House Votes For Bill To Comply With Obamacare
The House on Wednesday approved broad updates to state health care laws to bring Massachusetts into compliance with the omnibus federal health care law before January, but not before Republicans challenged lawmakers to reject Congressional efforts to impose changes on a universal access system that predates the Affordable Care Act (ACA).
While states around the country have grappled with whether and how to implement President Barack Obama's federal health care overhaul, the Legislature here has largely been able to avoid the debate until now because so much of the federal law was based on systems already in place in Massachusetts.
Rep. George Peterson, R-Grafton, urged the House to reject the bill, which passed along party lines 116-32, and take the fight to court if necessary to stand up for the state-based system and reject the federal changes being imposed that critics worry could drive up premiums by 17 percent for over 60 percent of small businesses.
"If we are the model we should be able to stand alone and say we're already doing it. And if that means we have to take it to court, so be it," Peterson said.
The ACA will allow children to stay on their parents' insurance until age 26, prevent the denial of coverage to people with pre-existing conditions, expand Medicaid and qualify individuals earning up to 400 percent of the federal poverty for subsidies to purchase health insurance.
But the law also makes changes to a system Democrats and Republicans largely view to be working in Massachusetts where 98 percent of residents are insured.
"We've been the most progressive state in making sure our residents are insured. We went through a lot of pains, trials and tribulations but we did it, and now the federal government is rolling in and rolling over us and saying we have to follow their rules," said Rep. F. Jay Barrows, a Mansfield Republican.
As Massachusetts implements a 2012 health care cost control law, small business groups are fearful that they will face premium spikes due to the federal law's requirement that a smaller group of four rating factors be used.
The bill calls for a three-year transition in the individual and small group market away from rating factors currently used by insurers to determine premiums for subscribers. State law currently permits the use of nine rating factors, but the ACA allows only four: age, family size, geographic area and tobacco use.
The Patrick administration sought a full waiver from the new federal rules, but instead Massachusetts became the only state granted a phase-in period over three years to transition to the new rating system to avoid "sticker shock" and smooth the impact of premium increases.
"It will cost our constituents jobs, jobs, and jobs," Barrows said.
Rep. Jeffrey Sanchez said the full implementation of the ACA is estimated to save the state $205 million in 2014 due to enhanced federal matching funds for MassHealth, or Medicaid, that will deliver $155.7 million in additional funding for Medicaid and $50 million in subsidies for qualifying patients to purchase private plans.
Federal Medicaid reimbursement rates under the ACA are due to jump from 50 percent to 75 percent in 2014, and will peak at 93 percent in 2019 and continue at 90 percent from 2020 and beyond. The expansion of Medicaid is expected to shift as many of 45,000 individuals currently ensure through a partially subsidized Commonwealth Care plan into Medicaid.
Questioning the time sensitivity of acting now, Rep. Daniel Winslow, a Norfolk Republican and former district court judge, proposed requesting a Supreme Judicial Court ruling on whether Congress can supercede a state-based universal access law like the one already in place in Massachusetts for health care.
"This body should not cede any of its sovereignty, especially to this Congress," Winslow said.
The amendment was rejected 32-117.
House Democrats also beat back another amendment from Winslow that would have prohibited any state tax dollars from being used to implement the ACA, with Winslow arguing the federal government should pay if it wants to impose its system on Massachusetts.
That amendment was also defeated 35-115.
While some expressed concerns about shifting patients into Medicaid and the impact that could have on the availability of doctors, Rep. Steven Walsh said the federal law will make Massachusetts eligible for $1.8 billion in federal reimbursements that could be used to increase Medicaid rates paid to doctors and hospitals and make it more financially appealing for doctors to accept Medicaid patients.
"Today's vote doesn't repeal anything we did in 2006. It also doesn't repeal anything we did in 2012," Walsh said.
Peterson said the $1.8 billion in federal money would require the state to spend $1.8 billion of its own money to obtain. Rejecting a call from GOP lawmakers for a fiscal estimate to be attached to the bill, Walsh said the bill was implementation legislation and would have a fiscal note of "zero" if it had one.
Walsh predicted other bills related to the ACA in the future could need fiscal notes or estimates of projected savings. "None of us can really predict the costs of health care," Walsh said.
House Minority Leader Brad Jones said he suspected Obamacare would end up costing "a lot of money" in Massachusetts and speculated that its costs would crowd out funding for other priorities.
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