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Massachusetts health care — wonky, with a healthy dose of reality

Massachusetts: Best Friends of the Court

Massachusetts: Best Friends of the Court

February 13, 2012

CSpan photo of Attorneys General Martha Coakley (MA) and Ken Cuccinelli (VA) discussing ACA constitutionality

As the nation awaits the fate of the federal Affordable Care Act (ACA) slated to go before the United States Supreme Court late next month, Attorney General Martha Coakley jump-started the debate with a recent trip to Washington. On Thursday, Attorney General Coakley co-led a National Press Club event debating the constitutionality of the ACA. She and Virginia Attorney General Kenneth Cuccinelli, an ardent ACA opponent, argued over several facets of the Supreme Court case, including the health care coverage mandate, the tax basis, the general welfare aspect, expansion of Medicaid, and severability of the law’s provisions (watch the C-Span video).

Attorney General Coakley fervently defended the law, explaining why the results in Massachusetts show that Congress had a constitutional basis to enact health care reform. She highlighted the benefits Massachusetts has experienced under our state law, including greatly expanded access to health care and a reduction of people seeking emergency care at hospitals.

The Massachusetts Attorney General’s office is amicus curiae on one of three amicus briefs submitted to the U.S. Supreme Court from Massachusetts organizations. We (Health Care For All) collaborated on a brief with Health Law Advocates, Mass Hospital Association, Mass League of Community Health Centers, GBIO and Community Catalyst. Blue Cross Blue Shield of MA also filed an amicus brief defending the constitutionality of the federal law.

As Massachusetts served as the blueprint for the federal law, these briefs underscore how the Commonwealth’s unique experience provides an important context for assessing the constitutionality of the ACA and continues to provide a model for successful reforms. The three amicus briefs focus in particular on defending Congress’ power to enact what's termed the “minimum coverage provision” of the law - which will require non-exempted individuals to maintain a minimum level of health insurance or pay a tax penalty. In other words, the briefs defend the constitutionality of the so-called individual mandate.

As the first State in the nation to enact health care reform requiring individuals to purchase health insurance, our experience confirms that Congress had a rational basis for finding that the individual mandate would advance the critical goals of reduction in barriers to insurance coverage and improving access to health care.

The brief of Health Care For All and our partners makes the point that health insurance and health care markets inherently involve activities between and among states that cannot be successfully regulated without federal involvement. The Massachusetts health system continues to be affected by the decisions of uninsured and underinsured people from other states who seek care in Massachusetts but remain outside the scope of many of the state’s reform laws, including its minimum coverage provision. Without assistance from the federal government, one state’s desire to create workable health care reform would be held captive to the decisions made by out-of-state individuals and surrounding states.

The Brief of Blue Cross and Blue Shield of Massachusetts described the the individual mandate as an integral part of Massachusetts health reform, essential to the nearly universal health insurance coverage gained for the Commonwealth’s 6.5 million residents. Looking at Massachusetts as a model, Congress therefore acted rationally in determining that the individual mandate provision is a necessary and proper regulation of health care market activities.

The brief of Commonwealth of Massachusetts concluded that through effective efforts to stop healthy people from opting out of purchasing health insurance, the Massachusetts reforms increased health plan enrollment and helped decrease the rate of premium growth, prompting a significant reduction in governmental and private free-care expenditures. Based on the Massachusetts experience, Congress acted rationally in drawing the same link to justify its regulation of activity affecting interstate commerce.

While these briefs highlight different aspects of the Massachusetts experience in defending the ACA, a common theme runs throughout the briefs: as a leader in health reform, the Massachusetts experience serves as a model for how health reform can work successfully on a national level.
-Alyssa Vangelli