for small businesses here in the state and may otherwise be hiding in plain sight. While premium value plans deliver savings to small businesses and Connector Care provides lower cost plans to individuals, the overall healthcare system continues to be threatened by price escalations. And we know there's more work to do. As we saw in recent weeks with the8863 release of the CHIA annual report, healthcare expenditures continue to grow at exponential rates and the time to8869 advance cost containment efforts is now. And the health connector would welcome the opportunity to work with the legislature to champion this work. Work. We are committed to using regulatory and market influencer tools at our disposal to work with the legislature, partner agencies, providers, issuers, advocates, and community organizations on finding meaningful solutions to high and rising health care costs. Again, thank you very much for the opportunity to discuss the Health Connector today, and my team and I look forward to working with you this session.
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DECKER - No. Just again, this is a legislative briefing on the issues facing, public health in this session. I just wanna say8907 thank you to everybody at the connector. You're invaluable8909 to many of us in the legislature providing8911 care to many of our constituents. And a reminder to say that this is a8915 duty of care that's under assault in8917 the previous reiteration of this administration. Yes. Fortunately, it failed because what is known as the ACA or called Obamacare really was also8926 referenced as Romneycare. I would say MarianoCare, who's the8930 majority leader there. Steve Walsh might say Walsh care, that he's not. I said that here. But there's a lot of pride in Massachusetts and in this legislature for innovating what is the most cost-effective health care. That's preventative care. That's right. Preventative care allows you to actually access a doctor, to do screenings, to access maintenance medications, and to get early diagnosis. And we will continue8955 to fight for that kind of care because quite8957 frankly, it is the most efficient way of using, our dollars. So thank you for all the work that you and your team do.
GASTEYER - Thank you. I appreciate that. We are in that fight with you. Anything you need, please let us know. Thank you for your attention to this and all the other important topics today.
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EMILY DULONG - MHA - Thank you. I think if he were here, he would say it's Mariano Care. That's it. Thank you, Chair Decker, Chair Driscoll, members of the Joint Committee on Public Health, and your staff, of course. Appreciate the opportunity to testify before you today. As mentioned, my name is Emily Dulong, and I'm the vice president of government advocacy and public policy with the Massachusetts Health and Hospital Association. MHA is fortunate to have such strong working relationships with the members of this committee, both in your capacity as public health policymakers, but also as elected members of the legislature who are patients yourselves and represent patients. To that end, we know you're very well aware of the state of the Massachusetts health care system and the state of Massachusetts hospitals and health systems particularly. Our members continue to grapple with the aftereffects of the COVID 19 pandemic, just like most of our other partner institutions in the health care industry, in addition to the reverberations of a shifting acute care market and the departure of Steward, from Massachusetts.
And those same economic challenges impacting small businesses, families, other industries, including the high cost of labor, excuse me, increasing input costs, the cost and general affordability of the services that we offer are affecting healthcare systems9056 as well. However, we continue to meet the moment to the best of our ability, ensuring that patients have access to the care that9062 they need in a system that is more dysfunctional than ever. But that said, not many of our partners in the provider space were not as fortunate, have not been able to not only return to their pre pandemic capacity, but many were unable to return to the market at all. This has had devastating impacts on the healthcare system that we all collectively worked towards, to build that prioritizes the delivery of high value care, to patients in appropriate care settings in order to minimize unnecessary use of high cost acute care services. With these community public health providers, having extraordinary difficulty navigating and surviving in this marketplace, resources continue to be drawn into the acute space, compounding our members' financial difficulties and keeping patients, providers, and our entire system in a cycle of limited access, lack of affordable options, and increasing costs.
And despite the challenges we continue to grapple with, many have been noted today, whether they be relative to the state budget funding or the chaos happening in Washington, our members remain committed to working to the best of our ability to make whatever improvements are possible in order to ride out this moment of deep uncertainty. And we hope this session will bring an opportunity for hospitals and health systems to work with our partners in state government and other stakeholders in the health care community to truly look at the underlying issues affecting our system and try to make some targeted short term fixes while also examining whatever the next iteration of Massachusetts health care reform looks like. With patients having less access to preventative community-based care, post-acute home care, and nursing care, the only available providers open 24/7 have become the last line of defense for all types9153 of care, and this is not how the system was designed to work.
As just discussed, we all know, it behooves our9159 members and our advocacy team to put our9161 best efforts forward in making improvements to the entire health care system, entities beyond just hospitals, and those that ensure the sustainability of our hospital community by alleviating capacity9170 on the inpatient space. So9172 while we have several pieces of legislation before9174 the public health committee, I won't belabor that, we have submitted copy of our legislative package as well as our budget letter for you all to review. And, obviously, in addition to our public health priorities, we remain concerned about the underlying, hospital finances and other matters mentioned here, in addition to the pending or impending cuts to Medicaid, coming out of Washington. We look forward to working with you on these and all other health care matters this session, and, thank you for your time today. Happy to answer any questions.
DRISCOLL - Could you expand upon I know you started tracking the boarding, across the state.
DULONG - Yes.
DRISCOLL - Where are we? What have you seen since you started tracking that, and what's the diagnosis of the state of affairs?
