The federal Affordable Care Act, for all its strengths, is a heavily compromised law, and as it continues to roll out this year and next its weaknesses will become apparent. That will require adjustment, not dismantling, as argued by ideologues. This is particularly the case in Massachusetts, even though the state's health reform law was to a large extent the model for what became known as Obamacare.

Under Obamacare, companies with 50 or more full-time workers could be penalized $2,000 per employee beyond 30 employees if they don't offer health insurance. That is far too punitive and could even encourage layoffs. While Massachusetts calls for penalties for companies employing 11 or more full-time employees who are not provided with insurance coverage, the fine is a more reasonable $250 per employee, which encourages compliance without unduly punishing companies.

Obamacare requires insurers to establish rates once a year, as opposed to Massachusetts where the requirement is four times a year. While this is more work for state insurance companies they don't have to look as far into the future. Required to forecast a year ahead, insurers are likely to err on the side of caution, which means higher insurance premiums. Massachusetts should be granted a waiver because its format is better for health consumers.


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Obamacare does have many strong provisions, such as the elimination of copayments for annual physicals and other preventive care measures. The problem is that insurers are likely to respond by raising premiums. Preventive care measures should be encouraged, not penalized, as they will reduce health care costs all the way down the line.

Complexities aside, the state and nation are better off with these laws. When it comes to the inevitable fixes, however, the state's law has for the most part earned the edge over its federal counterpart and should take precedence.