Leading Massachusetts federal, state, and local officials were rallying support this weekend against efforts to repeal Obamacare and replace it with a bill that Republican leadership hopes will pass the U.S. House of Representatives this week.
The American Health Care Act, as the Republican plan is titled, may not garner a single vote from the Massachusetts delegation, or any Democrat in Congress, but there are those in the Bay State that support it.
“The bill is a decent first step to address some of the issues in healthcare, but much more will be needed over the long-run,” wrote Joshua Archambault, a health care analyst at Boston’s Pioneer Institute, in an email to the New Boston Post over the weekend. “Most encouraging is the attempt to put Medicaid on a budget for the first time.”
MassHealth, the state’s version of Medicaid, now covers nearly 2 million people, according to state records released earlier this year. Obamacare allowed states to expand Medicaid to anyone making less than 138 percent of poverty level, and Massachusetts was one of 31 states that did so. The state currently is spending more than 40 percent of its budget on MassHealth.
Supporters of Obamacare say it has dramatically increased access to health care for people who don’t have much money. Opponents point to rising costs and the erosion of the free market in health care.
Controlling Medicaid spending is a major goal of House Speaker Paul Ryan and his Republican allies in Congress.
“Hopefully these efforts, along with additional state flexibility, will allow for a sustainable program to emerge that prioritizes the care of the truly needy,” Archambault added. “However, the bill that is likely to emerge from the Senate will look different, and it is important to remember that we should expect to see numerous other pieces of legislation that are healthcare-related in the next year as well. The AHCA is step one of a multi-step journey.”
The Ryan health care bill’s current version allows states to continue much of Obamacare’s Medicaid expansion through 2020 before the Obamacare expansion is shut off, which some Republicans say will cause states that have held off expansion to expand it rapidly before the cutoff date. One such state facing that question if the Ryan bill is passed is Texas, which has the highest per capita rate of uninsured in the nation.
“It’s going to be a huge rush — an inducement to drag in as many people as they can drag in, because the more they can drag in, the more federal dollars they can get,” Dr. Deane Waldman, of the right-leaning Texas Public Policy Foundation told NPR. That news outlet added that there are things Waldman likes in the bill. But, in general, he told NPR listeners, “It’s bad deal for Texas. It’s a bad deal for the American people.”
Despite conservative opposition, Speaker Ryan is planning to have to have the U.S. House vote on the bill this week.
“I think Thursday is most likely the day to bring it forward,” Ryan told Fox News on Sunday. “We are still having conversations with our members. We are making fine-tuning improvements to the bill to reflect people’s concerns, to reflect people’s improvements.”
Ryan was confident about having the 218 votes needed to pass the bill in the House while appearing on Fox, saying, “I feel very good about it, actually.”
Massachusetts Governor Charlie Baker, a Republican, is concerned that Ryan’s bill would deprive Massachusetts of $1.5 billion in federal funds for health care over the next five years. He sent a letter to the state’s members of Congress (all Democrats) making that point, with explicitly opposing the bill.
But some Massachusetts conservatives are encouraged that the new American Health Care Act would states more freedom to address health care as they see fit.
“Obamacare has proven to be disastrous to the public and for Massachusetts,” wrote Paul Craney of the Massachusetts Fiscal Alliance in response to questions from the New Boston Post. “Massachusetts had our own program before ACA that worked well. So many of the empty promises from the previous administration, including if you liked your doctor, you could keep your doctor, proved to be untrue. Whatever the next plan may be, it has to be well thought out and if need be, give states like Massachusetts the freedom to do what is best for Massachusetts.”
Federal cuts in Medicaid may actually force Massachusetts political leaders to make needed changes, said the Pioneer Institute’s Archambault:
“Massachusetts needs to fix many things in healthcare regardless of what happens at the federal level. However the repeal bill may force some of those local conversations as there will be a financial impact of the federal legislation, especially on the Medicaid program. The untold [story] of the Massachusetts reform in 2006 was that it was largely funded by federal taxpayers, so any changes at the federal level on financing will have an impact here. The question is if Massachusetts leaders can be creative enough to cut out waste, and deliver high-quality care at a better value, more often.”
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Key Obamacare Repeals & Replacements under the proposed American Health Care Act:
Repeal the requirement to have health insurance or pay a tax penalty and replace it with a 30% premium surcharge for one year when buying health coverage if a customer allowed health insurance coverage to lapse for more than 63 days.
Repeal income-based assisted health plans and replace them with refundable, age-based tax credits between $2,000 a year for those under 30 and up to $4,000 a year for those over 60. Under Obamacare insurers could charge senior citizens three times more than the young; under the new American Health Care Act insurers can charge five times more.
Repeal expansion of Medicaid to those who make less than 138% of the federal poverty level, which 31 states did; repeal would be delayed until 2020. Individuals who qualified under this Obamacare Medicaid expansion can continue to sign up until December 31, 2019, and can remain on Medicaid until they no longer qualify. Also, the American Health Care Act would make changes to how states are reimbursed for Medicaid recipients, and several other key Medicaid changes are included in the bill, such as allowing states to tinker with eligibility. An amendment proposal passed in committee last week allows states to institute work requirements to recipients.
Key Items the American Health Care Act Would Not Change
The American Health Care Act does not repeal the requirement that insurers cover preexisting conditions and continue to allow renewability of policies
Children can stay on their parents’ plan up to age 26
The bill caps out-of-pocket expenses and includes prohibitions on lifetime or annual limits
The bill keeps provisions stating that insurers cannot discriminate.
Andrew C. Nelson is a former reporter for several newspapers in Massachusetts.
U.S. House Speaker Paul Ryan 