DULONG - So I appreciate the boarding, metrics being highlighted, and thank you so much. It goes up and down. It ebbs and flows. I think what we continue to see is a lot of, stagnation in terms of just general improvement to those folks who are in emergency departments because there's nowhere else to go. So it continues to be a pervasive issue that has been better at times and worse at times. I know, you know, Chair Decker, we work with you very closely on the matters relative to children's behavioral health, you know, during, summer months, boarding drops. During winter months, boarding skyrockets. So it continues to be an issue, not only in the behavioral health space, but also with folks just trying to get, into the emergency department for whatever type of care that they need. Those bottlenecks, that capacity, we continue to monitor because it remains an issue.
So not only the behavioral health boarding on the front end, but also the back end folks who are able to be, released to post acute or to home or to another site of care that can't access that bed due to either, you know, administrative hurdles or, most of the time, availability of services. Sometimes it can come down to transportation. You know, it's a bed is approved, a bed's available, but there's no, transport there to move the patient. The patient stays another day. So that's also why we have some proposals, and, Chair, Driscoll, appreciate your your continued work on the emergency medical services side of things. These are some of the examples of ways in which we are trying to direct our resources and our advocacy to shore up the other members of the other9297 elements of the health care system because we don't want not not every patient9301 needs to be in a hospital, and, unfortunately, when9303 that's folks' only option due to coverage challenges and other issues, you know, there's only so long the center can hold. So we're looking to do everything that we can to work with our partners here moving forward. Thank you.
DECKER - Yeah. I think one of the things that's important to note for anyone who's still watching this hearing, or this briefing, I should say is that the important role that the association plays is often near the canary in the coal mine for the legislature. We're looking at trends that are happening9331 across hospital systems. I9333 will also note that Stuart hospitals were not a part of the association.
DULONG - Thank you for noting that.
DECKER - Yeah.
DULONG - I think that's important to note. And that for the legislature to, you know, many of us are looking at our own hospitals, the ones that are still open. And looking to, MHA to help us, like, anticipate what the impacts of, what's happening in hospitals, you know, across the state or a few communities over will have on our hospital system. And during the pandemic played a really important role in bringing our hospitals together to collaborate, and I think have helped usher in a different culture amongst you know, Massachusetts is so lucky to be so rich in resources in many things, but particularly9371 in hospital care. But it also has meant that we've had a lot of islands of hospitals competing with each other, and particularly our poor safety net hospitals. But to say that the role of the association has played is both informing us, as well as trying to bring greater collaboration about so that our healthcare system, while individually hospitals are run, it's still a more a continuum of care across the state.
DECKER - So thank you.
DULONG - We really appreciate that. Thank you. And thanks to you all for your continued work with us.
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PAUL JONES - BLUE CROSS BLUE SHIELD OF MASSACHUSETTS - Chair Decker, members of the committee. I'm Paul Jones. I represent Blue Cross Blue Shield of Massachusetts. We are a Massachusetts based, not for profit company that provides coverage for more than 20,000 employers and 3,000,000 residents, around the Commonwealth. We're really proud of the reputation that we have developed over the years as9444 a collaborator on difficult problems dating all the way back to, the original, Massachusetts health care reform. I believe, MarianoCare is is the name that we're using now, and I think that's fantastic. We were a convener at in the development of chapter 58. And in recent years, we have supported bills that have expanded coverage for contraception services, for reproductive services. Just last session, we were able to support bills that passed addressing coverage for prescription drugs for chronic medications, maternal health, breast cancer, diagnostic screenings, fertility preservation, recovery coach pure recovery coaches, and more.
We're able to take those positions9492 because unlike most of the rest of the country, the Massachusetts-based, health insurers are not for profit companies. We're not answering to stock prices. We're not beholden to shareholders. We're really serving three constituencies. First, our9509 members and the patients who need access care, then the providers who9515 are offering that care, and then the employers and members who are paying premiums every month with an expectation that those premiums are going towards care that's both clinically effective and cost-effective. Our job is really to find a9530 balance between those constituencies as a not-for-profit health plan. And that balance has really never been9536 of greater importance because our health care system, as you've heard this morning, is stressed. Patients are having trouble finding access to appointments. Workforce shortages are plaguing our primary care providers, our hospitals, our mental health centers, and many providers are find, facing financial struggles even without the, threat of federal funding cuts.
Those challenges are compounded though by the fact that in Massachusetts, we have among the costliest health care in the country and, in fact, in the world. Spending on hospital, physician, pharmacy services are exceeding, regional inflation and, wage increases. New breakthrough drugs are coming at sky-high costs. And affordability continues to be our number one concern because affordability is an access issue. And we hear every day from our9593 accounts and members that the strain of the cost of health care is putting on their budgets and squeezing out other priorities. And we wanna continue to work with you and really be a resource to you as you're thinking through issues like primary care, like, care for menopause, which as you know, chair Decker, is a top priority for Sarah Islin, our CEO, and really just wanna offer to, continue to be a resource and work with you and other stakeholders to solve these difficult problems.
