Clipboard: With health law mostly upheld, what next?

Now that the Supreme Court has upheld most of the Affordable Care Act, modeled largely after the 2006 state health law, Massachusetts could be in the spotlight once again as it struggles to control rising health care costs.

Globe reporters Tracy Jan and Liz Kowalczyk explain the need for cost control and the challenges in meeting that goal:

Like the Massachusetts law, the federal Affordable Care Act uses Medicaid expansion and subsidies for private insurance to cover the uninsured.

“Both will rapidly become unaffordable if health care costs grow as rapidly as they have in the past decade,’’ said Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer. “When you require people to buy insurance there’s almost a related promise you have to make that the coverage will be affordable. If not, then support for the law will fade.’’

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The court’s ruling significantly changed one aspect of the law: It said the federal government could not take away existing Medicaid funding if states refused to expand the Medicaid program as outlined in the law, leaving states free to opt-out. Republican governors in Florida, Wisconsin, and Louisiana have already said they will not expand the program to cover more low-income people.

Florida Governor Rick Scott also said that he will not create a health insurance exchange, as required by the law. Tia Mitchell of the Tampa Bay Times reports on Scott’s comments on Fox news Friday:

Scott’s spokesman said Saturday that if there are other aspects of the law that Florida is obligated to do, the state will comply. But the governor’s hope is that Republican Mitt Romney defeats President Barack Obama and makes good on his promise to roll back the health care reforms.

“Hopefully we won’t have to worry about it because by November we’re going to have a new president-elect who is going to repeal it,’’ Scott press secretary Lane Wright said.

The battle over the law is likely to intensify in the political arena. On Sunday, House Speaker John Boehner pledged to repeal the law, a Reuters report explains:

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“This has to be ripped out by its roots,’’ House of Representatives Speaker John Boehner, the top Republican in Congress, said of the 2010 law on the CBS program “Face the Nation.’’ Boehner added: “We will not flinch from our resolve to make sure this law is repealed in its entirety.’’

The House, controlled by Republicans, has scheduled a vote on July 11 to repeal the law. The Democratic-led Senate, as it has done in the past, is certain to block any repeal legislation.

House Minority Leader Nancy Pelosi responded to the call for repeal on Meet the Press, Meghashyam Mali of The Hill reports:

“They’ll bring it up, and when they bring it up they will ask for repeal, repeal of all the things I said that help children, help young adults, help seniors, help men or women who may have prostate cancer, breast cancer, whatever it is, any precondition. And everybody will have lower rates, better quality care and better access. So that’s what they want to repeal, we’re happy to have that debate,’’ she said.

Asked by Meet the Press host David Gregory if she believed “repeal is unrealistic,’’ Pelosi replied “yes.’’

Chris Cillizza, on the Washington Post’s blog The Fix, wonders about the logic of the repeal talk. Republican candidate Mitt Romney can’t afford to deviate from talking about the economy “for even a second,’’ he said. :

…It’s why he is likely to spend the vast majority of his time on the campaign trail between now and November talking not about the health care law but about the fiscal health of the country.

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In down ballot contests, it’s possible that the “repeal’’ message could have some resonance as it allows Republican candidates to aggressively link less-defined Democrats to a president who is not terribly popular in Republican leaning states.

Reporter Robert Weisman hosted a conversation with leaders in the health care industry, including the chief executive of the Massachusetts Hospital Association, Lynn Nicholas, executive director of consumer advocacy group Community Catalyst, Robert Restuccia, chief executive of Tufts Health Plan, James Roosevelt Jr., and chief executive of Mattapan Community Health Center, Azzie Young.

In case you missed Sunday’s Globe, here’s an excerpt:

GLOBE: Assuming the law is not repealed, look 10 years into the future. Will we have better, more affordable health care?

RESTUCCIA: When I think about Louisiana, Texas, Florida, it’s actually a revolution there. This is the biggest thing since the Civil Rights Act. We just do not understand the impact that it’s going to have in states like that, where you have 25 percent uninsured or close to it.

You just think about those people getting health care, what’s that going to mean? The workforce issues, think about the money that’s going into that state. I mean it’s crazy that these governors are opposing the ACA. It’s going to be an amazing experience for those people.

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