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Insurers to stay with key benefits of US health law

By Chelsea Conaboy
Globe Staff / June 18, 2012
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The largest insurers in Massachusetts have pledged to extend two popular provisions of the Affordable Care Act even if the US Supreme Court decides to overturn the federal health law in a ruling expected before the end of the month.

Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan said in statements to the Globe that they would continue to allow young adults to remain on their parents’ insurance plans up to age 26, even though state law requires people in that age group to be covered by their parents’ plans only for two years after they lose tax status as dependents, typically by age 24 or so for a child who attends college.

The insurers also said they would cover a broad array of preventive services with no copayments, as outlined by the federal law. Among them are certain immunizations and screening for diabetes, depression, and colorectal and breast cancer.

“These important benefits and protections provide stability to our members and the community,’’ Blue Cross chief executive Andrew Dreyfus said in a statement.

The announcements add to the ways that Massachusetts residents will be insulated from many of the most dramatic effects if the law is partly or entirely overturned. The state had near-universal health coverage and some of the most aggressive insurance regulations in the country even before passage of the 2010 federal law.

Even if the law’s most controversial provision, the individual mandate to have insurance, is tossed aside, the state’s requirement that most people buy health coverage would remain.

But there are dozens of new or expanded programs in the state that depend on other provisions of the federal law. While some analysts in Massachusetts would welcome a decision to overturn the law, others say repeal would disrupt efforts to curb health costs and improve quality.

“When I think about trying to unwind the entire law or even major elements of it . . . I get a headache,’’ said Dr. Don Berwick, who oversaw rollout of the law in its early stages as administrator of the Centers for Medicare & Medicaid Services, a job he left in December.

The mission of the agency he ran would change, he said. Staff might “move from builders to a demolition crew.’’

To understand the effects in Massachusetts, it helps to look at the infrastructure already built here.

As of Feb. 22, by the state’s accounting, Massachusetts had received or was promised $199 million in grants from the Affordable Care Act for new or expanded programs, including $110 million to move hundreds of elderly and disabled people from institutional settings to community ones with support services. Other grants would expand support for teen mothers, address childhood obesity, and train health workers. A state spokeswoman said Friday she did not know how much money the state had in hand to date.

“If the law changes, we will adapt accordingly,’’ Dr. JudyAnn Bigby, secretary of Health and Human Services, said in an e-mail. “Regardless of the outcome, Massachusetts will not change course from our nation-leading efforts to provide affordable and accessible care.’’

The federal law requires states to create online health insurance marketplaces, often called exchanges, in which individuals and small businesses can buy health insurance plans that meet minimum coverage standards.

Massachusetts already has one, run by the Health Connector and created under the 2006 state law that served as a model for the national one.

The exchange will have to grow if the federal law stands. The state now provides full or partial subsidies to help people who make up to 300 percent of the federal poverty level afford insurance. The federal law increases that level to 400 percent, or $44,680 for an individual this year.

The state received $44.5 million from the Affordable Care Act, with plans to apply for more, to create one Web portal through which people could search for subsidized health insurance programs and enter biographical and financial information. Connector executive director Glen Shor said the data would be verified instantly with federal databases to tell people what benefits they qualify for.

“It’s the concept of a real-time, no-wrong-door shopping experience that quickly and accurately gets people to the right place for the coverage that they need,’’ Shor said.

The Affordable Care Act made the early planning for the project possible, he said. A repeal could halt further progress.

“We’d be losing a significant tool to make things better’’ if the law were overturned, Shor said. “It would be a very hard loss, and I hope it’s one we don’t have to face.’’

Community health centers have been winners under the Affordable Care Act, given the job of serving many of the newly insured.

The state’s centers have received $4.5 million for expanded operations and $77.2 million for construction projects, including new buildings at Codman Square, Lynn, and Cape Cod health centers, among others.

The federal law nearly tripled the number of clinicians serving in the National Health Services Corps, a program that rewards people who work in underserved communities with loan repayments. Many of the clinicians work in community health centers. As of mid-June, the awards for 143 of the corps’ 254 providers serving in Massachusetts were funded by the federal law, a corps spokeswoman said.

James W. Hunt Jr., president of the Massachusetts League of Community Health Centers, said he worries health centers could be more vulnerable to future federal cuts without the protection of the Affordable Care Act.

“The plans that are being laid to grow primary care access require the state-federal partnership,’’ he said.

The list of local effects of the law that could be undone by the court could go on: Primary care doctors are scheduled for a temporary bump in pay starting in 2013. Five Massachusetts hospital systems are testing a new way of paying for seniors’ care, meant to reward them for keeping people healthy and saving money. And all hospitals increasingly would be docked pay if they fail to meet certain quality standards.

Still, some in the state would welcome a decision to overturn the rule.

Josh Archambault, director of health care policy for the conservative Pioneer Institute, said repeal would offer an opportunity to rethink the approach nationally and in Massachusetts, particularly regarding how to pay for care for the poor. He favors reducing subsidies and requiring people to pay more out of pocket, giving them a bigger stake in medical decision-making.

Trade group MassMEDIC has opposed a tax created by the Affordable Care Act on the profits made by medical device makers the group represents.

“We would welcome a repeal of the medical device tax,’’ said Tom Sommer, president of the group. “If the Affordable Care Act is overturned in its entirety, then it would achieve this goal.’’

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

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