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    Senate rivals divided on future of health care law

    Brown urges repeal; Warren cites gains

    US Senator Scott Brown was elected on a promise to be the 41st vote that Republican senators needed to block Democrats from passing a major overhaul of the nation’s health care system.

    But Democratic leaders devised a way to skirt a Republican filibuster, and the Affordable Care Act ­became law in spite of Brown’s 2010 victory. Almost three years later, that law remains a bright line in Massachusetts politics, separating Brown and his challenger for ­reelection, Democrat Elizabeth Warren, on health care: He would repeal it, she would keep it in place.

    Brown, who as a state senator supported the 2006 Massachusetts health care revamp that became the model for the Affordable Care Act, argues that the federal law hands the federal government too much power. Each state, he says, should come up with its own plan tailored to its unique needs.


    The federal law, he says, hurts Massachusetts by raising taxes, reduc­ing Medicare spending, and slowing economic growth by discouraging midsize companies from growing.

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    “States can be incentivized to do what we’ve done and provide care and coverage like we have,” Brown said recently on a Springfield radio show. “But we do not need the long arm of the federal government telling us in Massachusetts how to provide for our citizens.”

    Warren counters that Massa­chusetts has much to lose if the federal law is repealed, includ­ing new rules that end insur­ance copayments for preventive care and lifetime limits on coverage. She notes that it also closes the coverage gap, ­often referred to as the “doughnjut hole,” in Medicare’s drug benefit, and offers tax credits for small businesses and insurance subsidies for some middle-income families not previously eligible. “We should not roll back these gains,” she says on her website. “They are too impor­tant for families.”

    In a race dominated by the economy, taxes, and the character of the candidates, the Afford­able Care Act has been something of a secondary issue. But it has provided each candidate with ammunition for attack­ing the other in campaign stops, ads, and debates.

    Echoing a similar charge made by GOP presidential nominee Mitt Romney against President Obama, Brown ­accuses Warren in a recent television commercial of supporting a policy of “raiding $716 billion from Medicare.”


    A number of political fact-checking efforts have cried foul at this argument. The law curbs Medicare spending growth by $716 billion over 10 years; it does not cut current Medicare spending. Democrats have ­argued that these reductions help slow the rate at which the Medicare trust fund is depleted, extending its solvency from 2016 to 2024.

    Much of the savings comes from two sources: reduced payments to hospitals, which stand to benefit from having more ­insured patients; and reducing funding for private Medicare Advantage plans, which cost significantly more per enrollee and typically offer more benefits than traditional Medicare. Some of the savings also come from requiring providers to meet quality benchmarks ­intended to improve efficiency and gradually drive costs down.

    Traditional Medicare benefits are not affected, but Medicare’s chief actuary has ­expressed concern that the payment reductions are too steep and could cause some hospitals, nursing facilities, and home nursing agencies to ­become unprofitable or stop accept­ing Medicare patients.

    Warren, meanwhile, has repeat­edly criticized Brown’s opposition of a rule under the law requiring employers to ­offer insurance that provides women access to free contraception. Some employers — particularly those affiliated with the Catholic Church, whose teachings oppose birth control — have fiercely objected to the requirement. Brown coponsored legislation, known as the Blunt amendment, that would let any employer who morally objects to covering a medical service to exclude it from benefits. (The Blunt amendment failed; the Obama administration created a religious exemption but some religious institutions, including the Catholic Church, said it does not go far enough.)

    Brown, who supports abortion rights and has opposed ­efforts to defund Planned Parent­hood, says he backed the Blunt amendment on religious freedom grounds. But Warren says it shows him as out of touch with women’s health care concerns.


    Brown has also used the law’s so-called “Cadillac tax” to try to lure union members away from Warren. The term refers to a provision in the law that in 2018 would tax the most expensive health care plans, defined as plans that cost more than $10,200 for an individual and $27,500 for a family. The 40 percent tax would apply to the difference between the total cost of the plan and those thresholds.

    The Cadillac tax helps offset the cost of subsidizing insurance for low-income people. It was also intended to discourage employers from offering extreme­ly generous health care plans that give beneficiaries little financial incentive to be thrifty about the medical services they use. Many health policy analysts believe such plans contribute to health care inflation.

    But Warren has found these to be tough arguments to make on the campaign trail. Many union members, who traditionally lean Democratic, have forgone raises and other benefits to preserve top-notch insurance benefits.

    Brown has won the endorsement of a few law enforcement unions and is now trying to use the Cadillac tax to cut into ­Warren’s support among other union members. Warren’s campaign says she would not have proposed the Cadillac tax, but “the overall law will lower health care costs, expand ­access, and provide improved benefits to seniors.”

    Warren’s campaign says her top health care priority, beyond blocking a repeal of the Affordable Care Act, is to reduce costs. She has not issued specific proposals, but has argued that the federal health overhaul lays the groundwork by funding ­research that aims to make care more efficient, therefore improv­ing quality and reducing costs at the same time.

    Warren often cites a recent study by Boston Children’s Hospital that showed how investments in preventing childhood asthma attacks saved money in the long run. In a statement to the Globe last July, Warren highlighted the study’s findings: After families were equipped with vacuum cleaners and better information about how to use medications and avoid asthma attacks, emergency room visits and hospitalizations plummeted, saving $1.46 in hospital care for every $1 spent on prevention.

    Brown has said little about how he would try to control medical costs. His top health care agenda item is repealing the federal overhaul, his campaign said. If that proves politically untenable, he will work to eliminate what he considers its most odious provisions.

    In particular, Brown has filed legislation to repeal the 2.3 percent tax the bill imposes on medical devices. Massachusetts is home to more than 400 medical device companies that employ more than 24,000 people, plus about 80,000 in related ­industries, according to a study commissioned by the industry.

    The tax, which will raise an estimated $29 billion, was supposed to be the industry’s contribution toward the cost of the bill. Architects of the health care overhaul maintain that the Affordable Care Act benefits many sectors of the health care industry by helping an additional 30 million Americans ­become insured. Drug makers and insurers, who stand to benefit from more people in the system, will also pay new fees under the law.

    Warren joined Brown’s call for a repeal of the medical ­device tax earlier this year. But she has not said how she would replace revenue the tax raises.

    Lisa Wangsness can be reached at lwangsness@globe.com.