DECKER - Well, now that you've pointed out your, work on menopause, I just wanna say that, we in the public health committee in the house are working on menopause legislation.9633 So when Gen X women come into leadership positions, we start looking at where, culturally9639 and our healthcare system has failed9641 our generation, and looking at the real, serious, health outcomes that are impacted when we don't treat the symptoms of menopause. We often think women should just survive it, versus actually treating it. So I want to do the rare moment of congratulating one of our, insurers, for their work, for willingly coming to the table and really thinking more innovatively, on menopause care coverage. Hoping it will inspire other plans to do the same, but if not, don't worry. We'll have a bill for that. So thank you for all that work.
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SUZANNE CURRY - HEALTH CARE FOR ALL - HB 2537 - HB 2477 - SB 1544 - Thank you. Morning, Chair Decker, Chair Driscoll, and members of the committee. Thank you for sticking around. My name is Suzanne Curry. I'm the Director of Policy Initiatives at Healthcare for All. For those who don't know us, we're a consumer health advocacy organization that advocates for health justice in Massachusetts. And, we promote health equity and coverage and access for all. I want to just echo a lot of what has already been said. So ditto to a lot of the testimony today and ditto to a lot of the appreciation from this committee and the leadership on things like maternal health, behavioral health, and, efforts that really help to, foster the health and well-being of residents across the state. So just thank you, thank you for your leadership in holding this time today for us to talk about issues across public health and healthcare. So healthcare for all, we have three areas of work. One is, we hope that you will use, for you and your constituents, is we have a direct service helpline, so we directly help people navigate the healthcare system and health coverage in 5 languages. We take about 25,000 calls or more per year.
About 70% of our calls are in languages other than English. We partner with community and faith-based organizations to run effective public health and healthcare-focused outreach education campaigns, and engagement campaigns. And using what we learn9771 from the helpline and from our community engagement9773 work, we advocate for policies that make healthcare9777 more affordable, equitable, and9779 accessible. We're also9781 a member of the Children's don't wanna be remiss in, saying that we, support all the testimony from our partners at MAMH, MSPCC, and health law advocates that you heard today. So we did talk about what progress we've made in Massachusetts and the leader that we are in the health care system, but we also know that that's that has the healthcare system, but we also know that that's that is being stretched, and people are9801 having a really hard time affording and accessing9803 care. The Center for Information and Analysis in their health insurance survey shows that 40 percent of people have trouble affording and accessing care. 25 percent of people can't get an appointment when they need it. And we know this is also includes startling racial inequities.
Black and Latino individuals, face far more barriers accessing and affording care than9824 white counterparts in the state. So in light of these challenges, we're prioritizing9828 three, legislative, buckets, this session, not to say that there's to the exclusion of others. One is around medical debt, both preventing it and mitigating the impacts of medical debt. Another is primary care, which you heard a lot about today and want to just flag one bill before your committee, H 2537, filed by Rep Schwartz, around access to primary care, which we'd love to talk9850 with you more about and you'll hear more from us on, and also addressing rising health care costs, which has been addressed here as well, both by holding accountable, rising, prescription drug costs and prescription drug manufacturers, hospital and health system costs for high costs, care, and also giving the division of insurance new tools to push back on premium increases. I do also want to, just mention another bill that is before your committee, relative to the what's going on on the federal level, H 2477 and S 1544.
What it does is it extends our interpreter services to all, healthcare facilities in line with federal regulations that might be under attack, but it's also we are serving as a starting point. So when we're thinking about all the things that might happen on the federal level, we wanna use this legislation as a vehicle to put protections into state law, and work with you all to do that. So we heard a lot of issues that might, impact. We also have other issues that we've been working on around community health workers, and thank you for your, leadership on that chair. Oral health, health insurance prior authorization, coverage for immigrant kids, and preventive behavioral health services for children. So we appreciate your commitment to holding again this time for us, to speak here today, and I'm happy to answer any questions even if it's not something I've spoken about specifically today. Thank9929 you.
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MIRIAM KOMAROMY - BOSTO MEDICAL CENTER - Perfect. Thank you so much. Yes. I'm Doctor Miriam Komaromy, and I wanna just say thank you so much to Chair Decker, Chair Driscoll, and members of the committee. I really appreciate the opportunity to speak before you today. I am the executive director of the Graeken Center for Addiction at Boston Medical Center. I'm also a professor at Boston University and an expert on addiction treatment. I wanna introduce you to the Graeken Center first. The Graeken Center functions as an umbrella organization for BMC's addiction treatment and support programs, all of which are tailored to patient population-specific needs. We're really proud to offer a multidisciplinary approach to meeting patients where they are in the course of their substance use disorder. So we offer addiction care across the lifespan, including care for adolescents, families, and pregnant people, and we offer specialized treatment for stimulant use disorder, opioid use disorder, and, problems affecting anyone who's struggling with whether they're just starting to engage with harm reduction or are in long term stable recovery.
In addition to providing clinical care, the Graeken Center for Addiction at Boston Medical Center provides education and training that reaches across The United States to professionals and to the public. We also produce highly influential clinical research on10049 addiction treatment, and we advocate for policies that benefit and protect people with substance use disorders. We're really happy to serve as a resource for you on this committee this session as you consider issues related to substance use disorder. As you know, so many public health issues impact people with substance use disorder. While there are bills that address this population in many legislative committees, there are issues that are before your committee this session that directly impact this population of people living with substance use disorders. I'm grateful for the committee's work to strengthen our local boards of health, which is so critical and must continue. Many communities are facing the dual challenges of addiction and homelessness. We need to continue to pursue a public health approach to these issues rather than criminalization. We know from the, long-term federal war on drugs that focusing on criminalization is likely to10113 worsen matters, and in the case of substance use disorders can result in increased risk of overdose and death.
