Commonwealth Magazine

Commonwealth Magazine

THE NOVEMBER ELECTION is in focus as the Supreme Judicial Court ruled on Wednesday that a matter regulating dental insurance can go to a ballot.

The election issue would require dental insurers to spend at least 83% of premiums on clinical costs and quality improvements, rather than administrative costs. It’s called a medical loss rate and is similar to an existing rule for health insurance, which was put in place by President Obama’s Affordable Care Act.

The issue pits dentists, who support the issue, against insurers, who oppose it.

Kevin Monteiro, executive director of the Massachusetts Dental Society, said the group was pleased with the SJC’s decision. “The Massachusetts Dental Society endorses this measure to ensure that, like medical patients, dental patient premiums are spent on their care, with key elements ensuring transparency and accountability,” Monteiro said in a statement. “This ballot measure continues to gain traction and support, and we’re confident voters will approve it in November.”

The SJC Challenge, filed by Lory-San Clark and Wendy Sutter, argued that the ballot issue includes two unrelated public policy goals. One part would establish rules limiting the amount insurers can pay for administrative costs; the second would require insurers to file annual financial reports. Under state law, a ballot question introduced through an initiative petition can only include “related or mutually dependent” topics.

In a 14-page unanimous decision, written by Judge Elspeth Cypher, the court sided with Attorney General Maura Healey, who certified the question and said the various sections of the ballot question would create “an integrated regulatory regime that would comprehensively address dental insurance rates that are excessive, inadequate or unreasonable.

Cypher wrote that the rules establishing the medical loss rate and the reporting rules share a common goal. The reporting requirements give the insurance commissioner the information needed to apply the medical loss ratio and determine whether the insurer is meeting plan cost reduction and quality improvement goals.

“Here, the required financial disclosures… do not relate to a separate general objective of transparency, but to the common objective of enabling the commissioner to implement and monitor compliance with the new [medical loss ratio] scheme,” Cypher wrote.

Proponents of the ballot question say it’s a way to save consumers money by limiting the amount of money dental insurers can use to pay salaries, cover overhead and make a profit, similar to current law for health plans. Massachusetts laws for health plans, which are slightly stricter than national standards, require health plans to spend 88% of premiums on clinical costs and quality improvements. Any excess premium must be refunded to consumers.

But opponents say dental plans are different from medical plans. Their premiums are lower – typically, 5-10% of the cost of health plans – but the plans still have the same fixed costs for patient enrollment, claims handling, fraud prevention, office maintenance , etc. So on a percentage basis, insurers are saying that a greater percentage of premium money should be spent on administrative expenses. In a brief, opponents of the issue feared that implementing a “medical loss ratio” would lead to higher premiums and make dental insurance less affordable and accessible.

The voting issue was sponsored by a group of orthodontists, a dentist and several patients, led by orthodontist Mouhab Rizkallah, whobeen prosecutedby Attorney General Maura Healey for submitting false statements to MassHealth.

The board of directors of the Massachusetts Dental Society, a professional association representing dentists, announced on Monday that it supports the ballot issue. Dr. Meredith Bailey, president of the Massachusetts Dental Society, said in a statement, “Patient dollars should be spent to support their oral health, and patients deserve to see how much of their dental insurance premiums pay for. cares. opposed to administrative costs.

Chris Keohan, spokesperson for the ballot issues committee, the Dental Insurance Quality Committee, said the committee was pleased with the decision and eager to continue its campaign. “Patients pay too much in premiums and out-of-pocket expenses for dental insurers to spend on lavish executive bonuses instead of patient care,” Keohan said. “This policy would save patients money, cover more procedures and force dental insurers to prove where the money is going.”

Who exactly opposes the question is a bit murky, but most of the opposition seems to come from the insurance industry. The SJC challenge was filed by two people – Clark is a former dental office manager and Sutter’s interest in the case is unclear.

Two national insurance trade associations that have Massachusetts members – U.S. Health Insurance Plans and the American Council of Life Insurers – filed a court case opposing the ballot issue. The Massachusetts Association of Health Plans also testified against the proposal.

Jason Aluia, vice president of government and external affairs for the Massachusetts Association of Health Plans, told a legislative committee that the proposal “would place unprecedented demands on dental plans that we fear will increase costs for families and small businesses”.

A voting committee formed to oppose the issue, the Committee to Protect Access to Quality Dental Care, was organized by political strategist Meredith Lerner Moghimi and attorney Louis Rizoli. As of the end of 2021, the committee had yet to report any donations. Kyle Sullivan, spokesperson for the coalition, said it was a coalition of “dental and other plans” that “partner with other people and organizations concerned about rising costs to consumers and small businesses and decreasing access to dental care”.

The committee, in a statement, called the ballot issue an “anti-consumer proposal that will increase costs for Massachusetts families and employers and may result in thousands of residents being denied access to much-needed dental care,” says the press release. “With consumer prices reaching all-time highs, the Commonwealth does not need this additional regulation which will only increase costs and reduce patient choice statewide,” the committee said.

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Journalist, Commonwealth

About Shira Schoenberg

Shira Schoenberg is a reporter for CommonWealth magazine. Shira previously worked for over seven years at Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, issues with the state’s foster care system and the elections for US senators. Elizabeth Warren and Governor Charlie Baker. Shira won the Massachusetts Bar Association’s Excellence in Legal Journalism Award in 2018 and several articles have won awards from the New England Newspaper and Press Association. Shira covered New Hampshire’s 2012 presidential primary for The Boston Globe. Prior to that, she worked for the Concord (NH) Monitor, where she wrote about state government, City Hall, and Barack Obama’s 2008 primary campaign in New Hampshire. Shira holds a master’s degree from Columbia University’s Graduate School of Journalism.

About Shira Schoenberg

Shira Schoenberg is a reporter for CommonWealth magazine. Shira previously worked for over seven years at Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, issues with the state’s foster care system and the elections for US senators. Elizabeth Warren and Governor Charlie Baker. Shira won the Massachusetts Bar Association’s Excellence in Legal Journalism Award in 2018 and several articles have won awards from the New England Newspaper and Press Association. Shira covered New Hampshire’s 2012 presidential primary for The Boston Globe. Prior to that, she worked for the Concord (NH) Monitor, where she wrote about state government, City Hall, and Barack Obama’s 2008 primary campaign in New Hampshire. Shira holds a master’s degree from Columbia University’s Graduate School of Journalism.

After Wednesday’s decision, the list of voting questions that will appear in November becomes clearer. In addition to approving the dental insurance issue, the SJC on Monday authorized a question reform the state’s liquor licensing regime moving forward. Tuesday, the court chased a matter governing the employment status of drivers for ride-sharing companies on the grounds that it comprised two unrelated policy provisions. A constitutional amendment raising the income tax rate by more than $1 million is expected to be on the ballot, though the SJC has yet to rule on it. a case this could change the language of the summary that appears on the ballot.

One wild card is whether the Massachusetts Republican Party and its allies will muster enough signatures to secure a referendum on the ballot repealing the recently passed law. right allowing people without legal immigration status to obtain a Massachusetts driver’s license.

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