While other state legislatures have struggled with decisions about whether to accept a federal expansion of Medicaid and how to set up exchanges for the purchasing of health care, Massachusetts lawmakers have largely sat back and watched.

Much of the heavy lifting to implement the national Affordable Care Act (ACA) by 2014 had already been done as part of the 2006 reform law in Massachusetts that served as a model for President Obama's federal reform. Until now.

Gov. Deval Patrick last Friday quietly placed before the Legislature a 21-page bill designed to bring Massachusetts into compliance with new federal regulations under the ACA that will further expand subsidized health coverage in Massachusetts and require major changes in the health insurance industry that some business groups say will drive the premium costs for small businesses in direct conflict with state efforts to get costs under control.

The House on Monday referred the governor's legislation to the Ways and Means Committee for review.

"This legislation will allow Massachusetts to realize the full benefits of the Affordable Care Act, including expanded federal funding to support coverage for low and middle-income families and federal insurance reforms that will secure additional protections for Massachusetts residents," Patrick wrote in his filing letter to the House and Senate.

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