Report lays out health care priorities for 2023

To address the current slate of health care challenges, state officials in the new year should create a Cabinet-level equity secretary, limit allowable growth in out-of-pocket consumer insurance costs, and develop a 10-year health care workforce plan, according to a new report.

The Blue Cross Blue Shield of Massachusetts Foundation framed its report as priorities for the incoming administration of Gov.-elect Maura Healey, who is set to take office in less than a month and begin working on public policy and spending measures with the Democrat-controlled House and Senate. Report authors based their conclusions on feedback solicited during interviews conducted between February and May from a "broad and diverse" group of health care sector stakeholders and leaders, who are named in the report's methodology appendix.

Ensuring consumer affordability was one of five priorities flagged in the report. According to the report, which was assembled with the help of Manatt Health, 41% of residents said they or their families had health care affordability issues in the past 12 months, and one-third of middle-class families in Massachusetts with employer-sponsored insurance devote more than a quarter of their income to health care.

The report recommends expanding ConnectorCare eligibility to more lower-income people and funding a new "affordable coverage program" for low-income immigrants who do not have access to government-funded programs like MassHealth or Affordable Care Act coverage through the Health Connector Authority.

From a regulatory standpoint, the report calls for an expansion of authority at the state Health Policy Commission, which has a cost control mandate. Recommendations include giving the agency more authority to enforce compliance with cost growth benchmarks, weaving provider price caps into benchmarks as other states have done, and limiting annual growth in consumer premium, deductible and co-pay costs by creating a consumer cost growth benchmark.

Addressing systemic racism and inequities in health care is another major recommendation, and the report calls for new laws overhauling the structure of state government to ensure an equity vision is carried out across departments and agencies. A new secretary of equity overseeing a Cabinet-level Executive Office of Equity is one recommendation, as well as creating equity offices within the nine other Cabinet secretariats.

According to the report, Black and Hispanic people are more than twice as likely to be uninsured compared to white people, are less likely to report being in excellent or very good health, and report higher rates of "fair or poor" mental health.

The report calls upon state leaders "to break new ground in creating a government culture and approach to health care policy development that engages a diversity of people with lived experience — community members and community leaders — who can help state leaders understand the root causes and impacts of these challenges and participate in co-designing solutions."

The other three major priorities are confronting the mental health crisis for children and youth, mitigating "critical" health care workforce shortages, and improving access to long-term services and support, including long-term care.

The report says that between 2016 and 2020, the share of children ages 3 to 17 in Massachusetts who had anxiety or depression jumped from 12.2% to 18.4%, a 50% increase. It anonymously quotes one "health plan leader" as saying, "We cannot allow ourselves to say 'kids are resilient' anymore. That was an excuse for inaction."

The report recommends establishing a Children and Youth Cabinet to improve the mental health of children and youth; developing a 10-year workforce plan that prioritizes long-term supports and services, long-term care and behavioral health; and promoting the purchase of private long-term care insurance through a federal Long-Term Care Partnership Program while standardizing state oversight of long-term care insurance beneficiary protections and rates.

"With the new administration taking shape on Beacon Hill, our goal is to encourage action on today's most pressing health care challenges," Audrey Shelto, BCBS of Mass. Foundation president and CEO, said in a statement. "Fortunately, state leaders do not need to start from scratch, as many of the action steps identified in our report build on existing or proposed initiatives. However, tackling these issues will require bold leadership, a collaborative approach, and long-term focus and investment."