Senate President Spilka's Remarks at the 2019 Health Care Cost Trends Hearing

Good morning, and thank you for inviting me to speak to you today.

I’d like to thank the Health Policy Council for the work you have done to monitor and analyze health care spending, so that we can have a better understanding of how we are doing as a state and to inform our work as legislators.

I’d also like to thank CHIA for its important work as well.

Finally, I’d like to thank Governor Baker, as well as Secretary Marylou Sudders, for the thoughtful healthcare bill released by the Administration last week, along with the Administration’s commitment to keep mental and behavioral health at the forefront of any discussion about healthcare.

I’d like to thank my friend and colleague, Speaker Bob DeLeo, for his partnership as we work through these important issues and also extend my thanks to Attorney General Maura Healey for her diligence in fighting the opioid crisis and protecting our young people from the harmful effects of vaping, among many other things.

Health care access and affordability has been a long-standing priority of the Massachusetts State Senate, — beginning with the reform of 2006 and continuing to the present day.

And so I’d like to take this opportunity today to give you a sense of what we have done, what we would like to do, and where we see an opportunity to make transformational change.

Most recently, the Senate, House and Administration came together to pass the most comprehensive supplemental rebate program in the country in the FY2020 budget.

Under the leadership of Senate Ways and Means Chair Michael Rodrigues, we also made significant investments in the areas of mental health, behavioral health and substance use disorder, nursing homes and aging-at-home, and protecting children’s health among other things.

In 2017, the Senate passed the HEALTH Act, driven by the work of a yearlong effort by the Special Senate Committee on Health Care Cost Containment and Reform to analyze best practices in other states and engage stakeholders.

In that bill, we focused on bringing our health care delivery system into the future by leading the way in telemedicine and mobile integrated health, while also finding areas to reduce costs.

And our work in these areas continues to this day.

The Senate Chair of the Committee on Health Care Financing, Cindy Friedman, is currently working on a number of health care initiatives, including a bill to control the cost of prescription drugs and we continue to look at other issues such as surprise billing, out of network costs, and scope of practice.

Inspired by the work of the Health Policy Commission, we have begun to look at the cost of insulin in particular, which constitutes a “tragic barrier to care for diabetes patients,” according to Robert Gabbay, the chief medical officer at the Joslin Diabetes Center in Boston.

The idea that diabetes patients, who have access to life-sustaining treatment, must choose between that treatment and paying rent is unacceptable in the Commonwealth in 2019 where you can’t turn on the radio or open the newspaper without hearing of the latest technological innovations in health care, thanks to our incredible research institutions and companies.

But it is also becoming increasingly difficult to turn on the news without hearing stories of individuals, families and communities in crisis due to either lack of access or lack of affordability in some step along the way in our healthcare delivery system and that, also, is unacceptable.

We can and must create an innovative healthcare infrastructure that provides an accessible, affordable, quality level of care for all of our residents, for all of their health needs while continuing to provide an environment where research and development and technological innovation can thrive.

The annual HPC Cost Trend hearings have provided an invaluable opportunity for raising, sharing and advancing ideas that have become important to our ongoing discussions around healthcare. That is why I would like to take the time I have remaining to raise a topic that is a personal priority for me – one that I think can have a profound impact on our residents. That is the idea that any comprehensive healthcare delivery system that we create in the coming years must include mental and behavioral health as integrated components.

Many of you may already know that my father struggled with mental illness.

What you may not know is that I did not talk about it until after I became a legislator because I was too afraid to talk about it and its effect on our family.

For too long, we have treated the subject of mental illness as something to be ashamed of, and that has prevented us from making sure that our residents get the help they are entitled to as part of their routine health care.

It also means that we have not taken an accurate measure of the impact of mental illness in all its forms, along with the associated effects of these diseases, on the cost of our health care system and on our state as a whole. But from what we do know, the numbers are staggering.

According to the National Alliance of Mental Health (NAMI), one in five US adults experience mental illness each year.

Across the US economy, serious mental illness causes with an estimated $193.2 billion in lost earnings each year, with the number going as high as $300 billion each year if you look at all mental health and wellness concerns.

But when you look at the systemic effects of untreated mental illness on our Commonwealth, the numbers grow even larger.

If you believe – as I do – that the opioid epidemic is the result of unmet mental health needs, we lose $2.7 billion a year in business productivity from employees suffering from opioid addiction, according to the Mass Taxpayers Foundation.

Mental illness and substance use disorders are the cause of countless emergency room visits, acute hospital stays, and co-morbid conditions. They also account for lost productivity at work and higher health care costs for employers.

Beyond our healthcare system, the prison system is now one of the largest providers of mental health care in our state, and untreated mental illness is a cause of repeated incarceration.

Thirty-seven percent of incarcerated adults have a diagnosed mental illness, and tragically, over 70% of youth in the juvenile justice system do too.

There is virtually no area of our economic, civic and personal lives that is not touched by the need for mental and behavioral health and wellness. And so we must take the integration of mental and behavioral health into our health care system – to create one continuum of care – seriously.

The Senate, under the direction of our Senate Chair of the Mental Health and Substance Abuse Committee, Julian Cyr, is currently taking a close look at ways to do just that.

In addition, the Senate recently dedicated $10 million in the FY2020 budget in new funding to support our efforts in mental and behavioral health. We will use these funds to expand access to services for every region and for all residents, increase the number of well-trained practitioners through workforce development programs, and examine ways to utilize technology, such as telehealth, to increase access in underserved areas.

Most importantly, we will tackle how to reduce the shame, silence and stigma surrounding mental illness and substance misuse through a public education campaign that centers the voices of those most affected, as well as work towards achieving true mental health parity, which we feel is crucial to our efforts to provide access and reduce overall costs.

I am proud to have both Senator Friedman and Senator Cyr continuing to work on the issue of parity.

And I hope all of you will join us in our efforts to end the stigma. We will need your voices, because, ultimately, this is about more than bottom lines. This is about people’s lives.

We know that the next health care challenge is just around the corner, and we must also anticipate that the next big mental health care challenge is just around the corner too.

We must create a health care delivery system that can not only head off rising health care costs, but mitigate or even prevent the next addiction crisis.

This is Massachusetts after all, the hub of innovation in technology and health care.

We have a lot of great minds here.

And so if any state should be able to figure out a way to reduce the stigma around mental illness, create true mental health parity, and build a comprehensive and affordable health care system — it is Massachusetts.

I look forward to working with all of you on these important goals.

And I thank you for your continued good work.

Thank you.