With momentum gathering behind the GOP-controlled Congress's efforts to repeal the Affordable Care Act, Gov. Charlie Baker is standing up for key patient protections in President Obama's signature health care law and urging Congress to avoid moving so fast to scrap the law that it would disrupt insurance markets.
Baker, a moderate Republican, wrote to House Majority Leader Kevin McCarthy this week outlining his thoughts for how to "improve upon the goals" of the ACA, but stopped short of endorsing a full repeal of the health care law that was modeled on the plan put in place in Massachusetts in 2006 to expand access to coverage.
The governor said giving states more flexibility to tailor their health care systems to the needs of its residents would be beneficial, but called the expansion of health coverage under the ACA and its patient protections - including a ban on insurance denials for pre-existing conditions, the elimination of annual and lifetime limits, and the promotion of gender equity - "important provisions" of the law.
The release of the letter, dated Jan. 11, comes as the U.S. Senate took its first vote in early morning hours Thursday to begin the process of repealing the controversial health care law known as Obamacare. Baker was responding to a congressional request for comment from governors.
President-elect Donald Trump has said he intends to offer a replacement for the ACA "almost simultaneously" with the confirmation of his nominee for Health and Human Services Secretary Tom Price. But while congressional Republicans and Trump have repeatedly declared their intentions to "repeal and replace" Obamacare, Massachusetts Health and Human Services Secretary Marylou Sudders suggested a slightly different approach.
"We need to review it and revise it if necessary," Sudders told the News Service, noting the federal law is "complicated."
Baker cautioned against a moving toward a system of block grants to states to fund their Medicaid programs, which has been considered as an alternative to the matching-funds system that currently reimburses Massachusetts for 50 percent of its spending to insure low-income and disabled residents.
The governor said any reform to Medicaid funding should "start with the assumption that every state's current federal share establishes the baseline."
"We are very concerned that a shift to block grants or per capita caps for Medicaid would remove flexibility from states as a result of reduced federal funding. States would most likely make decisions based mainly on fiscal reasons rather than the health care needs of vulnerable populations and the stability of the insurance market," Baker wrote.
Among the changes being sought, Baker said Congress should continue to allow states to keep an individual mandate of insurance, but also allow them to establish state-specific benefit rules and choose the rating factors that apply to small-group premium development. He also recommended the elimination of ACA premium taxes and permission for insurance products to be offered through group purchasing cooperatives or professional employer organizations.
The News Service earlier on Thursday reported on how a surge in enrollment in MassHealth driven by an expansion in coverage under the ACA over the past decade has put increasing financial pressure on the state.
According to Baker administration health officials, the number of full-time employees not covered by employer-sponsored insurance grew by 15 percent, or 118,000 workers, between 2011 and 2015 from 740,000 to 859,000.
During that time, the number of full-time workers not offered coverage through their employer grew by 38,000, while 80,000 more workers declined their employer-sponsored coverage in favor of MassHealth, costing the state $511.5 million in the fourth quarter of 2015.
The governor expressed concerns about how the ACA has allowed workers that meet certain income thresholds to decline insurance from their employer in favor of publicly subsidized coverage.
"The significant shift in lives from private to public coverage as a result of implementing the ACA - without a change in the uninsurance rate - has disrupted the stability of the Commonwealth's coverage landscape and contributed to challenges in the growth of the Medicaid program," Baker wrote.
Health care workers, consumers and advocates rallied Thursday morning at the State House to draw attention to what they see as the risks Massachusetts faces if Congress "repeals or guts" funding for the ACA, and called staving off repeal a "winnable battle."
Health Care For All Interim executive director Stephen Rosenfeld said 180,000 Massachusetts residents are insured "only because of subsidies and tax credits" available under the federal health care law, and another 300,000 people have benefited from Medicaid expansion.
"That's almost 500,000 people whose coverage is being threatened by this spectacle we're viewing in Washington," he said.
Rosenfeld also said he was "very proud to see that kind of a strong letter from our governor."
He drew applause from the gathered crowd when he read a line from the letter citing Massachusetts' "unwavering commitment to universal coverage."
"It's a very strong letter and we should be very, very grateful to Governor Baker for standing up so strongly for Chapter 58 and the ACA and our people," Rosenfeld said.
Speakers at the State House rally pointed to the slim majority Republicans hold in the 100-member U.S. Senate, saying that three of the 52 Republicans could block a repeal effort by refusing to support it unless a clear and sufficient replacement were offered.
"We must not give in to cynicism or pessimism," said John McDonough, a professor of public health practice at the Harvard T.H. Chan school of Public Health. "We should understand this is a winnable battle if we stand up together."
A former state representative, McDonough said people in Massachusetts should not assume that state law and a health insurance coverage rate of 97 percent will prevent them from feeling effects of changes at the federal level.
"We cannot be complacent," he said. "We should not assume that because we passed reform in 2006, Massachusetts is somehow immune to what is going on in Washington, D.C. We need to understand that the threat absolutely is aimed right at the heart of Massachusetts health reform."