Report: ACA Repeal Could Leave 422K Mass. Residents Without Health Insurance

A case that aims to repeal the Affordable Care Act is before the U.S. Supreme Court on Tuesday.

A report out Monday found losing Obamacare could leave 422,000 Massachusetts residents without health coverage.

Joining WBUR's Morning Edition with more details was Audrey Shelto, president of Blue Cross Blue Shield Foundation of Massachusetts, which funded the report.

Here are the interview highlights, lightly edited for clarity.

On Texas v. California and overthrowing the "individual mandate" overturning the ACA

So the plaintiffs are arguing that if that section is unconstitutional, then the whole law is unconstitutional — that you can't sever that one section from the rest. So they're basically saying if the individual mandate is unconstitutional, the whole law is unconstitutional.

On what that means for Massachusetts

So our estimate is that approximately 422,000 people could lose coverage if the Affordable Care Act were overturned. The majority of those individuals are people that are covered through the state's Medicaid program, Mass Health, and also through some subsidies that come through the [Massachusetts Health] Connector, the Massachusetts exchange for subsidized coverage. If that many people lost coverage, the associated federal revenues that tie to those people would also be lost to the commonwealth.

So given that the Medicaid program in every state is a combination of state and federal dollars, a huge portion and a huge number of federal dollars come to the commonwealth of Massachusetts through this program. If 422,000 people lost coverage, the state would also lose $3.3 billion per year in federal funding, so that funding is tied directly to the reduced enrollment in the Medicaid and Connector programs.

On if the state could make up lost money from the ACA

Well, technically, yes. You could [see] the state could go back and say, 'OK, we had health care reform in Massachusetts before the ACA, so let's try to go back to that.' However, that program that served as the model eventually for the national program also relied on a combination of federal and state funds. So if the state tried to make this up, go back to the 2006 programs, still we project that 69,000 people would lose coverage.

If the federal government said, 'OK, we'll go back and participate with you in that arrangement that we had back in 2006,' then state spending would need to go up by $988 million in order to retain those coverage levels.

If the federal government said, 'Sorry, you're on your own, you have to cover this yourself,' then the state would have to raise spending by $2.1 billion. So technically, the state could try to restore most of the coverage that would be lost if the Affordable Care Act were overturned. But financially, politically, it's very hard to imagine how the state could come up with that money. It would either require very difficult choices within the state budget or increasing the size of the state budget through additional revenues.

On the impact of losing the ACA during the pandemic

It looks worse for two reasons. One is that more people are covered now by Mass Health and therefore, more people are at risk of losing coverage. And more people are covered because of the pandemic and because of the economic impact of that. Also, in this more updated analysis, we were able to identify approximately 56,000 Mass Health members who are eligible for Mass Health through the ACA and therefore would also lose coverage through the overturn of the ACA.

On how the court case will play out

It's hard to project because both justices Brett Kavanaugh and Neil Gorsuch will vote on this case, and neither were on the court when previous major cases challenging the constitutionality of the ACA were presented. And I would say personally, it's hard to imagine that in the middle of a pandemic that the Supreme Court would want to throw millions of people across the country off of insurance coverage. So it's hard to imagine it happening, but in my opinion, [it's] hard to predict.