The health care battle that began this morning at the Supreme Court is one of the most important of our lifetime. But the direct effect on Massachusetts, which created the framework for the federal Affordable Care Act (ACA), is minimal, at best.
“The real bottom line is that consequences for Massachusetts are not that great, except the extent to which we care about the uninsured in the rest of the country,” says Harvard School of Public Health professor John McDonough.
The Individual Mandate
The question for the high court is whether the requirement that residents have health insurance is constitutional. But either way, it is already part of state law in Massachusetts and would stand regardless of what the Supreme Court decides. A related provision, that says residents can’t be denied insurance if they have a pre-existing condition, is also already in state law.
Can the ACA stand without the Individual Mandate?
Again, this doesn’t matter for Massachusetts. Harvard Law School professor Lawrence Tribe says: “There are no legal issues before the Court in which a decision would either trump the Massachusetts law or compel a review of that law.”
Massachusetts residents would lose some additional benefits provided by the federal law such as preventive care with no copays and coverage for dependent children up to age 26 (this is in the state law, but state law doesn’t apply to self-insured, usually large, employers).
What if the justices decide the federal government can’t force states to expand coverage for low income residents?
Massachusetts is already doing this voluntarily. Glen Shor, the director of the state’s health insurance exchange which is known as the “Health Care Connector,” says he doesn’t expect that will change. “Public support for health care reform has remained strong in Massachusetts because it is based on the facts,” says Shor. The law, Shor argues, “can weather many a political storm because, at its core, it is making people’s lives better in Massachusetts.”