Editor’s note – The following are excerpts of a letter that AIM sent to Senate President Stan Rosenberg and members of the Senate as they began debate on a health-care reform measure. The Senate passed its health reform bill last week.

Dear Mr. President and Members of the Senate:

After eleven years of universal health insurance, Massachusetts has made great strides to ensure our residents have access to some of the best health care in the nation and the world. Thus far, we have failed to make comparable progress in containing the cost of both health-care services and insurance for employers and their work forces.

Massachusetts residents are assured of access to high quality health care, without the assurance that they can afford it. Our complex, confusing health-care system leaves both consumers and employers at a disadvantage when it should empower them to advocate for their long-term health and productivity.

According to the most recent data available from the Centers for Medicare and Medicaid Services (CMMS), Massachusetts was the second highest-spending state for health care in 2014 shelling out 30 percent more than the national average. Personal health-care spending in Massachusetts, per capita, has increased more than 12 percent in five years ” from $9,417 in 2009 to $10,559 in 2014.

Cost growth like this is unsustainable and has increased unabated in the face of attempts by both employers and the commonwealth to contain it.

Employers, especially smaller employers, have almost nothing to show in the way of cost savings and efficiencies five years after Massachusetts’ major push toward health-care cost containment. These cost increases are occurring in an industry in which experts agree that at least one-third of all care is unnecessary ” delivered in the wrong setting; marked by a lack of coordination; provided with an inadequate emphasis on prevention; harmed by medical errors; burdened with rules and fraud; or just plain excessive.

We are pleased by the Senate’s focus on difficult and expensive issues like Massachusetts’ high re-admission rates, to encourage more efficient care focus on keeping consumers healthy and out of care settings. We also support the Senate’s efforts to include provider costs in the commonwealth’s efforts to track and contain year-over-year spending increases.

We would like to express our support for Amendment #38, filed by Senator Donaghue, and Amendment #67, filed by Senator deMacedo, both of which return assessments on carriers and providers to rate payers in the form of premium reductions. The most meaningful immediate health-care reform for employers and workers is a reduction in their monthly premiums.

With that in mind, we would urge careful consideration of any new policies, with particular focus on potential financial implications. A number of amendments have been filed that expand the mandated benefits required for coverage in Massachusetts. Although many health-care services are worthy, before acting to expand benefits we must understand the complete financial effects of any such changes, particularly since the Affordable Care Act requires that states pay for any mandated benefits enacted after December 31, 2011 in excess of the federally required essential health benefits.1

AIM would oppose the implementation of any new mandated benefits, without the completion of a fiscal analysis by the Center for Health Information and Analysis. The following amendments contain some form of expanded mandated benefit:

We should, instead be further supporting innovative products and practices that lower costs and encourage healthy habits and practices. We would like to express our support for Amendments #51 and 101, filed by Senators Moore and Timilty, respectively, to reinstate the Wellness Tax Credit for small employers.

AIM also supports Senator Moore’s Amendment #45, which would remove confusion about the definition of telemedicine and would allow licensed providers to prescribe certain medicines. We are supportive of facilitating market-based solutions that could help employers innovate and bring down costs.

However, in a state facing an alarming deficit in its Medicaid program, employers are now shouldering the escalating costs of the public healthcare system. For the next two years, employers statewide will provide at least $200M annually in funding for MassHealth. This is in addition to the cost and administrative burden of providing commercial health insurance to their workers.

Most importantly, employers are tasked with closing a funding deficit absent any of the long-term structural reforms needed to solve the underlying financial problems with the program. Over the past eleven years, employers have implemented wellness programs, purchased innovative insurance products, embarked on employee educational programs ” all with the goal of providing higher quality insurance that keeps their employees healthier and costs lower.

The same cannot be said of the public health insurance program. We oppose any amendments that expand the current MassHealth program, including Amendments #2, 93, and 153. Regardless of enrollment rates, action must be taken to improve the efficiency and cost-effectiveness of this currently unsustainable program. The result will not be simply cost reductions, but higher quality of care for enrollees in the long term.

Thus, we express our support for Amendments #74 and #122, filed by Senator Tarr, which not only eliminate the buy-in option for MassHealth, but also provide a framework for efficiently determining eligibility so those who truly need it can access much-needed health-care services.

We would like to voice our strong support of Amendment #57, filed by Senator deMacedo, which would eliminate the so-called Name and Shame list.

The Affordable Care Act (ACA) reversed existing Massachusetts law and now allows income-eligible employees to decline employer coverage and seek insurance through MassHealth. That change created a migration of newly eligible individuals to MassHealth, substantially increasing the Commonwealth’s financial burden. The ACA made public health insurance an economically rational choice for eligible residents in a state known for its expensive health-care system, and employers should not be publicly shamed for a choice they cannot control.

As MassHealth enrollment grows, the commonwealth experiences the reality that employers have faced for years: the high cost of health-care coverage in this state threatens the underpinnings of our economy. Policymakers who have concentrated almost exclusively on access and coverage now face a renewed imperative to lower the cost of health insurance for everyone in Massachusetts.

We are active participants in providing health insurance to the majority of residents in the commonwealth, a role that we have played for the past 10 years and more. It is an integral part of the Massachusetts economy and we look forward to working with you to bring the same level of innovation and sustainability to health care coverage, traits which Massachusetts is known for worldwide.