In Massachusetts, one of the pioneering states for healthcare reform, concerns are rising among advocates and healthcare professionals regarding the Trump administration’s attempts to dismantle a widely-favored program that offers healthcare coverage and essential medication to hundreds of thousands. On Thursday, the House approved a vast tax and spending cuts bill that threatens to strip health insurance from about a quarter of the state’s 400,000 people enrolled through the Massachusetts Health Connector, as per state estimates.
The legislative measure, a key component of President Donald Trump’s agenda, is anticipated to create new insurance coverage gaps. Massachusetts was the first state to mandate nearly universal health insurance in 2006 to close such gaps, according to state officials. Losing coverage could have severe impacts not only on residents’ health but also on the program’s financial integrity and citizens’ livelihoods.
“The thought of going backward on this promise is really frustrating, heartbreaking, and cruel,” stated Audrey Morse Gasteier, the executive director of Massachusetts’ health insurance marketplace.
Trump and his Republican supporters in Congress argue that these measures, which include stricter documentation for applicants and limitations on tax credits, are necessary to tackle fraud and waste. According to the Congressional Budget Office, the bill’s changes to the Affordable Care Act (ACA), alongside massive Medicaid cuts, could slash healthcare spending by about $1.1 trillion over the next decade.
Lawrence, a city on the Merrimack River with a predominantly Latino population, is already observing a decline in people accessing the healthcare system. Kesia Moreta, who manages a program that assists with healthcare enrollment, explains that many are fearful of enrolling due to the administration’s hardline approach to immigration controls.
Moreta recalls a father who, driven by fear of deportation despite having a U.S. citizen son with epilepsy, stopped interacting with health agencies altogether. Once his son’s medication ran out, he finally asked in a hushed voice if remaining enrolled would lead to his deportation. “That breaks our hearts,” Moreta said.
Massachusetts boasts over 98% insured residents, the lowest uninsured rate nationwide, as per the Massachusetts Health Insurance Survey. However, the recent bill, according to Vicky Pulos from the Mass Law Reform Institute, seems to be a covert method of dismantling the ACA’s achievements.
Pulos points out that the changes may significantly increase the number of uninsured without openly repealing the ACA, adding barriers like more documentation for income verification, which Morse Gasteier warns would cause red tape and delays. The administration insists these measures would halt immigrants from misappropriating taxpayer-funded benefits. However, states do not offer illegal immigrants federally funded health insurance. In Massachusetts, state tax income is used to fund basic healthcare services for vulnerable groups, including children.
Presently, roughly 60,000 noncitizens legally residing in the U.S. might lose federal premium tax credits on their health plans. This group includes survivors of domestic violence, refugees, and those on humanitarian parole, among others. Losing such credits would raise premiums to unmanageable levels for many, Morse Gasteier explains. Many others, predominantly U.S. citizens, might find the process of re-enrollment too arduous under new stipulations.
Morse Gasteier reflects on the marketplace’s rigorous efforts to enroll vulnerable populations since the state initiative—dubbed “Romneycare”—was introduced under former Governor Mitt Romney. She fears that if the perception prevails that help is vanishing, entire communities might abandon health insurance efforts altogether. This scenario could economically impact the state and its healthcare system dynamics.
With Lawrence’s advocacy groups underscoring the toll particularly on patients with chronic ailments, skepticism is growing over the longer-term economic ramifications. Vilma Martinez-Dominguez, CEO of the Greater Lawrence Community Action Council, mentions the stark reality that health deteriorations limit individuals’ work abilities and, consequently, their financial security.
Moreta also recounts stories of individuals in desperate situations, such as a man whose insurance unexpectedly lapsed and who opted to leave an emergency room rather than seek help amid fear and uncertainty. Without action, such stories are feared to become more common, painting a grim picture of the potential fallout.