Harm reduction, treatment on demand, and low-barrier supportive housing remain the keys to addressing these problems, and our local public health officials need continued support, technical assistance, and resources to be able to respond to these crises with the appropriate tools, especially in light of the public health approach. Another critical area of overlap for public health and substance use disorder treatment is support and funding for testing and10153 treatment of HIV. Infectious disease care is critical for our patients' health and the health10159 of our communities. We cannot control the spread of HIV unless we also provide effective treatment to people who use drugs. A final key issue that I want to highlight is the importance of10171 access to naloxone, commonly known as Narcan, which remains limited in some marginalized communities in spite of, really, excellent efforts here within the state. We must provide ways to provide education on overdose prevention and to distribute naloxone widely and in a cost-effective way in order to save lives. Thank you again for the opportunity10195 to speak before you today. I appreciate you highlighting the interactions between public health and substance use disorder, and I hope that my comments are useful as you approach your work this session. I'm happy to answer any questions.
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ROBERT MCLAUGHLIN - MAHP - Thank you, Chair Decker and Chair Driscoll. It is10244 still good morning. Just wanted to thank you guys for the opportunity to reintroduce10248 MAHP, the Mass Association of Health Plans, to the entire public health committee. A lot of you I've worked with in previous roles that10255 I've had, but just really wanna say to all of you that we're here to be10259 a resource for you. The biggest thing that happens that I've learned in this job, not so new to me anymore. It's been about a little bit over a year. The biggest10268 thing that I wanna be available to you in the legislature is to call anytime. Something that happens with one of your constituents, please, you all have my cell phone number. Please call it at any time. And I know that you, the chairs, having worked on two different committees myself as a former senate staffer, the other members rely on you guys, to be experts in these issues. And you're not gonna be experts in absolutely everything. So, please, if there's anything we can ever answer, please feel free to call at any time. So I'm gonna introduce, Liz Murphy to get into some of the details of what we have planned for this upcoming session, but here's this.
ELIZABETH MURPHY - MAHP - Thank you, Rob. My name is Liz Murphy. I'm the vice president of legislative and regulatory affairs at MAHP. MAHP represents 13 health plans and one behavioral health organization. We often say all of the plans except Blue Cross that operate in Massachusetts, and they are largely nonprofits and very regional and local to their communities. They provide insurance coverage to 3,000,000 state residents in Massachusetts, and our plans participate in all public programs, including MassHealth and Medicare, as well as the commercial markets and the self-insured space. I just wanted to say a big thank you for the comprehensive maternal health legislation that you crafted last session. I really do feel it has the potential to remove some barriers. I have been committed to this issue personally as a member of the Ellen Story Postpartum Depression Commission for 12 years, and it is very much a priority of MAP and the health plans.
We are hopeful that more pregnant women and new mothers who are experiencing the symptoms of PMADS will be screened, and more screening results will be discussed between women and providers, and more women will be referred to the most appropriate medical care. So thank you for that. Our plans are now working closely with the division of insurance to implement these provisions of the maternal health law. And, in the name of affordability, I just wanted to say there are a number of bills before your committee this session10395 that would have a positive impact on containing excessive health care spending in the state. We are committed to affordability proposals that will lower costs for families and small businesses, and we agree with all of the stakeholders before you. We really need to focus on addressing the true cost drivers that have been identified by the state repeatedly, and that is provider care and also the high cost of prescription drugs. So, as Rob said, we look forward to serving as a resource to you and happy to answer any questions.
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DECKER - Yeah. Thank you for your, support around the maternal health bill, and glad to hear about your work on the Ellen Story Commission. My first campaign in college was working for her, the young child.
MURPHY - That's amazing.
DECKER - So and I've got to be her aide here. You know, one of the things that we did that, we know will have a real important outcome that when birthing people and women have more access10458 to the birthing choices, we see, particularly with women of color, we see a, better outcome, a better health outcome for both, parent, mom, child. We also know that, and in this bill, one of the historic things it did was to really modernize regulations for birth centers. To really increase support for midwifery and doulas. We also know that that actually has a lower10482 cost for insurers. And so as you know in that bill, we were also able to provide parity for, midwives through MassHealth, and there may be a bill floating around, that is also hoping that the private insurers will also follow suit and not have to be legislated to do so. We know that there is a lower cost to your members when, healthy, not high-risk, birthing people have access to midwifery care and10512 doulas. The data is clear. Absolutely. So I'm10514 just wondering if there's been conversations amongst10516 your members about sort of following suit with what we were able to do with MassHealth in that bill.
MURPHY - Absolutely. Absolutely. And thank you for that. Our plans completely agree that culturally competent care is necessary, and plans are working to diversify their provider networks. We absolutely see the value of midwives. Our health plans10537 are all contracted with midwives as they have been for years. Our health plans are also contracted with the one birthing center in Massachusetts and are looking forward to seeing more take place over the horizon. And our plans are now experimenting and contracting with doulas. Some of them, are working, to model the MassHealth program, while others are looking to identify specific populations that they could try this out with. One barrier for us is licensure. So the health plans in Massachusetts are required to, work with licensed providers. So we appreciate that MassHealth stood up, a way to get doulas certified. And my understanding is that, to date, there's still less than 200 doulas certified. So we're looking forward to continued updates on that, as we expand our coverage as well.
