• Lawmakers add extended Lyme coverage amendment to budget

• By Elaine Thompson
  Telegram & Gazette Staff

  
  Posted Jun. 21, 2016 at 6:01 PM
  
  

  Legislators who have been fighting unsuccessfully for years to get a law requiring insurance companies to cover extended treatment for Lyme disease are trying a new tactic by attaching an amendment to the proposed fiscal 2017 state budget.

  State Rep. David P. Linsky, D-Natick, and state Sen. Anne M. Gobi, D-Spencer, attached amendments to the budget that would cover extended treatment. Each has a bill that would require insurers to cover extended antibiotic treatment to Lyme disease victims, if ordered by a licensed physician.

  Treatment is controversial in that there are two schools of thought. The Infectious Disease Society of America has expressed concern about overuse of antibiotics and recommends limited treatment options. Currently, most insurers limit coverage of antibiotics to a four-week period. The International Lyme and Associated Disease Society recommend treatment determined by clinical judgement. In some cases that means long-term treatment with antibiotics.

  Several legislators, including Mr. Linsky, Ms. Gobi and state Rep. Theodore Speliotis, D-Danvers, who personally know Lyme victims have filed bills each year to get the longer treatment for people whose physicians say need it. Some victims say they have had to spend tens of thousands of dollars for treatment.

  Lyme bills filed this year are now before the Joint Committee on Health Care Financing. But, the formal session ends July 31.

  “I felt we were running out of time,” said Mr. Linsky. “There are never any guarantees so I decided to take this procedural step as well.”

  Lyme disease ended the baseball career of Mr. Linsky’s son after he was diagnosed as a sophomore in high school several years ago. He missed almost a semester from school, but he recovered after a lot of treatment.

  Lyme disease is the most prevalent vector-borne disease in the country. It affects many more people than Eastern equine encephalitis and West Nile virus combined. Lyme disease is difficult to diagnose. If not treated early, it can spread to many organs and systems in the body, including the central nervous system, cardiovascular system, the eyes, the liver and muscles and joints.

  The Massachusetts Medical Society, the Retailers Association of Massachusetts and the Massachusetts Association of Health Plans, which represents insurance companies, are among opponents of the mandated extended treatment for Lyme disease.

  Eric Linzer, spokesman for the MAHP, said the mandate is not supported by existing science. The association represents 17 health insurance plans that provide coverage to about 2.6 million Massachusetts residents. Mr. Linzer said several national medical groups have said the use of long-term antibiotics is not effective and can result in serious complications.

  Jon Hurst, president of RAM, said the bill would disproportionately affect small businesses because most large companies are self-insured, which are regulated under federal law.

  Mr. Hurst said he has contracted Lyme disease twice in the past five years and one of his sons also has had the disease. Each was diagnosed relatively early and only required treatment for one month, which was covered 100 percent by insurance.

  “Politicians are pricing health insurance out of the realm of affordability for those who work for small businesses,” he said. “All these specialty provider groups keep piling on to get everything covered under health insurance. It’s rigging the system … just hammering small business owners.”

  In 2014, the state Center for Health Information and Analysis issued a report that said extending coverage for long-term antibiotics on average would increase a person's monthly health insurance premium by no more than 11 cents per year. Some other states where the disease is prevalent have already passed legislation allowing extended coverage

  New England and the Upper Midwest are hotbeds for the disease. It has reached epidemic proportions in Massachusetts. In 2014, Massachusetts ranked No. 2 behind Pennsylvania in the number of confirmed cases, according to the Centers for Disease Control and Prevention. In 2014, Massachusetts had 3,646 confirmed cases and 1,658 probable cases. There were 6,470 confirmed cases in Pennsylvania and 1,017 probable cases.

  Trish McCleary, a longtime Lyme victim and co-founder of Sturbridge Lyme Awareness of Massachusetts, has worked on bills with legislators for several years. She is pleased that Mr. Linsky and Ms. Gobi are taking extra steps to try to finally get legislation enacted.

  She said she is hopeful that the amendment will stay in the budget and make it to the governor’s desk.

  “It sounds like he’s a governor who lets the legislators make decisions. I think in this case, the legislators are well aware of how many people in their districts are really suffering and need some sort of access to affordable treatment. I can only hope that Gov. Baker understands that we’re in the midst of an absolute epidemic. We need this. It’s commonsense legislation."

  The governor, however, indicated recently that he thinks adding policy changes to the budget is "a bad practice."

  “I think it could jeopardize the delivery of a timely budget," he said. "I think those issues are best handled through the processes that are already in place to deal with them."