BOSTON — Massachusetts must prepare for the possibility that Congress could wipe away the Affordable Care Act and leave the issue of health insurance legislation to the states, a central tenet of President-elect Donald Trump’s platform.
That was the message Tuesday, Nov. 29, from Robert Blendon, a Harvard health policy professor and director of the Harvard Opinion Research Program, as well as former state Democratic Party chairman Philip Johnston and Trump-backing Republican Rep. Geoff Diehl.
The three agreed that while Trump ran on the promise of a “full repeal” of the ACA, very little is known about exactly how Trump will dismantle the federal health insurance law or whether his administration would propose or support a replacement.
“I think that Massachusetts is likely to be protected” because of the health care law the state passed in 2006, Johnston said during a panel discussion hosted by the Massachusetts Health Policy Forum before adding, “If there’s one thing we know about Trump it’s that he believes in revenge and Charlie Baker was not a Trump supporter and … this is not a state that’s Trump-friendly. … I would be a little bit nervous about Massachusetts.”
Johnston served as state secretary of health and human services from 1984 to 1991 and in 1992 was appointed by President Bill Clinton to serve as New England administrator for the U.S. Department of Health and Human Services.
Trump defeated Democrat Hillary Clinton in the Nov. 8 election and on Tuesday announced House Budget Committee Chairman Rep. Tom Price of Georgia — a vocal proponent of repealing the ACA in its entirety — as his pick for secretary of health and human services.
“I actually do believe something is going to happen here out of this momentum,” Blendon said, noting that Republicans will control the White House and both branches of Congress for at least the first two years of Trump’s term. “It is very important for this state to basically have a series of public and private commission and committees looking at how the state would adapt to what will be some changes.
“The big mistake would be because you’re in a state that has the history with this to believe that nothing could happen here.”
Massachusetts implemented a health care access expansion law in 2006 when Gov. Mitt Romney signed what came to be known as RomneyCare. The law, which made health insurance mandatory, was used as a model for the federal ACA, which was passed into law in 2010. The state’s expansive health care programs rely greatly on federal funding, which could be in play if Congress reopens health care for debate, as expected.
Diehl, who was the first elected Republican in Massachusetts to endorse Trump, said he expects the incoming president to make changes to federal health insurance policies but not to an extent that would cause serious trouble for individual states.
“My gut feeling on Donald Trump is he is a fairly pragmatic politician for a non-politician. I think what he plans to do is not leave states high and dry on health care, but rather try to integrate some of the plans the legislature has wanted to make for a long time,” he said. “I don’t think we’re going to see a disaster as Phil’s predicting, but it’s certainly going to be an adjustment.”
In a position paper posted to his campaign website, Trump said the ACA has “raised the economic uncertainty of every single person residing in this country,” and “is certain to collapse of its own weight.”
“On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” the paper states, before listing a series of possible reforms including Medicaid block grants to states, health savings accounts and price transparency requirements for providers.
Johnston paraphrased Trump’s proposals as: “They’re going to move these programs to the states and they’re going to slash the funding. And so millions of people — the lowest income people in the country and the most disabled people in the country — are going to get screwed.”
Diehl said the discussion and debate should not revolve around whether the ACA should be dismantled, but rather how the country and states transition from the ACA to whatever comes next.
“I think one of the scary things is the word repeal. I think if you realize that the legislature is not going to just create a vacuum for 25 million people that depend on government-provided health care — this is the real trick — I don’t know how you transition from one to the other,” he said. “It’s certainly going to be the trick everybody’s talking about for the next month or two.”
No matter how the administration approaches the issue, Diehl predicted any healthcare plan developed in Congress will be done with the input of Democrats.
“I don’t think it’s going to be a reverse of eight years ago,” when the ACA passed without support from a single Republican, Diehl said. “I think that they know that if they want a healthcare plan that stands the test of time, they’re going to have to have buy-in from Democrats.”
— Antonio Caban contributed to this report