DECKER - Yeah. Thank you for that. We know that when we can also provide pay parity for the same services to both our doulas and to particularly our midwives, then we will see more people who10610 are actually able to enter the field. It just makes more sense for them financially if they know they're going to actually recoup the cost on that. So I look forward to the ongoing conversations around that and also really excited that10622 in that bill, we were able to license for the first time lactation counselors. Prior to that, I know Blue Cross had a workaround, to reimburse, women who were, nursing. But until then, under the ACO, we could only provide reimbursement through insurers if it was a licensed lactation counselor. So really excited that that is also something now that, more of your members will able to provide that kind of critical support.
MURPHY - Yeah. My understanding is that our plans were already reimbursing lactation consultants because it is an ACA requirement as well, but I wonder the level. They could not, have them in their networks because they were not licensed. That's the distinction.
DECKER - Bill was filed because, in10670 fact, that you. Under
MURPHY - So now we can contract with them directly.
DECKER - Is right. That's anyway, very excited as well. Thank you. And, thanks for all of your work.
MURPHY - Thank you.
DRISCOLL - Just wanted to follow-up, a question earlier around boarding and, how it relates to prior authorization, within the membership. I10694 know the, you know, the last five years, there's been different arrangements, different agreements,10698 to, you know, help, you know, throughout the life of the pandemic. And I just wonder at this stage in the game going into the new session if there's conversation around how to solidify some things that have been done, you know, kind of on the fly, so to speak, or, you know, seasonally, and or things you're thinking about in terms of trying to work within the ecosystem of boarding?
MURPHY - Absolutely. So boarding, I will say, is10724 not a direct, result of prior authorization. Boarding in a lot of cases is10730 because there are not available locations or facilities to transfer members. So oftentimes, they're getting caught up in the hospitals because there's not skilled nursing facilities or other very highly specialized locations for these people to get into, particularly behavioral health facilities as well if they're needing inpatient care. As for our prior authorization, we do see a value in some prior authorization. It really does protect the safety of members and situations. Our plans are totally committed to working with you closely this session on prior authorization, and agree there is, room to find ways to eliminate some of the burden of prior authorization.
DECKER - Can you just clarify when you say that you believe10780 having prior authorization10782 provides additional protections for patients?
MURPHY - It does in many instances. For example
DECKER - Yeah. So I just want because if we're doing this right, it's their medical providers that are asking for actually directly in consulting the medical care of their patients.
MURPHY - Correct. Our plans are required by state law to cover evidence-based medical care, and10805 that means that this is care that is supported by clinical guidelines that are widely accepted by the provider community, really. And10816 so in situations where, say,10818 a member is on multiple medications and then is getting a surgery, there are, I don't know the specific examples for you, but there are situations where it's important for someone besides that individual provider to be looking at all of a member's care to ensure that that's the most appropriate.
DECKER - I would love any data that you have because if I'm hearing correctly that we think that the clinician that's working for the insurer has a better sense of a patient's need and complex care than the actual provider. So I would love to know, is there data suggesting that, in fact, providers are overreaching and asking for procedures that are, in fact, a danger and not coming out of a recommended best evidence-based, recommendation. That sounds really off to me. So I'd love to just see what data that this really comes out of, an evidence-based data that supports that.
MURPHY - Absolutely. I'd be happy to go back and share some of that with you. The example I'm trying to show is someone who has a provider who feels that treatment is important for them, but that individual also has 15 other providers that treat other parts of their comorbidities, etcetera.
DECKER - So are you saying10900 that the clinician or the insurer is reaching out to all 15 providers on that one patient every time before deciding whether or not that?
MURPHY - No, I am not but the interoperable electronic medical records, it is very difficult for an individual provider, to see the complete care that a member's receiving. So our plans aren't necessarily outreaching the member's providers, but they can easily see the providers that they are seeing, the services that they have received recently, etcetera. Okay. I'm not the expert on prior auths, so I would love just from. I would love to get our experts
DECKER - For the last several years. Most of these, requests that are coming from providers are pretty basic in terms of, like, understanding their care. I don't think these are emergency room docs for the most part.
MURPHY - I'm happy to share those examples and get back to examples.
DECKER - I want data because I think there's a lot of, you know, an anecdotal things, but I would love data around. Absolutely. Thank you. Thank10964 you.
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SUNG POBLETE - FARE - HB 1359 - Thank you,10992 and good afternoon, distinguished members of this joint committee. Food Allergy Research and Education or FARE is the leading nonprofit organization in The United States, working to improve the health and quality of life11009 of those with food allergy through transformative research, education, and advocacy. We're focused on raising public awareness of food allergy as a disease of the immune system and on promoting preventive strategies like eat early, eat often, which is a recommendation that stems from the conclusions of the groundbreaking LEAP study conducted by Doctor Gideon Lack. This study, which determined that frequent exposure can train an infant's immune system to recognize peanut protein as food. And this evidence-based study demonstrated that if you introduce peanuts early and often between four to six months, you can reduce the peanut allergy by up to 81 percent. In The United States, States, there are more than 33,000,000 Americans with a life threatening food allergy, and that is including nearly 6,000,000 children. If you translate that to Massachusetts, that is 611,000 adults and 102,000 children.
