Our Opinion: ACA's departure would hit hard in Massachusetts

Posted Friday, March 10, 2017 6:06 pm

Massachusetts' health care plan was in many ways a model for the Affordable Care Act (Obamacare) so the state has a particularly keen interest in Republicans "repeal and replace" effort and its impact on state residents. We're fortunate to have Romneycare as a bulwark against the gutting of Obamacare, but if the GOP plan becomes law the state's health care system could suffer a body blow.

The state's health care plan is not without flaws and failings but it has nearly met its fundamental goal of providing health insurance to every resident of the state. The same can be said of Obamacare, although its percentage of insured has not reached the high level achieved by the state. Businesses in Massachusetts and the U.S. have complained that both plans burden them with red tape and complex regulations that Republicans aim to reduce. The strength of both plans is that they had clear, readily definable goals of providing health insurance to all. A flaw of the Republican plan is that its goal is not entirely the formation of a health care plan.

First District U.S. Representative Richard Neal, a Springfield Democrat who serves as the ranking member of the House Ways and Means Committee, hit upon what he refers to as the bill's "identity crisis" when he asked if the bill was a health care bill or a tax cut bill (Eagle, March 9.) The cost savings from the Republican legislation are designed to carve out room for tax cuts which has been acknowledged by proponents. Americans don't know if those savings are real because the Congressional Budget Office has not had time to analyze the plan.

Massachusetts, thanks to its pioneering health care reform law of 10 years ago, will have measures in place to help the low-income residents who could be hurt by the Republican plan, a claim that most other states cannot make. Those state programs, however, are not invulnerable.

Massachusetts has a subsidy program to assist low-income residents to buy insurance but it is designed to supplement the federal tax credits provided under Obamacare. Those credits would largely disappear under the GOP plan which, unlike the ACA, is based on age not income. Similarly, an end to an expansion of Medicaid eligibility by 2020 would deprive Massachusetts of funding needed to assure that those most in need will have health insurance. Massachusetts has a requirement that everyone have health insurance or pay a penalty, which is critical to providing a broad pool that includes healthy residents who don't tax the system as much as those with health problems. The Republican bill dumps this necessary provision and it is unclear how that would impact the Massachusetts individual mandate.

Those without health insurance will, of course, still seek treatment when they are ill. They will likely end up in hospital emergency rooms where care is expensive, and without insurance, the cost of their treatment will be absorbed by the hospitals, a costly burden for community hospitals like Berkshire Medical Center and Fairview.

The Republican plan does include some of the key components of the ACA, such as enabling young people to stay on their parents' health care plans until they are 26 and the prohibition against insurance companies rejecting patients with pre-existing situations. As the bill goes through Washington, we hope these worthy provisions remain and some of the best elements of the Massachusetts plan are included. The state offers 10 years of valuable experience to draw upon.