Future of MassHealth still unclear; national repeal efforts, costs of state health insurance program part of uncertainty

“We depend on those dollars, and if they were to change or disappear because of efforts to repeal ‘Obamacare,’ we’d have to figure out how maintain the high percentage of insured people we have," said state Rep. Stephen Kulik

Somewhere between the federal government’s intensifying efforts to remove the Affordable Care Act and the state budget proposal to be unveiled Wednesday could be clues to what the future holds for the future of Massachusetts’ first-in-the-nation state health insurance program.

The future, though, remains unclear, say legislators who look to deal with costs of the landmark 2006 health program that has resulted in 97.2 percent of Massachusetts residents having health insurance.

As part of the Fiscal 2018 budget, Gov. Charlie Baker plans to call for a $2,000 assessment on businesses per full-time worker if they fail to offer their employees health insurance as part of a plan to blunt the impact of escalating, enrollment-driven costs in the state’s Medicaid program, according to the State House News Service.

It would also impose growth caps on the rates health providers can charge for medical services as a way of controlling the cost of care in the commercial market and making it more affordable for employers.

But apart from Baker’s plan, which would affect businesses with more than 10 full-time workers, a bigger piece of the future of how the landmark Massachusetts health care program fares could be how the President Donald Trump administration treats a $53 billion, five-year federal Medicaid waiver agreement Baker negotiated Nov. 4 with the Obama administration to help pay for the MassHealth program that now serves 1.9 million residents, about one-third of the population.

“Our health care system in Massachusetts is really dependent on a Medicaid waiver, which allows us to spend Medicaid dollars in Massachusetts by expanding Medicaid to cover a broader cross-section of people, and spend it differently, so we’re not just paying for people’s emergency room visits, we’re paying for wellness care,” said state Rep. Stephen Kulik, D-Worthington. “We depend on those dollars, and if they were to change or disappear because of efforts to repeal ‘Obamacare,’ we’d have to figure out how maintain the high percentage of insured people we have and maintain access to health care.”

With so many moving parts, including an executive order signed by President Trump on his first day in office Friday to scale back aspects of ACA and Senate’s pending approval of Rep. Tom Price of Georgia as Health and Human Services secretary, said Kulik, “We don’t yet know what they’re gonna do. It seems to change every day, and it seems Trump is not even in sync with what some Republicans in Congress want to do.”

Kulik, the Ways and Means vice-chair and a formerly a member of the study commission that created the original Massachusetts health care reform legislation, said he’s received calls from constituents concerned about the effects of federal action.

“At this point, anything could happen,” he said. “I think the more they dig into this, the more difficult they’re gonna find it is to walk back Obamacare ... If they do repeal the Affordable Care Act and don’t replace it with something right away, I think Massachusetts is very likely to try to rebuild the system we had before, a state-only version signed under Gov. (Mitt) Romney … I feel it would be a major priority for us in Massachusetts.”

Depending on what the president and Congress do, he added, “We could have to be dealing with this very soon.”

Baker’s plan, which also call for price caps by health care providers, come as the state grapples with how to control growth in health care costs in the public and private markets and as enrollment in MassHealth has reached an all-time high. putting unsustainable pressure on state finances.

Kulik said he believes Baker’s plan is an attempt to deal with changes he anticipates coming down at the federal level.

“We’ve been struggling,” said Senate President Stanley Rosenberg of Amherst, about Medicaid costs. “It’s 42 percent of the budget and takes up a very substantial portion of the annual revenue growth.”

Rosenberg said the federal agreement with Massachusetts, due to take effect July 1, “could be changed, reduced, eliminated — we don’t know. It’s hard to believe it would be completely eliminated, but any significant change wd have a material impact on our state budget and our state Medicaid program. We’re very concerned. They types of changes they’re talking about appear to me would likely hurt Massachusetts, and are worrying.”

Massachusetts, Rosenberg said, “had a plan that was working. The national plan was based on the Massachusetts plan, but it took out some key features, which we later had to remove from our plan, and that made our plan less workable. The key for us if you repeal it and don’t replace with something that makes sense, it could blow up state plans all around the country.”

The effect would have “a ripple effect” on hospitals and other health-care providers, said Rosenberg. “The Massachusetts plan was built, in part, on an expansion of Medicaid, bringing more of the working care into Medicaid. What people lost track of is that Medicaid used to be for poor and disabled people who were not working, but Medicaid now is MassHealth, hundreds of thousands of people who go to work every day but don’t make enough to be able to afford insurance, or whose employers don’t provide insurance that’s affordable, who then go onto the state plan.”

Meanwhile, Rep. Jeff Sanchez, D-Boston, who co-chairs the state Joint Committee on Health Care Financing, said, “In health care, everything is connected in one way or another. What we’re all waiting to see is how any changes affect the way people access benefits, the types of benefits, and regulations. We’re listening intently about what folks are talking about in Washington, and we’re working to hit the ground running once they figure out where they’re going. Right now, everything is nebulous.”

He noted that one Republican proposal being floated would replace Medicaid with federal block grants, which he said, “have been controversial for a long time … The question is, how would anything affect that Medicaid waiver directly? I don’t know the how (federal) agencies are going to interpret that executive order, which authorizes agencies to grant waivers, exemptions and delays of ACA provisions. I don’t know how they’re going to implement that. I’m hoping for a pleasant surprise. We’ll see.”


(Material from State House News Service was included in this article.)

You can reach Richie Davis at: rdavis@recorder.com 
or 413-772-0261, ext. 269