One in 10 Americans, one in 12 children live with a life-threatening food allergy. That is a lot of individuals. And in fact, the rate of children in The United States with food allergies is accelerating. The CDC found that over the past 20 years, the rate of children with food allergies have more than doubled, and the rates of children with peanut or tree nut allergies have tripled. This is a silent public health epidemic that is increasing every 10 years, and it is not gonna stop until we put serious interventions behind it. And sadly, food allergy is still often misunderstood as a preference or a diet. This is extremely troubling because food allergy patients live under the constant threat of an exposure that could cause a severe type of allergic reaction called anaphylaxis. Anaphylaxis is life-threatening, and the only rescue medication can reverse it is epinephrine. And we must make it readily available, accessible, and affordable. And we appreciate the bill H 1359, that is before, the committee. But I wanna stress that, for allergy patients, administering epinephrine can be the difference between life and death.
And while traditional epinephrine autoinjectors have been the standard approach for reversing anaphylaxis, there have been advances that have been made. And the bill currently states only autoinjectors should be capped. There is one reason why FARE strongly recommends public health policies are crafted in a manner that can keep pace with emerging science and treatments.11212 Doing so ensures that laws and policies will accommodate innovations like this one in epinephrine administration, but also future innovations that are ensuring11225 protection for the food allergy community that will reflect latest breakthroughs. I'm not sure if you're all aware. There's now a nasal spray. And in the near future, there will be a sublingual film and also a inhaler. Imagine if you're a child. We always say epi fast, epi11247 first. But if you're a child and you're feeling the signs and symptoms and you know your parent is11253 going to inject you with a needle, there is no way you're gonna tell11257 them that you're having an anaphylactic reaction. Food allergy patient myself, we all need treatment options.
And when you limit a bill language as an autoinjector, that means we, as a community of food allergic patients, will not have that option. So if we can change that language to epinephrine administration, it would really make our lives a lot easier. And I'm a nurse. I love to inject everyone except for myself. Alright. So, the public health costs of food allergy affects us all. Statistics indicate this growing public health epidemic sends a patient to the emergency room every 10 seconds, cost individuals with a food allergy more than $4,000 per year, and has an economic impact more than $25,000,000,000 per year. FARE is committed to reaching new levels of funding for food allergy research, attracting the leading scientific minds, advanced new discoveries, moving closer to a world free from food allergy. We welcome your support of these goals at the state level here in Massachusetts, and we are here to be your resource. Appreciate the opportunity to speak with you today, and I would be pleased to take any questions.
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KEENAN - How we doing today? So I have two children that suffer from peanut allergies. And one of the things that I found curious is, there was really not a lot11365 of promotion from the doctors about11367 having, like, a peanut challenge. That's something that11369 we really had to advocate for our children for.11373 So I'm wondering if there's any lower policies or anything we could do to promote that11377 because now I feel a little bit safer with my kids. Now they can have, like, a peanut or two. So if they're out and about and they get exposure yeah. Like, we're not paying that cost of, an ER visit. Oh. So is there anything like that in the coming up down the road that you might be looking into?
POBLETE - Absolutely. And, you know, it's a travesty. Even though there are scientific literature to support eat early, eat often, USDA did not include peanut products for infants in their WIC 1 WIC 2 packaging. And we really need to increase awareness because more than 57% of Americans depend on WIC 1 WIC 2. So that means just in the next 10 years when USDA relooks at the packaging, in that 10 years, we will have caused more than 330,000 kids from developing a peanut allergy. I hope that you will talk to, your, colleagues and encourage them to, add peanut products in WIC 1 WIC 2 because that is a no cost, addition. That's free. Just have to add that language.
DECKER - Thank you. I would say that, I'm assuming you guys will continue to11466 provide testimony as we hear these bills, as somebody who also has personal food allergies as well. Important really important to understand more about the different kind of options that are available to families, and I think also really important to understand sort of where the continued growing expansion of research does, and even just what testing looks like, which is, we went through this with my kids as well. Fortunately, they do not have my food allergies, but really scary as a parent to try to, like, start that journey to understand if they do. So thank you for all of your work. We look forward to hearing more about, your, suggestions and recommendations as briefing to actual hearings after11508 today.
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DOONER - And through you, Mr Chair, I first just wanted to thank you for your testimony. I honestly did not know that, so I learned something new today. Especially as somebody who hopes to have children one day, that is an interesting fact. So do you did you find it was just like the lack of exposure or having more exposure to it at a young age? I'm just curious. I didn't know that, and I think it's, very useful information.
POBLETE - Yes. It's really about training the immune system at an early age. And the statistics show that the window is between four months and six months, that you have to expose your infant to the allergens. And if you delay it even optimum time really is from the four to six months.
DOONER - I find that so fascinating. So thank you for sharing that.
POBLETE - Absolutely.
