BOSTON (AP) — The next chapter in the national health care debate has yet to be written, but Republican Gov. Charlie Baker is already laying the groundwork for returning Massachusetts to key elements of the state’s 2006 universal health care law, which provided a blueprint for the Affordable Care Act.
Baker has taken steps in recent weeks including asking the Legislature to reinstate a version of the employer contribution that was part of the original state law, and urging congressional leaders in Washington to keep some provisions of the federal law, while offering states more flexibility to achieve their own health care goals.
The law signed by then-Republican Gov. Mitt Romney expanded the state’s Medicaid program, known as MassHealth; created publicly subsidized insurance coverage sold through the Massachusetts Health Connector; and imposed tax penalties on individuals who could afford to buy insurance but didn’t.
In the decade since, Massachusetts has boasted the highest rate of insured residents in the nation.
With President Donald Trump and the Republican-led Congress intent on repealing and replacing the federal law, analysts contend that falling back on “Romneycare” won’t be as easy as it may sound, even though much of the state law remains intact.
“I think there are financial issues and logistical issues,” said Jonathan Gruber, an MIT economist who served on the connector board and was a consultant to the Obama administration on the ACA. “It’s not as simple as snapping our fingers and saying, ‘Let’s go back to Romneycare.”
If the federal government pulls back on Medicaid funding, the state could be forced to use its own financial resources to maintain current standards of coverage, further straining an already tight state budget. Gruber said it’s far too early to know the potential cost but speculated it could run into the hundreds of millions.
Baker drew the ire of some business groups by proposing that businesses with more than 10 employees that do not offer a health insurance benefit pay a $2,000-per-worker penalty. The 2006 law imposed a more modest $295-per-worker contribution and was repealed in 2013 in anticipation of a federal employer contribution that has yet to be implemented.
The employer mandate is seen as helping address another issue vexing state budget planners: The increasing number of people both working are receiving Medicaid benefits from the state.
Under the Massachusetts health care law, workers offered health insurance coverage through their employer were ineligible for Medicaid.
“Federal law took away the firewall between employee-based coverage and MassHealth, and we have 300,000 to 400,000 people who have enrolled in MassHealth who are working, most of them full time, and many of them with access to coverage through their employers,” Baker said while announcing his state budget proposal last month.
He also sought to limit the growth of some rates charged by health care providers and impose a moratorium on new coverage mandates for Medicaid.
In his Jan. 11 letter to U.S. House Majority Leader Kevin McCarthy, a California Republican, Baker made a number of recommendations to congressional leaders weighing repeal and replacement, including providing states with “flexibility to meet the unique needs of their state’s population,” but without shifting cost burdens to states.
The governor warned against proposals for replacing the current federal Medicaid reimbursement system with lump sum payments to states, which he suggested could sharply reduce federal funding to Massachusetts.
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