BOSTON — The state Senate has passed legislation intended to bring Massachusetts into compliance with the federal Affordable Care Act while simultaneously instructing the Patrick administration to seek a waiver from the Obama administration on a key provision of the federal law set to take effect next year.
But Senate Minority Leader Bruce Tarr, the Gloucester Republican, said the legislation that cleared the Senate was at cross-purposes by both seeking to avoid the federal requirement while providing for a phase-out of the five additional state rating factors, a fallback that he said brought into question the “candor” of the move to secure a waiver.
The Senate unanimously backed a waiver from the Affordable Care Act’s insistence that states limit rating factors used to calculate small group premiums to four considerations – age, family size, geographic area and tobacco use. State law allows for additional consideration of industry, participation rate, group size, intermediary discount and group purchasing cooperatives.
Business groups, such as the Associated Industries of Massachusetts, and others worry that the new rating system could increase the premiums for as man as 60 percent of the state’s small businesses, though, in some cases, the new system could reduce premiums. The directive to seek a waiver is not in the House version of the bill.
Senate Chairman of Health Care Financing James Welch, a West Springfield Democrat, said that merely seeking the waiver without providing a plan to implement the federal law without the waiver would “inject instability” into the market, while Tarr called the legislation a “usurpation” of the state’s policies.
The Senate legislation clears the path for an expansion of MassHealth, priming the state for the 2014 implementation of the federal health care law. The ACA drew in large part from the Bay State’s 2006 law, which imposed an individual mandate requiring Massachusetts residents to obtain insurance.
The debate harkened to past health care overhauls with musings on the state’s relationship to the federal Affordable Care Act, questions over how great a role the state should play in trying to shape the federal law and some fawning compliments — including Tarr’s alternately calling Sen. Richard Moore, an Uxbridge Democrat, the “pharaoh of federal mandates” and the “high commander of health care.”
“It is being imposed upon us. You must do this pretty much or else,” said Sen. Michael Knapik, a Westfield Republican. “Or else what? You don’t get the dough. You don’t get the waiver,.
“We’re just hitching our cars to this train wreck,” he said.
Moore said the national Republican Party had impeded passage of the ACA and has since been more interested in repealing it than working to improve it.
Welch said the ACA would be providing hundreds of millions in savings, grants and other money, and the compliance would not fundamentally change the state’s health care system.
Moore, who worked on the 2006 state law that was a building block for the 2010 federal law, left his co-chairmanship at the Joint Committee on Health Care Financing to Welch at the start of this year to become president pro tempore.
Senate Democrats rejected several Republican ideas to study the economic effects of the ACA on the medical device industry, which is subject to a new tax under the law, and other aspects of health care.
“We’ve had a couple votes today to deny ourselves information,” said Tarr before his amendment to study the state’s cost for implementing the federal law went down on a voice vote.
Some Democrats joined in the failed effort to add a study into the medical device tax, which failed on a 14-25 roll call vote. Sens. Michael Barrett, William Brownsberger, Barry Finegold, Joan Lovely, Michael Moore, Kathleen O’Connor Ives, Michael Rodrigues, Michael Rush, and James Timilty broke with the Democratic majority to join the four Republicans on that vote.
Moore, meanwhile, said the IRS, which will play a major role in implementing the law, would be better positioned to assess the impact of the federal tax.
Republican Sen. Robert Hedlund of Weymouth, who sought more income verification in MassHealth, was the only member to vote against the legislation, which must now be reconciled with a House bill that was approved last week.