Mass. ready for potential ACA repeal, Baker says
If the Affordable Care Act is repealed, Gov. Charlie Baker said his administration would push for authority for Massachusetts to strike out on its own and provide access to health coverage in a manner similar to the 2006 Massachusetts law that was a model for the ACA.
Gov. Charlie Baker said Wednesday his administration will be ready to deal with the consequences of a repeal of the Affordable Care Act, though his $40.5 billion budget plan for fiscal 2018 presumes that the federal health care landscape will remain unchanged.
Though the prospects of an ACA repeal appear bright -- President Donald Trump ran on the promise of repealing it quickly and Republicans control both branches of Congress -- very little is known about exactly how Trump and Congress will dismantle the federal health insurance law or what type of system would take its place.
If the ACA is repealed, Baker said his administration would push for authority for Massachusetts to strike out on its own and provide access to health coverage in a manner similar to the 2006 Massachusetts law that was a model for the ACA.
"If the game changes at the federal level, then obviously we'll have lots of adjustments we'll have to make to deal with that. And we'll be prepared to deal with that," Baker said Wednesday. "But on some level, if the feds were to give us the authority to go back to doing something similar to the way we did it once upon a time ... that would be something we would seriously consider."
The idea of dramatic changes to the federal law has not been met with great enthusiasm in Massachusetts, where federal aid for Medicaid expansion and subsidies for the Health Connector are expected to total $29 billion over the next five years.
Noah Berger, president of the Massachusetts Budget and Policy Center, said Wednesday that an ACA repeal or a federal change to turn Medicaid into a block grant program "would be really serious blows to the state budget."
In a letter to U.S. House Majority Leader Kevin McCarthy this month, Baker defended some provisions of the ACA, urged Congress to uphold its funding commitment and broached the idea of allowing states more flexibility to implement health care access laws that would work best for them.
Because such little is known about the fate of the ACA or what, if anything, takes its place, the governor built his fiscal 2018 budget -- which he had to file by Wednesday -- based on the current system.
"I wasn't all that comfortable just waiting," he said. "I don't know how long whatever the process is associated with the statutory process around the ACA is going to take and we felt we needed to make some policy recommendations on this one sooner rather than later."
Eileen McAnneny, president of the Massachusetts Taxpayers Foundation, said the uncertainty around the ACA left the administration without many good options as it prepared its budget.
"It's tough, and I think that the health care landscape is very tumultuous and no one really knows, right, we don't have a crystal ball, and so you have to go forward under the law as it is today and try to work as best you can," she said. "I don't envy the administration for that, because it is a particularly trying time in health care."
A series of reforms in his budget, including spending growth controls and an assessment on employers with 11 or more workers who do not offer health insurance, Baker said, "should be able to protect our health care system and give us the ability to move back to a system that more adequately reflects what we were doing before the ACA was implemented."
As a candidate for governor in 2014, Baker focused steady criticism on the state's implementation of the federal ACA and repeatedly said Massachusetts should push for a full waiver from the ACA, noting success under the state's 2006 health care access law.
But Baker acknowledged that the flexibility he is seeking could only happen with a legislative change at the federal level.
"What they would need to do is make a statutory change ... if they were to write it exactly the way we would want it would be something that says, 'There are a number of people who are covered in your commonwealth or in your state. Submit a plan to us that demonstrates how you think they should be covered, how you would propose to pay for it and what you think the role of employers, the state and the federal government should be,'" Baker said.
And if Congress were to make such a change, Baker said his administration would "probably propose something that would look a lot like what we were doing before the ACA took some of these elements away."
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