Massachusetts senators squared off Thursday on a sweeping bill that seeks to control the rising costs of medical care and prescription drugs, including a controversial plan that would fine the state’s largest hospitals if spending rises too fast.
The legislation also would require pharmaceutical companies to submit to more scrutiny from state officials.
The bill’s drafters say it will help curb costs for consumers and the state budget, while improving patient care.
“We cannot wait for these challenges to resolve themselves,’’ Senator James T. Welch, a West Springfield Democrat and lead author of the bill, said as debate on scores of amendments stretched through a second day. Lawmakers debated the issue late into Thursday night.
Opponents and skeptics say now is not the time for sweeping legislation, given the ongoing uncertainty around health care in Washington and the fact that Massachusetts passed a health care cost control bill in 2012.
Republican Bruce Tarr, the Senate minority leader, questioned the need for additional “bureaucracy’’ that could drive costs higher, adding that lawmakers should focus instead on measures to increase the transparency around health costs.
The bill’s fate in the House remains unclear. House leaders have not said when they will take up health care legislation.
Some provisions in the 100-page Senate bill have proved to be controversial.
The bill attempts to help struggling community hospitals by setting a floor for the reimbursements they receive from insurers. Hospitals would have to be paid at least 90 percent of the average price of a service, according to the legislation.
Hospitals are already major contributors to health care spending. So to control costs, the bill also sets a benchmark for annual growth in hospital spending, estimated at 2.7 percent. If the industry exceeds that benchmark, three hospitals with the highest commercial spending would have to pay penalties.
The idea of the penalties has drawn strong objections from the hospital industry, particularly the state’s largest health system, Partners HealthCare. Partners executives expect their two biggest hospitals, Massachusetts General and Brigham and Women’s, could be fined hundreds of millions of dollars under the measure — even if those two hospitals make progress in controlling costs.
Partners executives say this provision of the legislation would harm their ability to provide quality care to patients, and they have taken the unusual step of asking thousands of their employees to help lobby against it.
The Massachusetts Health & Hospital Association also opposes “the direct redistribution [of money] from one hospital to another as a mechanism to reduce variation.’’
The Massachusetts Association of Health Plans, which represents insurers, has raised concerns that this part of the bill could encourage many hospitals to spend more, not less, because only three would be penalized if spending blows past the benchmark.
Senate leaders omitted several proposals from Governor Charlie Baker to curb spending in the state Medicaid program, called MassHealth, which covers poor and low-income residents. Baker wanted to change eligibility rules and move some adults off of MassHealth and onto other subsidized coverage, but lawmakers have so far rejected those ideas.
The governor said Thursday that the Senate effort doesn’t address the rising costs of MassHealth. The state spends $16 billion a year on the program, sharing the costs with the federal government.
“My big concern with the Senate health care bill is it doesn’t save the state any money,’’ Baker told reporters. “If we don’t do some things to change the way our system operates, we put education spending at risk, we put transportation spending at risk, and we put general local aid to cities and towns, public safety, and fire protection at risk.’’
Senate leaders, however, predict that in 2020, their legislation would save an estimated $114 million on MassHealth, part of an overall savings in the health system of up to $525 million.
The Senate bill would require pharmaceutical companies for the first time to submit price and other data to the state Health Policy Commission, a watchdog agency. It would also require drug makers to testify at the commission’s annual hearing, where health care executives discuss what they’re doing to control costs.
“We are concerned with the current form of the Senate bill but know it’s only the first step in the process,’’ Robert K. Coughlin, president of the Massachusetts Biotechnology Council, said in a statement Thursday. “We look forward to working with the House to develop approaches for the state to adequately measure the value that prescription drugs bring to patients and the health care system, in lives improved and costs avoided.’’
The legislation would expand the role — or scope of practice — for several types of health care workers: nurse practitioners, nurse anesthetists, psychiatric clinical nurse specialists, optometrists, and podiatrists. The idea is that these providers can provide some medical services at a lower cost than physicians, who are paid more.
The bill would also create a new type of dental care provider, called a dental therapist, who could do some of the work now left to dentists.
In addition, the legislation would require hospitals to be more aggressive in preventing patients from being readmitted just days or weeks after being discharged. It sets a benchmark for reducing readmissions 20 percent by 2020, with the potential for penalties for hospitals that miss the target.
The Mass. Hospital Association says the legislation is too aggressive and punitive in trying to reduce readmissions.
The Senate bill is the most comprehensive health care bill to be debated on Beacon Hill in five years. In 2012, lawmakers approved legislation that set a benchmark for controlling the overall growth in health spending to 3.6 percent a year, among other measures.
Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.
