BOSTON — In the state that served as the model for Obamacare, advocates and health care workers fear the Trump administration is trying to dismantle piece-by-piece a popular program that has provided insurance, preventive care and life-saving medication to hundreds of thousands of people.
Provisions contained in both the Senate and House versions of the massive tax and spending cuts bill advancing in Congress — a centerpiece of President Donald Trump’s agenda — could strip health insurance from up to a quarter of the roughly 400,000 people enrolled in the Massachusetts Health Connector, according to state estimates.
The changes would create anew the coverage gaps state leaders were working to close when Massachusetts in 2006 became the first U.S. state to enact a law requiring nearly every resident to have health insurance, state officials say. Beyond the effect on residents’ health, losing care could have broader repercussions — both for the program’s finances and residents’ ability to make a living.
Trump and Republican supporters in Congress say the changes, which include new documentation requirements and limitations on who can apply for tax credits to help pay for insurance, are necessary to root out what they call fraud, waste and abuse. The Affordable Care Act changes proposed in both versions of the bill, along with massive cuts to Medicaid and other programs, would eliminate roughly $1.1 trillion in health care spending over the next decade, according to the nonpartisan Congressional Budget Office.
In Lawrence, a mill community of around 90,000 people on the Merrimack River, where more than 80% of the population is Hispanic or Latino, Kesia Moreta said she’s already seeing people slip out of the state’s health care network because of the Trump administration’s aggressive effort to crack down on illegal immigration.
Moreta, who manages a program created under the ACA that helps people sign up for coverage, said clients have been missing meetings out of fear that being enrolled for health insurance will harm their effort to stay in the U.S. legally.
Recently, a father of a U.S.-born teenage son with epilepsy deleted every email related to his health plan and stopped answering calls from the Connector after watching reports about deportations on social media. When his son’s medication ran out, Moreta said the father finally reached out, whispering over the phone, “Is this going to get me deported?”
“That breaks our hearts,” Moreta said.
Proposed changes
More than 98% of Massachusetts residents have health insurance, the lowest rate of uninsurance in the country, according to the Massachusetts Health Insurance Survey.
Vicky Pulos, an attorney for the Mass Law Reform Institute who helps low-income people gain access to health care, said Republicans who tried and failed to repeal the Affordable Care Act during the first Trump administration have decided to take it apart incrementally despite its growing popularity.
“It really seems like this is just a less transparent way of effectively dismantling the accomplishments of the Affordable Care Act in both Medicaid and the marketplace,” Pulos said.
The changes, she added, “will massively drive up the number of uninsured but without openly repealing the ACA.”
Another provision included in both the House and Senate bills would require people applying for or renewing coverage to provide more documentation of their income, household size and immigration status to be eligible for premium tax credits when the state marketplace already has that information, which Morse Gasteier said would cause “friction, red tape and delays.”
The Trump administration has said the proposals will “put a stop” to immigrants “stealing taxpayer-funded health care benefits meant for American citizens.”
