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As Massachusetts seeks to secure another $1 billion annually in Medicaid funding by renegotiating a federal waiver, state health officials on Tuesday contemplated moving health care spending into housing and nutrition.
“We need to be providing you [first] with more money, and how we do that is going to be difficult. And b[second] we’re going to be asking you within yourself to be reallocating some of your health care dollars more for these social services,” Dr. Stuart Altman, chairman of the Health Policy Commission, told a panel of health care providers.
The panel included the president of Holyoke Medical Center, the chief medical officer at the Commonwealth Care Alliance and the pediatrics chief at Massachusetts General Hospital, among others.
Unlike most expenditures, providing housing for the homeless both improves health and saves money, Lauren Taylor, of Harvard Business School, told the commission as it considered the economic landscape of health care Tuesday. She said nutrition programs can have the same dual cost-health benefits as vaccines, while most health investments have a net dollar cost.
“Maybe what we can do differently is not in health care at all,” said Taylor, who argued social welfare programs can be more important than spending on traditional medical care.
Attorney General Maura Healey expressed a similar sentiment Tuesday.
“Social and environmental factors do indeed contribute to or detract from the health and healthiness of our communities,” Healey told the commission, highlighting the role housing, food, transportation and sick leave play in a person’s health.
Taylor told the Health Policy Commission that Oregon and California are “duking it out” with the Centers for Medicare and Medicaid Services over whether those states can use the federal funding to pay people’s rent. She also said that while the United States outspends other countries on medical care, it does not put as much emphasis as others on social services.
Massachusetts officials are negotiating their own Medicaid waiver changes, which Baker administration officials say they need to continue a roughly $1 billion annual stream of federal funding next July.
The discussion at the second and final day of the Health Policy Commission’s annual hearing on health costs delved into areas outside the traditional confines of health care – including housing development – raising a fundamental question for one of the panelists.
“Where do our responsibilities begin and end?” asked Boston Medical Center President and CEO Kate Walsh. She hypothesized about a person who breaks a hip falling in a pothole and requiring care, asking, “Am I responsible for the pothole?”
Walsh said she has contemplated the idea of creating housing, but she has concerns because the hospital already has a number of serious responsibilities towards patients.
“I’m kind of wrestling with that. There’s people on my team who are saying, ‘Housing first.’ And I’m thinking, ‘Woah,’“ Walsh told reporters. “We do really complicated things to people at very vulnerable points in their life. Think about what happens when you have an operation. You’re naked. You’re on a cold table. You’re paralyzed. And then we cut you open. We have to do that right.”
The waiver under negotiation could have major implications on the state budget – where MassHealth, the state’s Medicaid program, is the biggest spending item. The waiver could also change the way the state and medical providers try to keep the state’s low-income population healthy.
Walsh said she believes the waiver will push providers to go beyond their traditional duties.
“I think it’s going to challenge us as deliverers of health care to think less about the episode of illness and more about the overall health of the patient,” Walsh said.
