Obamacare repeal could upend Mass. health insurance market | Crain's Boston

Obamacare repeal could upend Mass. health insurance market

President Barack Obama meets with healthcare stakeholders in the Roosevelt Room at the White House. | Photo by Pete Souza for the White House

As a Republican-backed health care bill makes its way through various House committees toward a full vote in Congress, the law still faces fierce opposition from Democrats, some Republicans and healthcare professionals, including many in Massachusetts.

The American Health Care Act—which must still clear one more House committee before a full vote—would replace the Affordable Care Act, the 2010 healthcare overhaul widely known as Obamacare. While some Republicans have labeled it “Obamacare lite,” Democrats and prominent medical groups including the AARP, the American Medical Association, and the American Hospital Association have said the bill will lead to a decline in health insurance, especially for poor Americans.

In a letter to the U.S. House of Representatives, Rick Pollack, CEO of the American Hospital Association, whose 4,500 member hospitals include Massachusetts General Hospital and Brigham and Women's Hospital, said he “cannot support The American Health Care Act in its current form.”

"It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care," Pollack wrote.

Massachusetts could be among the most affected states if Republicans succeed in repealing Obamacare. According to a study by the company WalletHub, Massachusetts could see more growth in its uninsured rate than any other state over the next three years if Obamacare is repealed.

Jill Gonzalez, an analyst for WalletHub said an all-out ACA repeal would nearly quadruple the number of uninsured residents in Massachusetts. The replacement under consideration in Congress would have less dire results, she said, but "the state would lose hundreds of millions of dollars in both business output and gross state product due to fewer tax credits and Medicaid changes post-2020."

Under the proposed replacement plan, she estimated losses of $935,000,000 in business output and $550,000,000 in gross state product by 2023.

Massachusetts’ own health care system, enacted in 2006 under then-Governor Mitt Romney, served as the template for much of Obamacare, from its provision that everyone carry health insurance or pay a tax—the so-called individual mandate—to its expansion of Medicaid. According to the Blue Cross Blue Shield of Massachusetts Foundation’s 2011 five-year progress report on the Massachusetts reform, the state’s uninsured rate fell to less than 2 percent while the average rate nationwide rose to more than 16 percent.

Jonathan Gruber, a professor of economics at MIT and one of the architects of the Affordable Care Act, spoke on WBUR’s Radio Boston this week, saying he thinks Massachusetts residents could see a drop in coverage if the new plan passes.

"The problem is that if you take away the individual mandate, you don't just offer a choice to a healthy person, you raise the price paid by a sick person,” said Gruber. “Remember, we ran this experiment in Massachusetts. If you try to end insurance discrimination without the individual mandate, you cause the healthy to exit the market and the sick pay exorbitant prices. So it's not just about individual freedom. It's about making the insurance market work for the healthy and the sick."

Julie Gonzalez, a home healthcare worker from Boston’s Mattapan neighborhood, said she’s worried that repealing Obamacare could jeopardize her health insurance and her job, if her patients can no longer afford their own healthcare. Many of the people she works with are covered by MassHealth, the state’s Medicaid program for nearly 2 million mostly low-income residents. About 500,000 direct care workers—home care workers, personal care aides, and nursing assistants—gained health insurance coverage under Obamacare from 2010 to 2014, according to a report by the Paraprofessional Healthcare Institute.

“I live paycheck to paycheck and I can’t afford to pay for health care without insurance,” Gonzalez said. “I think it’s foolish for someone to try to fix something that’s working.”

March 9, 2017 - 1:37pm