Brown treads a fine line in push to alter health law

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By Matt Viser
Globe Staff / November 19, 2010

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WASHINGTON — Senator Scott Brown teamed up with a Democrat yesterday to file legislation allowing states to more quickly opt out of certain portions of President Obama’s health care plan — the Massachusetts Republican’s latest move to alter the controversial measure.

The move illustrates Brown’s attempt to work with Democrats to make targeted changes to the overhaul, even while top Republicans stirred by Tea Party fervor are largely focused only on repealing the entire law.

“We’re just going through it, trying to make it better. Trying to fix the problems,’’ Brown said in a brief interview. Asked about the contrast between his effort and that of many GOP colleagues who want to repeal the law, he said, “You should probably talk to them on that. Nice try.’’

Brown, who ran his election in part on opposition to the federal health care legislation, said he remains opposed to the overall law and would still like to repeal it — even as he attempts to change it.

Brown finds himself in a delicate position as he attempts to alter a national health care law that was modeled on one he supported in his home state — and as GOP leaders plan to repeal it next year.

Christen Varley, president of the Greater Boston Tea Party, said that “it’s a little discouraging’’ that Brown is not putting greater emphasis on repealing the law altogether, but she recognizes he is attempting to win reelection in 2012.

“His efforts to mitigate damage until we can just get rid of [the health care law] wholesale will be appreciated,’’ she said. “It was known all along that he doesn’t have the same limited-government beliefs that members of Tea Party have. But is he the best we can do in Massachusetts? Yeah, probably.’’

Separately, Brown earlier this week sponsored legislation — along with eight Democrats — that would eliminate a section of the law known as the 1099 provision, which many small businesses consider an overly onerous reporting rule.

In September, he filed a bill that would fix an inadvertent mistake in the law that will cost Children’s Hospital Boston up to $3 million a year.

The bill Brown filed yesterday with Senator Ron Wyden, a Democrat from Oregon, addresses a provision that allows states to obtain waivers that would exempt them from some of the requirements of the law, including the individual mandate and health care exchanges. In order to do so, states would have to prove that their insurance plan is at least as competitive and affordable and covers as many residents as the federal plan would.

Under the current law, states would be able to apply for those waivers starting in 2017, but the new measure would move that up to 2014, when most of the other aspects of the federal bill are implemented.

Closing that gap, proponents say, would let states begin to apply for waivers before implementing certain portions of the federal law. It also is in line with Brown’s philosophy of giving states more authority than the federal government.

“These . . . changes are good for Massachusetts,’’ Brown said yesterday in a speech on the Senate floor. “They are good for other states who are trying to innovate and advance in the areas of health care reform, cost containment, and coverage.

“We should be encouraging state innovation, not hampering it,’’ Brown said, adding that the bill is supported by the Massachusetts Hospital Association.

The effect could be to allow states to go further than the current law. In Vermont, for example, it could lead to a single-payer health care system.

“I hope and expect that the state of Vermont will be the first state in the country to move forward on a Medicare for all, single-payer system,’’ Senator Bernie Sanders, an independent from Vermont who supports the change, said in an interview.

But Senator John F. Kerry, a Massachusetts Democrat, opposes the effort — and says the Bay State won’t need any waivers.

“The new health reform law includes billions of dollars in federal assistance for Massachusetts and strong protections for our health care system,’’ Kerry said in a statement. “It is in our best interest to reconcile the new law with existing state requirements and implement it on time. I have every confidence that Governor [Deval] Patrick and the state Legislature will do this with success and without the need for a waiver.’’

Patrick administration officials said Massachusetts had no plans to seek federal waivers. JudyAnn Bigby, the secretary of health and human services, praised the health care law in a statement and said the state was “taking steps to implement it as enacted.’’

The White House said it was willing to look at changes to the law and would examine the proposal filed by Brown and Wyden.

While Brown aides insist the senator’s goal is to kill the health care law, so far he has not joined several efforts to repeal it. He was not among the 22 Republicans who signed onto repeal legislation in March that was sponsored by Senator Jim DeMint, of South Carolina.

For now, analysts said, Brown’s approach is a pragmatic one.

“To say that ‘Because we want to win the argument about repealing this law, we want to leave the worst part in — including mistakes,’ is ridiculous and counterproductive,’’ said Michael Chernew, a professor of health care policy at Harvard Medical School. “Sincere opponents of the bill shouldn’t want to win that way. They should want to win on a serious discussion on the merits of the essence of the bill.’’

Several weeks ago, Brown introduced legislation that attempts to correct a mistake that was added to the bill in the final frenetic days before passage. Staff working on the bill meant to allow children’s hospitals continued access to a drug discount program that sells them 347 medicines for rare conditions at below-market rates. Instead, the final language in the law inadvertently cut off access to that program.

The change hurts 25 hospitals across the country, including Children’s Hospital Boston.

“We got no sense of, ‘I’m doing this as a step to repeal health care reform,’ ’’ said Joshua Greenberg, vice president of government relations at Children’s Hospital Boston. “It was, ‘How can I help you?’ ’’

Some outside observers praised Brown filing legislation to address health care, while others said he was in a politically dicey spot ahead of a 2012 reelection campaign in which he will be one of the most vulnerable Senate Republicans.

“You’ve got to feel bad for the guy,’’ said Varley, of the Greater Boston Tea Party. “Every time he does something he’s getting hit from one end. The left is looking to nail him on anything that looks like anything but moderate; and then you’ve got our people out there who are tied up in knots of emotion who say, ‘He was supposed to save the world for us.’ Poor Scott. I do feel bad for him. He’s one of the most challenged politicians in the country right now.’’

Matt Viser can be reached at