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Massachusetts insurers look for clarity on health care law

President Obama’s reelection lifted much of the cloud that hung over the health care industry in Massachusetts, where caregivers and insurers anticipated a push to repeal the national health care overhaul if Mitt Romney had become president.

“This outcome provides an opportunity for greater cooperation and less contention,” said James Roosevelt Jr., chief executive of Tufts Health Plan.

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But health care organizations are still seeking clarity on many features of the now secure Affordable Care Act, many of which have not yet taken effect. The federal overhaul includes regulations requiring insurers to invest in new technology and funds for expanding Medicaid and revamping Medicare payments as the state presses forward with its own efforts to rein in costs and build more integrated health care networks.

Obama’s victory “removes a layer of uncertainty for health plans, providers, and employers,” said Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer. “Now we’re waiting to hear about the rule-making.”

Some executives said the lack of any near-term challenge to the national health care law cements Massachusetts’ position as a model for other states working to expand medical care coverage and coordinated care. In particular, they cited controversial provisions such as state health insurance exchanges, pioneered here in 2007, that will now go forward.

The national overhaul, modeled after the state’s landmark law passed in 2006 under Governor Mitt Romney, was supported by most health care leaders in Massachusetts.

“In my mind, the election confirms the wisdom of what we’re already doing,” said Gene Lindsey, chief executive of Atrius Health, a Newton-based alliance of community physicians groups that includes Harvard Vanguard Medical Associates. “Now it’s up to us to make it work.”

‘This [election] outcome provides an opportunity for greater cooperation and less contention.’

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But while a second term for Obama may have, for now, settled the large issue — will health care overhauls move forward? — there is less certainty about many of the details, including a range of new regulations and costs yet to be spelled out.

For example, health plans are expecting federal rules in coming weeks mandating technology investments to handle new insurance products. Implementing them could cost Boston-based Blue Cross Blue Shield $10 million to $15 million next year, Dreyfus estimated. The law also permits a “rate band” allowing insurers to charge older members up to three times as much as younger members under some policies. Currently, the state permits them to charge up to twice as much.

The biggest question remaining may be the impact of the automatic spending cuts set to take effect Jan. 1 — or similar reductions in any deal reached in Washington, D.C., between now and then — on federal funds to expand Medicaid in states.

Reductions could also hurt pilot programs that redesign Medicare to save money by setting quality standards and fixed payments rather than reimbursing doctors and hospitals for each medical visit, test, and procedure. The looming cutbacks have the potential to shave payments to medical care providers by about 2 percent, Lindsey said.

Roosevelt said federal money gives Massachusetts and other states the flexibility to shift from fee-for-service to so-called global payments.

“If there was a dismantling of Obamacare going on, some of that funding would be in jeopardy,” he said.

While the effect of cuts on other areas isn’t yet known, community health centers look forward to expanding under an $11 billion fund created by the Affordable Care Act. The fund aims to roughly double the number of neighborhood health centers and the population of patients they serve nationally by 2015.

In Massachusetts, more than a dozen centers are expected to apply for money in the coming year, from Codman Square Health Center in Dorchester to Brockton Neighborhood Health Center to Community Health Center of Cape Cod in Mashpee.

“We’re going to have to evaluate as a country where we make our health care dollars available,” said James W. Hunt Jr., president of the Massachusetts League of Community Health Centers. “We’re going to reach out to populations to make sure they can get their health care needs met and can enroll in the health insurance programs available, including the expanded Medicaid program.”

Robert Weisman can be reached at weisman@globe.com.
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