REP ARRIAGA - Thank you.One quick question following all this. I think we're all very amazed and learning a lot. Same here. Food allergy, black berries. So I found out the really hard way. You need a EpiPen, etcetera. My daughter, who is now 11 years old, when I was introducing apple juice and, applesauce, she was, she broke out in an11602 allergy attack, hives. Right. The first thing11604 that pediatrics told me, do not give her anymore.11606 And I said that was insanity. I mean, apple juice and applesauce, like, that's every child's to go to, especially mine as a child. And I said,11615 I it cannot be. Right? So I personally11617 took it on myself through research. And what I found out was11621 that by giving her organic versus just standard stuff, she11625 was perfectly fine. So I was able to give her the juice, the apple stars, apple sauce, and apples to this day. I give her organic, and she has no problem. So my question here is besides, of course, being exposed to peanuts early, right, we see that that does help significantly, which is awesome to know. Is there a reason? Is this something, the chemicals are processing? Is it pesticides? What do you think?
POBLETE - So there are more than 160 allergens that cause a life threatening food allergy, And you really need to do specific tests with an allergist, and I would strongly encourage you because it may not have been the apple. It may have been something else, and that needs to be thoroughly worked out because you may have just had the rash,11676 but the11678 next time, it could be a full-blown anaphylactic reaction if it is indeed a food allergy-related, rash. And I'm happy to recommend really great food allergy, specialists, especially here in Massachusetts.
ARRIAGA - No. Thank you. I do appreciate that. I just wanted to see if there was a correlation with the peanuts. Is there something about the processing of the peanuts is act is causing our folks, our children to be allergic, if there's anything in that.
POBLETE - No. But there is something called an oral allergy syndrome, and your immune system can identify the apple protein as some of the pollens. So there's a crossover with some of the pollens, and your immune system recognizes it as a foreign invader. Yes. Okay.
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JANET DOMENITZ - MASSPIRG - Thank you. Thank you. Chair Driscoll, Chair Decker, members of the committee, thank you very much for the opportunity. My name is Janet Domenitz. I am the director of MASPIRG, the Public Interest Research Group. We are a statewide, nonpartisan, grassroots membership organization working on public interest issues. And I wanted to, highlight two bills that are in this committee, that are priorities for us this session, and I'll say three quick things about each of them. The first one is a bill to reduce PFAS, the forever chemicals. You already know from the excellent work this committee has done last session and before that PFAS chemicals are threatening our health. Already 171 public water systems in 96 cities and towns exceed the legal11800 limit for this chemical. So that's number one. Number11804 two, I do wanna especially thank the committee for the progress that was made last session. Related to PFAS and firefighter gear was a tremendous victory.
We want to pick up on that and pass the bill this session, and use that as wind behind our sails. And the third thing I11824 just wanted to mention is our organization is now going door to door on this bill, and there is so much awareness and support. So I just wanted you to know the public is behind this. So that's the PFAS bill. The second bill I wanted to mention would reduce the use of styrene, otherwise known as styrofoam. Every day now, we read plastics. They're in our blood. They're in our brain. They're in our breasts. They're in our I mean, it's just I don't think I'm telling you anything you don't know. We need to reduce plastics. Secondly, this bill has been pending for a while. We are behind other states, and so I don't think we need any more studies or rumination. I think we know that we need to reduce plastics, and11865 this is a simple way to do it.
And the third thing I'll say, especially listening to all this testimony this morning, it won't I don't think it will cost the Commonwealth a cent to do this, to take this measure, and it will be good for public health and the environment. So those are three quick things about two important bills, and I'll just repeat what others have said11884 already very quickly. This is our time to shine. We are not gonna be we are not gonna look to the federal government and a lot of the age federal agencies that we relied on for much progress. But here in Massachusetts, we have got the know it all. We have got the as I said earlier, I think the public is behind all these, you know, public health, environmental protection, and common sense provisions. These are two of them. I hope we can act on them quickly, and I really appreciate this opportunity.
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LAURA SPARK - CLEAN WATER ACTION - Chair Driscoll, Chair Decker, and the public health committee, thank11943 you also for the opportunity to speak.11945 I'm Laura Spark. I'm the environmental health program director at Clean Water Action. Clean Water is a multi-issue environmental nonprofit that helped pass the Clean Water Act in 1972 and now works at the national level and in 12 states, including Massachusetts, to advocate for clean water, clean energy, and the protection of human health from toxic chemicals and other environmental hazards. In Massachusetts, we coordinate a coalition called the Alliance for Healthy Tomorrow which is a group of over 60 public health, civic, environmental and labor organizations that are working to reduce, exposures to toxic chemicals. Per and polyfluoro substances or PFAS are a large class11989 of chemicals used in hundreds of consumer products and industrial processes.
They're in food packaging and children's products and things like paper and rubber and plastic manufacturers, semiconductors, PV panels, heat pumps, or a huge number of different types of products. Despite not existing, before 1946,12013 this class of chemicals is now in the blood of 9912017 percent of Americans that have been tested and are in water, soil, animals, and plants in Massachusetts and across the globe. Toxic at extremely low levels, PFAS are both bioaccumulative and persistent. That means as we make and use these chemicals, the levels of PFAS in our blood rises and the higher level of PFAS in our blood, the greater risk that we will become sick with one of the many serious illnesses that PFAS can cause. And I'm not gonna list them today because we will list them in testimony but there are several different types of cancer, immunosuppression, liver impacts, birth defects, and a number of other serious illnesses.
