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AHCA Defeat Spells Relief For Massachusetts, Groups Say

A Friday afternoon tweet from AARP Massachusetts is simple:

AARP was one of dozens of groups that urged members to call their congressional representatives and urge them to vote no on the American Health Care Act (AHCA). The intense lobbying effort may be one reason House Speaker Paul Ryan could not muster the 216 votes needed and pulled his bill — leaving the Affordable Care Act (ACA) in place "for the foreseeable future."

Hannah Frigand, associate director of the helpline at Massachusetts' Health Care For All, was on the phone helping someone with a health insurance problem, when she heard the news.

“I heard people shouting ‘It’s been pulled!’ It was so exciting,” said Frigand, who’s been calling voters in other states, urging them to lobby against the AHCA.

Doctors, nurses and accountants in hospitals across the state celebrated the demise of the AHCA.

"Without question this bill would have been harmful to our patients, including the most vulnerable, and to our members' ability to provide them quality care," said Dr. James Gessner, president of the Massachusetts Medical Society, in a statement.

The Massachusetts Hospital Association echoed Gessner's sentiment, "but we remain greatly concerned with the continuing efforts to dismantle the ACA," said CEO Lynn Nicholas.

Some of President Trump's supporters expect him to continue efforts to repeal and replace the ACA. In remarks after Ryan pulled his bill, Trump said he expects Obamacare to explode this year with higher premiums and deductibles.

Lou Murray, a Trump delegate from Quincy, said the president is just warming up.

"I’m excited. I think today was a great victory for Donald Trump as far as learning how to work with Congress," Murray said.

Trump spoke to reporters after learning that the House would not vote on the AHCA and said he expects to produce a great bill in the not too distant future. “Recrafting this bill, he may actually get a few Democrats to come over and work with him on the next go-around,” Murray said.

Groups that fought the AHCA say they know this may only be a temporary reprieve, but relief spread on Beacon Hill among Democrats and Republicans Friday. Gov. Charlie Baker warned just a few days earlier that the AHCA would cost Massachusetts $1 billion in 2020 and nearly $2 billion by 2022.

“Massachusetts has worked very hard on a bipartisan basis to get to what most people would call near universal coverage for people here in the commonwealth, and if we lose a billion dollars it gets a lot harder for us to do that, in fact it gets dramatically harder,” Baker said after a warehouse opening in Fall River.

The governor called the defeat of the AHCA "good news." But Obamacare, which remains the law of the land, includes rules and restrictions that are costing the state of Massachusetts a lot of money. A rule that is getting a lot of attention says anyone who qualifies can apply for Medicaid, even if they have access to health insurance through an employer. Baker says approximately half a million Massachusetts residents have moved from private coverage to Medicaid since the ACA became law. The governor is negotiating with employers, seeking money to compensate the state and he's asking the Trump administration for help.

In a letter this week, Baker's Secretary of Health and Human Services Secretary Marylou Sudders asked for a waiver from federal employer mandate rules and the flexibility to create "an alternative policy for employers to share responsibility in the costs of health care coverage."

In addition, Sudders wants:

  • The authority to negotiate with drug companies and limit the range of pharmaceuticals Medicaid must cover. Right now, says Sudders, the state must offer all drugs approved by the FDA
  • The option of adding small co-pays for more services used by residents who qualify for the Medicaid expansion that's part of the ACA
  • To relax some restrictions on substance use and mental health treatment that are part of the federal Medicaid program.

In all, Sudders is seeking dozens of changes that would help the state save more than a billion dollars a year.

"The ACA was a comprehensive, complicated piece of legislation and that kind of legislation needs to be tweaked and revised over time," Sudders said. "We have been clear that there have been some unintended consequences that have had a negative impact on Massachusetts."

Sudders' request comes in response to a letter and calls from Trump officials who've asked states to spell out changes they'd like to make to Medicaid, in particular. She's asked for "swift federal intervention," which could mean changes that take place in 2018.

Related:

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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