Cost control called key in healthcare rollout

On the day President Barack Obama signed a bill that will ensure insurance coverage to tens of millions of Americans, the head of a key Dorchester health center warned that cost control efforts must be ramped up as the legislation takes effect.

“Overall, the fact is the people who are going to be entitled to health insurance and get services are the working poor of the U.S.,” said Bill Walczak, founder and CEO of the Codman Square Health Center. “They’re the people that wash the dishes, clean the floors. If nothing else, this bill is about social justice for working people. This is a victory for them.”

The federal bill carries a price tag of $940 billion and health centers nationwide are going to see an $11 billion increase in funding. “Health centers will be able to expand,” Walczak said. “There will be more of them across the country.”

Dorchester’s two representatives in the U.S. House, who share the area, were split on the bill in Sunday’s voting. Congressman Michael Capuano (D-Somerville) voted “yes,” while Congressman Stephen Lynch (D-South Boston) voted against the original bill then said “yes” to a “reconciliation” bill that contains fixes to the first bill. The House voted 219-212 to send the legislation to the president’s desk.

Capuano, who briefly weighed a vote against the main bill, told supporters that the legislation keeps safe about $4 billion for Massachusetts, prohibits insurance companies from denying coverage based on pre-existing conditions, and creates health insurance exchanges for people to purchase affordable coverage.

Lynch told the Associated Press the “reconciliation” bill was an improvement over the original bill, which he argued did not do enough to reform the health insurance system.

Lynch’s “no” vote, the only one against the main bill in the Massachusetts delegation, earned him howling criticism from liberals, who angrily said they would seek to yank him out of office in the November elections. Needham activist Harmony Wu, who worked on the Obama campaign, is weighing a run. Independent candidate Phil Dunkelbarger, who challenged Lynch as a Democratic anti-war candidate in 2006, is also a potential challenger.

Lynch, who is widely expected to be re-elected, is also being challenged from the right: combat photojournalist Keith Lepor is running as a Republican.

State Rep. Marty Walsh said the federal bill was “in some regards pro-consumer,” but he joined Walczak in saying that cost containment was still left on the table and noted that the “ultimate reform has to rein in costs.” Both pointed to the Massachusetts plan, which the federal plan is partly based on, as an example. “Every year it takes more and more out of the budget,” said Walsh, who voted for the state health care reform effort in 2006.

Walsh said he sometimes has doubts about whether he made the right choice. He said there was a “good chance” he could have voted the same way as Lynch, but added, “It’s hard to say.”

Republicans were quick to criticize the new law. Jennifer Nassour, the chair of the state Republican Party, said that Massachusetts would end up subsidizing other states’ costs. “Our small business community, which is already substantially weakened by a harmful sales tax increase, will be burdened with new taxes and regulations,” she said in a statement.

U.S. Sen. Scott Brown, who was in the state Legislature when the 2006 state law was passed, said the state law is different from the federal health reform law. “The bill that we passed did not raise taxes, it did not cut, it did not do a lot of what the federal bill is doing, with the backroom deals, the lack of transparency, the arm-twisting,” he said during a radio appearance on WRKO.

A number of discrepancies exist between the state and federal versions of health care reform. Both federal and state policies require individuals to purchase health insurance, but federal penalties for those who fail to obtain coverage will begin in 2014 at $94 a year and grow to 2.5 percent of annual income or $695 by 2016, while state penalties can reach $1,116 a year for residents who fail to purchase insurance.

Bay State businesses employing 11 or more workers are required to insure 25 percent of their full-time workforce and pay a third of their premiums. If they don’t meet the threshold they must pay a $295 a year fine per employee. But under the federal law, only businesses with 50 or more employees would be subject to fines, which amount to $2,000 per employee while exempting the first 30 employees.

Walsh said the federal changes make for a more a better bill.
The Massachusetts Medical Society offered qualified support. Its president, Mario Motta, said in a statement, “Even though the bill is far from perfect, our country is much better off with the legislation than without it. Thanks to this legislation, 32 million more people will have health insurance, insurance company abuses will forever be prohibited, the deficit will be significantly reduced, primary care will receive extensive financial support, and our state’s bold universal coverage program will not only be supported, but enhanced. We thank our congressional delegation for its tireless work in this regard.”

Material from State House News Service was used in this report.