410 Mass. 165 | Mass. | 1991
At issue in this declaratory judgment action is whether six statutes enacted by the Legislature in 1987 and 1988, mandating the inclusion of certain benefits in all individual and group health insurance plans sold in Massachusetts, violated art. 115 of the Amendments to the Massachusetts Constitution.
The plaintiffs are cities and towns (municipalities) that purchase group health insurance plans for their employees pursuant to G. L. c. 32B (1988 ed.), and Blue Cross and Blue Shield of Massachusetts, Inc. (Blue Cross/Blue Shield), from whom they purchase the plans. Pursuant to G. L. c. 231A (1988 ed.), the plaintiffs sought a declaration that art. 115 permits the towns to exclude the mandated benefits from their contracts with Blue Cross/Blue Shield.
The six challenged statutes mandate the following benefits: PAP smears (screening for cervical cancer) and mammography (screening for breast cancer), St. 1987, c. 363; preventive and primary care services for children, St. 1988, c. 23, §§ 48, 52, and 60; lead poison screening for children, St. 1987, c. 773; nonprescription enteral formulas for Chrohn’s disease and ulcerative colitis, St. 1987, c. 683; diagnosis and treatment of infertility, St. 1987, c. 394; and chiropractic services, St. 1987, c. 711.
With the exception of St. 1988, c. 23 (preventive and primary care services for children), which passed by a simple majority in both houses of the Legislature, the challenged statutes were enacted by voice vote in each house, and there was no record made of the number of members of either house present and voting either for or against the statutes. The Legislature did not provide for assumption by the Commonwealth of the additional costs to the towns that may result from application of the statutes. The towns have not accepted these statutes, either by vote or appropriation.
The current group health insurance contract between the city of Cambridge and Blue Cross/Blue Shield includes all of the benefits mandated by the challenged statutes except those for chiropractic services and infertility treatment.
Pursuant to the Home Rule Amendment, art. 89, the Legislature was authorized to make the application of certain laws to a particular municipality dependent on approval by
Since insurance companies (in this case, Blue Cross/Blue Shield) will seek to raise their premiums* ***
We begin by briefly reviewing the background of art. 115. The collective bargaining law passed in 1973, and codified as G. L. c. 150E (1988 ed.), which broadened the scope of
Article 115, which originated in the 1977 joint legislative session soon after the decision in Arlington, provided the “specific constitutional provision” required by Arlington to overcome the binding arbitration law. The argument for the amendment (Question 5 on the ballot) that appeared in the Voter Information Supplement issued by the State Secretary said, in part, that “if a mandate concerning municipal employee salaries or benefits is passed without full state funding or without a % vote of each house, then voters and taxpayers within each city or town would have the right to
Article 115 limits the Legislature’s power to regulate the terms. of municipal employment. Like the Home Rule Amendment, however, it did not limit the Legislature’s ability to enact laws for the general welfare. In considering the meaning of § 8 of the Home Rule Amendment, prior to the addition of art. 115, this court stated, “We do not interpret the words ‘to act in relation to cities and towns’ as precluding the Legislature from acting on matters of State, regional, or general concern, even though such action may have special effect upon one or more individual cities or towns. If the predominant purposes of a bill are to achieve State, regional, or general objectives, we think that, . . . the Legislature possesses legislative power, unaffected by the restrictions in art. 89, § 8.” Opinion of the Justices, 356 Mass. 775, 787-788 (1969).
Article 115 was adopted by popular vote the same day as G. L. c. 29, § 27C (1988 ed.), the “local mandate” provision of Proposition 2Vz:
Mandated benefits laws are designed to ensure the availability of certain benefits considered necessary for the public welfare and which otherwise, because of a distorted insurance market, might not be offered or might have a prohibitively high cost.
The municipalities claim their provision of group health insurance is not “voluntary.” It is true that, once having ac
One final point: the plaintiffs charge that application of the mandated benefits statutes to municipal employees’ group health insurance contracts violates G. L. c. 150E, under which the “wages, hours, standards or productivity and per
We therefore declare that the provision of art. 115 of the Massachusetts Declaration of Rights does not render ineffective the statutes challenged in this action.
The Attorney General does not claim that the municipalities may not challenge the constitutionality of the statutes and we do not therefore reach the issue. See LaGrant v. Boston Hous. Auth., 403 Mass. 328, 330 (1988); Trustees of Worcester State Hosp. v. The Governor, 395 Mass. 377, 380 (1985); Spence v. Boston Edison Co., 390 Mass. 604, 611 (1983).
The towns also sought an order enjoining the Attorney General from enforcing the statutes against them, and requiring the Commonwealth to reimburse them for costs incurred to date “by reason of the unconstitutional application of the mandated health care benefit statutes.”
Cambridge entered into an agreement with Blue Cross/Blue Shield purporting to indemnify Blue Cross/Blue Shield from any liability resulting from excluding those two benefits from coverage.
Subject to the approval of the Commissioner of Insurance for group and individual health plans sold by nonprofit insurers, and for individual health plans sold by commercial insurers. See G. L. c. 176A, § 6; G. L. c. 176B, § 4; and G. L. c. 175, § 108 (1988 ed.).
No record was made of the exact votes for the challenged statutes, except for St. 1988, c. 23, which was passed by a simple majority.
The Home Rule Amendment to the Massachusetts Constitution, art. 89, returned to local government some measure of power over local affairs. Section 8 of art. 89 provided that the Legislature “shall have the power to act in relation to cities and towns, but only by general laws which apply alike to ... a class of not fewer than two, and by special laws enacted [by certain procedures]
The referenda enacted on that day were an attempt to control the rise of local costs and local taxes. The “local mandate” provision was a response to the enactment by the Legislature, in the 1970s, of a number of statutes which imposed substantial costs on municipalities without the assumption of those costs by the Commonwealth. See, for example, St. 1972, c. 766, the so-called Special Education Law.
Subsection (a) of G. L. c. 29, § 27C, provides that “[a]ny law . . . imposing any direct service or cost obligation upon a city or town” shall be effective oply if it is accepted by such city or town or if the Legislature provides by appropriation for the assumption by the Commonwealth of such cost.
In the case of preventive services, which account for at least three of the six challenged statutes, although such services may reduce total health care costs in the long run, an employer looking only at short term costs might elect not to provide coverage for such services, since the expense of treatment for the condition to be prevented may not be incurred for many years. In addition, the cost of coverage for some conditions, such as infertility, may be prohibitively high because “good-risk” individuals do not purchase coverage, thus driving up the price of coverage for those who would otherwise purchase it.
The fact that, according to the plaintiffs, G. L. c. 32B was “universal [ly] accepted],” and the number of years ago that it was accepted also have no bearing on the voluntariness of the acceptance.
A mandated benefits statute covering some treatment for mental illness had been enacted by the Legislature several years earlier, by St. 1973, c. 1174, § 2, and was effective in 1976.
Contrary to the defendant’s argument, the holding of this court in Attorney Gen. v. Travelers Ins. Co., 385 Mass. 598 (1982), and of the United States Supreme Court in Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724 (1985), that mandated benefits do not conflict with the Employee Retirement Income Security Act or the National Labor Relations Act, is not relevant to the issues in this case.