Health & wellness

Planning for health care overhaul in Mass. still ‘full steam ahead’

The long debate over the constitutionality of a federal requirement that most Americans buy health insurance could be settled by June. The Supreme Court announced this morning it will hear a case challenging the mandate, a key provision of the Affordable Care Act signed by President Obama in March 2010.

The court could upend the national health law if the justices decide the mandate is unconstitutional. Yet, planning for full implementation of the law in Massachusetts is moving “full steam ahead,” said Glen Shor, executive director of the Massachusetts Health Connector, the agency that runs the state’s health insurance exchange.

The agency vets insurance plans and allows consumers to make side-by-side comparisons. Under the federal law, all states must create an exchange where individuals and small businesses can purchase plans.


“There’s a lot of work that needs to be done,” Shor said. The year 2014, when most of the major provisions of the law take effect, “to some might seem eons away, but to us it’s the blink of an eye.”

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The court’s decision to take up the case is not especially surprising. Both supporters and opponents of the law had been pushing for a fast hearing.

A ruling by the Supreme Court that the federal government lacks the authority to require people to buy insurance would have little impact on Massachusetts’ authority to do so. But it could hamstring efforts in other states.

It’s unlikely, now that there’s a timeline for a court decision, that other states will put their planning on hold, said Jon Kingsdale, former director of the Connector and a founder of the Boston office of Wakely Consulting. Kingsdale has provided advice to about a dozen states on creating state insurance marketplaces of their own.

The legal challenge to the mandate has long been an “overhanging issue,” he said. It is not clear what will happen if the court shoots it down.


“Nobody’s terribly confident that the parties will get together in the middle of an election year and say, ‘Here’s another way to skin the cat,’ ” Kingsdale said.

Despite that, many states have been moving forward under the assumption that the Affordable Care Act will remain the law of the land. Others have tried to straddle the divide, putting up a political or legal fight while doing behind-the-scenes work necessary to implement the law as it moves forward.

Lawmakers in Colorado, for example, created the infrastructure needed to set up the state’s health insurance exchange earlier this year. That included establishing a board to oversee the system and a legislative review panel. In September, however, Republican members of that panel blocked the state’s application for a $22 million federal grant to further the state’s planning.

Kingsdale said states can’t afford to wait until the court issues a ruling, possibly in June. Federal rules require states to be well into their planning for a health insurance exchange by January 2013 and to have exchanges operational as soon as January 2014.

“I think everybody involved in it is looking for some clarity on this issue,” Kingsdale said. “For a lot of people it can’t come too soon.”


Compared to many other states, Massachusetts is leaps and bounds ahead in implementing the national law. Massachusetts in 2006 instituted an individual mandate and created an online insurance marketplace, run by the Connector. The state’s law provided a model for the national one.

But there’s still plenty of work to do, Shor said.

The Connector has hired consultants to help chart the transition under the national law, which requires significant reworking of the structure of subsidies provided to make insurance affordable for lower-income residents. The federal law allows for a greater segment of the population to receive assistance in buying insurance and allows some to receive tax credits that don’t currently exist in the state’s system.

Shor noted that the state continues to work on reducing health care costs and expanding coverage to the 2 percent of people in Massachusetts who remain uninsured.

“That work will continue regardless” of the court’s decision, he said.

Chelsea Conaboy can be reached at Follow her on Twitter @cconaboy.