Baker to Congress: Ensure Flexibility, Stability During Obamacare Repeal, Replacement

BOSTON, MA — As Republicans on Capitol Hill and the president-elect embark on long-sought efforts to dismantle the Affordable Care Act, Massachusetts Gov. Charlie Baker sounded a cautionary note in a message offering his feedback on the process.

In his letter, addressed to House Majority Leader Kevin McCarthy, a California Republican, Baker shared the broad outlines of Massachusetts' longstanding health coverage program. He writes that, bolstered by the ACA, "we have made considerable progress toward a goal of ensuring near universal health care for our residents."

Politico Massachusetts has published Baker's letter in full. You can read it here.

The pending changes come within months of Massachusetts receiving a hefty, $52.4 billion federal waiver intended to retool the MassHealth system over the next five years. Uncertainty is, to understate, less than ideal when pursuing what Baker has called the system's "first major overhaul in 20 years."

So far, Republicans' planned demolition of the Affordable Care Act is rife with unpredictability.

Congressional leaders intend to dismantle key parts of the legislation starting as soon as this month. Senate Republicans took the first step toward gutting the legislation Thursday, following a marathon session that lasted into the wee hours of the morning.

President-elect Donald Trump, meanwhile, has called to repeal the ACA "immediately" and replace it "very quickly," a virtually impossible request given the need for Democratic buy-in to swiftly pass a new health care package. Even Republicans have not yet agreed among themselves on a suitable replacement proposal.

Trump on Wednesday additionally promised his administration will propose its own legislation that would repeal and replace the law "essentially simultaneously."

As the process moves ahead, Baker's letter lists several specific recommendations, quoted below:

• Maintaining market stability as reform options are considered.
• Reviewing and revising key provisions of the Affordable Care Act and Medicaid program to provide states with flexibility to meet the unique needs of the state's population.
• Providing ample time for transitioning into new health care coverage and/or delivery models to ensure operational readiness.
• Maintaining state health care safety nets, including retaining existing federal subsidies and uncompensated care pools that support health coverage and charity care providers.
• Avoiding proposals that only offer more flexibility and control in exchange for shifting costs to states.
• Expanding state flexibility in response to unique needs that meet the overarching goals of health care coverage, access, quality and affordability in the ACA and the Medicaid program.

Health care workers and advocates in Massachusetts gathered at the State House Thursday to protest the law's rollback.

“The Affordable Care Act plays a significant role in Massachusetts and the Commonwealth will face substantial health and economic burdens if it is repealed,” said participant and Harvard Public Health Practice Professor Dr. John E. McDonough, according to a press release. “Much is at stake, and the repercussions will be felt across the state, as Massachusetts could lose billions in federal funding, jeopardizing coverage for hundreds of thousands of residents.”

One of several key concerns, according to that release, is the federal expansion of Medicaid, which provides significant funding to Massachusetts and provides coverage for more residents than the state’s original healthcare law. Enrollment in MassHealth is surging – now covering about 300,000 Massachusetts adults – as a result of the ACA’s Medicaid provision, it states.

The protest from Massachusetts continues Sunday, with a planned rally against rolling back the ACA headlined by Massachusetts Senators Elizabeth Warren and Ed Markey, as well as other Congressional and City of Boston leaders.

Image via governor's office