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After House Approves GOP Health Care Bill, Mass. Health Leaders Express Grave Concerns03:14Download

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President Donald Trump, accompanied by GOP House members, speaks after the House pushed through a health care bill, in the Rose Garden of the White House on Thursday in Washington. (Evan Vucci/AP)MoreCloseclosemore
President Donald Trump, accompanied by GOP House members, speaks after the House pushed through a health care bill, in the Rose Garden of the White House on Thursday in Washington. (Evan Vucci/AP)

Statements from Massachusetts health care leaders denouncing the House GOP's health care bill began pouring in minutes after it narrowly passed, 217-213.

The Massachusetts Hospital Association said "members are distressed."

The state's largest health care union, 1199SEIU, called the vote "reckless."

And the Massachusetts Medical Society denounced the "grievous harm this bill would inflict on our patients."

Residents May Lose Coverage

Photographer Craig Bailey learned of the narrow win for the American Health Care Act (AHCA) in a call from an exasperated friend.

"We hoped against hope that this vote would not go the way that it did," Bailey said.

That’s because the AHCA would phase out enhanced funding for the current Medicaid expansion, which is how Bailey gets health coverage. He’s one of the half million Massachusetts residents whom advocates have estimated would become uninsured if the bill becomes law.

The Congressional Budget Office (CBO) has not said how many Americans would lose coverage under this version of the AHCA, but the CBO predicted 24 million Americans would lose or drop coverage if the draft released in March were to become law.

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A study out of Harvard and MIT offers reasons to wonder if the number of uninsured would be even higher than the CBO estimate. It finds that very few low-income residents choose to buy health insurance or can. So if subsidies and other assistance shrink or become more difficult to obtain, as proposed in the AHCA, then most residents who previously qualified would go without.

"Low-income individuals would tend to almost completely drop coverage if they’re not receiving very large subsidies like those that Massachusetts was offering before the Affordable Care Act and are now being offered under the Affordable Care Act," said Mark Shepard, a Harvard Kennedy School assistant professor of public policy.

Mass. May Lose Federal Funds

When the uninsured seek care, clinics and hospitals will see their uncompensated care rates rise — that's if they have the capacity to offer care.

Jim Hunt, president and CEO of the Massachusetts League of Community Health Centers, says his members will lose $78 million on Oct. 1 if a grant that’s part of Obamacare is not renewed.

If that happens, "we’d be able to see 58,000 less patients than we see today," Hunt said. "So this is really a serious situation that’s complicated by the vote in the House today."

There is no firm tally of federal funds Massachusetts would lose if Obamacare goes away, but Gov. Charlie Baker says it would be at least $1 billion a year to start.

"I remain deeply concerned that this particular bill — and admittedly, there are still facts to be learned about it — would be a very difficult pill for the commonwealth to swallow," Baker said.

No one in the Baker administration or the Legislature has laid out a post-Obamacare plan to the public. Hypothetically, a $1-to-2-billion shortfall could mean cutting benefits for Massachusetts residents on Medicaid, making people wait to enroll or changing eligibility rules. Arizona is considering a five-year lifetime cap.

In Massachusetts, Baker and a coalition of more than 70 organizations say they are committed to maintaining strong insurance coverage.

"I don’t think it’s going to be easy," acknowledged Audrey Shelto, president of the Blue Cross Blue Shield Foundation of Massachusetts and a coalition co-leader. "I don’t know if it’s feasible to close the entire gap at that level, but I definitely believe that there’s a commitment to try to do so."

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Some Trump supporters say part of the point of repealing and replacing the ACA is to shrink government spending on health care. Patrick Walsh, who campaigned for Trump in Massachusetts, argues the AHCA is an improvement because it would give Americans more affordable care and more health plan choices.

"They can get less insurance if they want less insurance, they don’t have this mandate that they have to have coverage, and they’re not penalized for not obtaining it," Walsh said. "So I think it’s a better plan."

The battle over whether to repeal and replace Obamacare is hardly over.

"We are of the school — don’t mourn, organize," shouted Rob Restuccia, executive director of the health care advocacy group Community Catalyst, during a hastily organized rally in Boston shortly after the House vote. "The fight continues, and we’re going to the Senate."

There, supporters of Obamacare vow to blanket members with calls, emails, tweets and face-to-face encounters in their districts. Some senators have said they'll craft their own bill, which might make reaching a compromise with the House on final language difficult.

This segment aired on May 5, 2017.

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

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