And because PFAS never fully break down, once they're manufactured, they remain in the world essentially forever. That's why it is so important to turn off the tap, to stop making, using, and disposing of things with PFAS. In 2022, the legislature convened an interagency PFAS task force that released a report recommending that Massachusetts ban most uses of PFAS by 2032 with earlier action12090 on some products. Clean Water Action supports this vision as well as Senator Cyr and, Speaker Pro Tempore Hogan's leadership in chairing the task force and then bringing forward, and also, Representative Kerans vice chair in chairing the task force and introducing, the act to protect Massachusetts public health from PFAS. We hope the public health committee will set an early hearing date and move quickly, passing in strong and protective PFAS bill. Thank you.
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DAVID MELLY - ELM - Thanks, Mr. Chairman, Madam Chair. Thanks for saving the best for last, and sorry to stand between lunch for a couple minutes. But, my name is David Melly. I'm the legislative director for the Environmental League of Massachusetts. I particularly appreciate the invitation to be here, as it helps send a clear message to your constituents, to your colleagues, and to everyone in the Commonwealth that there is a clear and inextricable link between the health of our environment, and the health of our people. We've long known that policies and investments that protect our natural resources, improve health outcomes across a wide spectrum, but with the accelerating impacts of climate change, threatening cities and towns across Massachusetts, the importance of working to protect public health through smart environmental policy has never been greater. Failure to respond to this global threat has dire consequences locally as well with basic everyday necessities like breathing clean air and drinking clean water becoming less and less certain.
Extreme heat is a serious threat to public health, particularly impacting our most vulnerable residents like seniors, people with disabilities, and low-income families, and weather events like drought and flooding threaten the integrity of our already overstrained water system. Fortunately, our commitment to emissions reduction also presents a once-in-a-lifetime opportunity to make transformative investments that can make our commonwealth healthier and more prosperous. Putting electric vehicles on our roads and battery powered trains on our tracks help improve air quality in the very same communities that have been overburdened by pollution for decades. Weatherizing and decarbonizing our buildings makes them healthier places to live, work, and learn, and transitioning away from gas-powered heat helps lower the risk of exposure to carcinogens. And using more sustainable materials and less single-use plastic products protects our bodies, our communities, and our wallets. There are two main issues I wanted to flag for the committee as you begin the process of reviewing the bills before you.
You've heard some about them from my colleagues, but12261 I'll be as brief as possible. Happy to provide additional information, answer questions. The first is the urgent need to address PFAS contamination in our environment and also in the everyday products that we use. The committee has been a great partner on this, and it's also been really, really urgent to address this issue since the task force work began, you know, almost five years ago. Passing this bill isn't going to solve every PFAS problem we have, but it represents a really thoughtful, common-sense step forward towards stopping the flow of new PFAS into our Commonwealth. The second is really two bills, both dealing with the disproportionate impacts of poor air quality on low-income residents and communities.
This is also an area where the committee has really led in advancing thoughtful legislation in the past, and we're hopeful that splitting up this legislation into its indoor components and its outdoor components, which are overseen by DPH and DEP respectively will help you and your colleagues in the environment and natural resources committee work together to address these distinct, but related issues comprehensively. Happy to answer the questions about any of these bills or any others that touch the nexus of public environmental health, and I really appreciate your time this morning, and now into this afternoon. Thanks so much for the time here.
DRISCOLL - Thank you. Any questions from committee members? Seeing none. Thank you for being here and closing this out. Appreciate it. I really appreciate it. You make a really valid point, as we start to wrap up here around the committee, really leading in the past in several areas. And so I look forward to working with my co-chair, continuing that leadership in public health space and the many intersections, that it has in the Commonwealth. I wanna thank the House and Senate staff members today for, their work on, today's hearing and certainly our court officers, for being here and LIS, for their support in setting this up and making it run smoothly. And it's a good reminder and a good introduction to, the session ahead and all the intersections that we have to contend with. And, you know, certainly some uncertainty as we heard at the beginning, but, ready to dig in with you, Chair.
DECKER - Thank you. It was great for us to do our first session together. I look forward to the session. Again, my thanks also to the incredible staff that's been serving on the house side, and really welcome to the Senate staff. We look forward to having you be part of this team as well. LIS, thank you as always. Today was maybe probably one of our least complicated days, but and thank you to everybody who's still here. Thank you. And to everyone who testified today. This gave a great overview, this briefing of what does what what this committee takes on. There's a lot of issues, really important issues that have been important at, at every day of the year. But certainly, as we've heard repeatedly, the, we have our federal government and, honestly, our president that is making this work even harder.
It's confusing, and it's going to be complicated as we have limited resources in Massachusetts, like every other state. We are not going to be able to step up and replace everything that the president takes away from us in protecting our food, our water, our health, our access to care, but we certainly are really fortunate to live in a state that in a legislature that has, proven its historical commitment to, protecting and uplifting and preventing, harm to residents of Massachusetts. Massachusetts is a legislature that shows what it means when government actually uplifts and doesn't actually try to create harm, and we will do our best to counter that at the federal level as we continue to experience the loss of important resources. So thank you to everyone who is here with us today, and I think we can adjourn. Alright.
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