Donald Trump’s upset win all but guarantees that big changes are ahead for health care in America. But Massachusetts’ groundbreaking reforms of a decade ago will probably shield the state from too much upheaval.
Trump has vowed to repeal President Obama’s Affordable Care Act, also known as Obamacare, a position backed by the congressional Republicans who retained control of the House and Senate. But the state was ahead of the game, pushing through its own overhaul in 2006 that helped reduce the share of residents without health insurance to about 3 or 4 percent.
“We are probably better insulated from any state in the country to federal changes — not completely insulated, but better insulated — partly because our reforms predated the Affordable Care Act, and partly because there is a political consensus in the state that our reforms are working well,” said Andrew Dreyfus, chief executive of the state’s largest health insurer, Blue Cross Blue Shield of Massachusetts.
Trump has railed against Obamacare, calling it a “disaster” in the final weeks of the campaign after the government disclosed that premiums for a key group of health plans available under the law would soar by an average of 25 percent. Most health plan premiums in Massachusetts, where the insurance market is more stable, are rising at slower clips.
But Trump has offered few specifics about how he would replace the law, which extended health insurance coverage to 20 million more Americans, prevented insurance companies from denying coverage to people with pre-existing conditions, allowed young adults to stay on their parents’ health plans until age 26, and pushed doctors and hospitals to adopt new payment systems.
“If they’re serious about this ‘repeal and replace,’ there is still going to be a lot of chaos when it comes to health policy [nationally]” said Lora Pellegrini, president of the Massachusetts Association of Health Plans.
Stephen Rosenfeld, interim director of the advocacy group Health Care For All, said repealing the national health care law would be disastrous for the country and could result in cutbacks to health coverage in Massachusetts. But, he said, “We were there first… We have in place a state law that can’t be repealed by the Trump administration.”
The Massachusetts health care law, like the federal law, expanded Medicaid coverage to more low-income residents and established an exchange where residents can buy commercial health plans, many of them receiving subsidies to help offset the costs.
Dr. Howard Grant, chief executive of Burlington-based Lahey Health, also said he hopes Trump and Republican House and Senate leaders will find a solution that doesn’t kick millions of people off health insurance rolls.
“There’s some powerful things that happened with the Affordable Care Act that hopefully reasonable people will recognize and try to preserve,” Grant said. “It would be unconscionable for us to do anything that would result in large numbers of people losing coverage.”
It’s unclear whether a possible repeal of the national health care law will affect the state’s so-called Medicaid waiver — an agreement with federal officials to fund health coverage for poor and low-income residents. Governor Charlie Baker’s administration wrapped up a deal with the Obama administration last week that provides $29.2 billion in federal dollars over five years to help Massachusetts fund Medicaid, known here as MassHealth.
“If [the Affordable Care Act] is repealed or dramatically changed, it could affect our waiver,” said Lynn Nicholas, president of the Massachusetts Health and Hospital Association. “Between Medicare and Medicaid, we have a lot of federal dollars at stake.”
Another question is whether the Trump administration would continue to push the health care industry to replace the traditional fee-for-service system of paying for care with new business models that reward doctors and hospitals for keeping patients healthy and out of hospitals. The Affordable Care Act established a new federal innovation center to push such changes in Medicare, the government program that insures seniors.
Nicholas said health systems are likely to continue adopting alternative payments, sometimes called accountable care, regardless of the election results.
Blue Cross’ Dreyfus, who has participated in health policy meetings with Republican and Democratic leaders in Washington, said there appears to be some bipartisan support for changing the way health care is paid for. “There’s a lot of agreement around the need for affordability, and value-based payments is one way to do that,” he said.
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