In Massachusetts, we've watched the nation's health care debate — four years long and counting — from a singular perch: We've been living with a version of the Affordable Care Act since 2006.
We've had strong opinions about Obamacare, pro and con, but the wild fears and exaggerations we hear from other parts of the country don't ring true. Politicians and pundits in other states wring their hands about the destruction of the American health care system, but here it's not all that big a deal. Most of us — those who get their insurance through their employer or a government program — are still dealing with the same insurance companies and the same doctors as before the adoption of what our former governor's GOP primary opponents dubbed "Romneycare."
Conservatives have raged for years against the slavery of the individual mandate. Republican governors in other states are making heroic efforts to keep their low-income constituents from getting a better deal on health insurance. Here in Massachusetts, we've seen friends and relatives go online to the Health Connector exchange and find insurance, often subsidized, that was a real comfort to them.
Opponents of the Affordable Care Act predict employers will drop their coverage and convert their workers to part-time to avoid having to ensure them. But in Massachusetts, more people are covered through employer policies and more employers offer insurance than before the law took effect.
It would still be much much cheaper for them to pay the state penalty than to provide health insurance, but it turns out Bay State business owners aren't as heartless as conservatives seem to assume. Most of them want to see their workers have health benefits. One example: Cumberland Farms, a Framingham-based convenience store chain, just announced that in response to the ACA it will convert part-time workers to full-time, extending health benefits to 1,500 additional employees.
Physicians like Romneycare — the state officials I talked with this week prefer to call it "Chapter 58" — because doctors want their patients to be able to afford the treatments they prescribe. People like it too. Polls consistently find majorities like the new system, and one place you never hear calls for repeal is in the Massachusetts Legislature.
So here comes Obamacare, to Massachusetts as well as 49 other states. Will the big bad federal program mess up the successful state one?
Not according to top state health officials. They say Obamacare will make Romneycare better.
For starters, more people will be eligible for Medicaid, and more will be eligible for larger subsidies for policies bought through the state insurance exchange.
There's a new, improved website coming to make comparison shopping for insurance easier. Thanks to information technology made possible through federal grants, the system will be able to identify other safety net programs insurance applicants may be eligible for.
The state employer mandate, which required insurance be offered by all companies with more than 11 employees, has been dropped. The federal mandate, which only applies to companies with more than 50 employees, now takes effect in January 2015. Officials don't expect anyone to drop their coverage, and dropping the state mandate relieves them of some paperwork.
Then there are the ACA benefits already kicking in: Coverage on family plans for children up to age 26, elimination of co-pays for preventive care, and the closing of the Medicare prescription drug "donut hole," which is saving Massachusetts seniors an average of $667.
Plus there's a big bonus for the state budget, since costs that have been borne by the state will now be reimbursed by the feds. That's going to plow an extra $400 million into state coffers in 2014, and more than that in the years that follow. Some of that savings will be used for long-overdue increases in reimbursements to physicians and hospitals serving Medicaid patients.
And the skyrocketing premiums the anti-Obamacare lobby keeps warning us about? Not happening. In state after state, insurers are offering policies through the new exchanges at prices sharply lower than under the old system.
The newest rates for Massachusetts increased less than 2 percent for individuals and small companies purchasing through the exchange. There's one point of contention, an Obamacare rule that prevents insurers from taking a few "ratings factors" into consideration when setting premiums, including the industry the business is in. That will end up raising some premiums for companies with fewer health claims, but just as many other companies will see their premiums go down. A fitness center may end up paying more; a construction company considerably less.
Health care's far from perfect here in Massachusetts. Costs are still too high, though the days of double-digit premium increases appear to be over. But 97 percent of Bay State residents have health insurance, and that's a good thing, right?
Not in the minds of the Obamaphobes in other states, apparently. Some of them are now promoting a boycott of the new state health insurance exchanges, figuring there's no better way to protest a president you don't like than to risk medical bankruptcy and your children's health by going without insurance.
From our perch in Massachusetts, those people look pretty crazy.