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States should embrace expanded health care

NOW THAT the Supreme Court has ruled President Obama’s health law constitutional, it would be heartening to see the hyper-partisanship and hyperbole fade, and a more reasonable perspective reassert itself.

If political level-headedness prevailed, several constructive changes might be accomplished. Congress could give the states greater flexibility early on to design innovative care alternatives. Policymakers might also consider adding a broader reinsurance program to pay for the most expensive medical cases, thereby taking those patients out of the regular system and easing pressures on premiums.

Sadly, bipartisan efforts to improve the law are apparently too much to expect in an election year; notwithstanding the high court’s decision, congressional Republicans insist they will push forward with repeal efforts that are preordained to fail.


It’s time for states to start preparing to comply with the law. In Massachusetts, a proud pioneer on universal health care, that task won’t be particularly difficult. “We will have to work on getting on the same page as the federal government, but fundamentally, we will continue doing what we are doing, which showed the way for the federal government,” says James Roosevelt Jr., president and CEO of Tufts Health Plan.

Other states, however, will need to undertake several large tasks. For example, the law calls for the states to set up exchanges that, like the Massachusetts Health Connector, will help those who need insurance shop for affordable policies.

According to the Kaiser Family Foundation, only 15 states have established the Connector-like insurance exchanges, though another 18 have been studying possible options. But in 14 states, Kaiser reports, there has been no significant activity on that front. Three, meanwhile, have decided not to set up the exchanges — including New Hampshire and Maine.

If the states want to control the process themselves, they need to get busy. The law allows the federal government to run the exchanges in states that aren’t ready to go forward themselves; under the law, states must be making solid progress toward establishing an exchange by Jan. 1, 2013.


State are also supposed to upgrade their Medicaid eligibility and enrollment systems, and to harmonize insurance regulations with the federal standards. They will also need to decide whether to expand Medicaid eligibility. There, the high court’s decision weakened the federal government’s leverage considerably by saying it couldn’t condition a state’s existing Medicaid dollars on its willingness to expand Medicaid coverage. Yet some analysts think the law’s carrots — its generous fiscal incentives — will lead most states to conclude it makes sense to embrace the Medicaid expansion.

“Almost any state that is smart and pragmatic can come out ahead financially,” says Stan Dorn, a senior fellow at the Urban Institute.

Many of those states will be studying Massachusetts as they decide how to move forward, predicts Kevin Tabb, the president CEO of Beth Israel Deaconess and former chief medical officer at Stanford Hospital & Clinics. “We have been on this path for years,” he notes. “Other states are starting from scratch.”

There’s also an interesting political lesson here. Our state law, which is very similar to the federal law, has become more popular over time, a result that suggests that familiarity dispels fear or contempt. There has been a blizzard of disinformation about the Affordable Care Act. Now that all doubts about its constitutionality have been resolved, it’s time for a determined campaign to clear the fog and make voters aware of what the law is really all about.