The incoming Trump administration is stirring uncertainty about the way forward for well being care funding for Massachusetts’ most susceptible residents.
Whereas well being care prices and entry weren’t a serious focus of this yr’s presidential race, as they had been throughout earlier marketing campaign cycles, President-elect Donald Trump has indicated a willingness to shake up federal companies and slash spending to make authorities extra environment friendly.
Trump’s deliberate nomination of Robert F. Kennedy Jr., who has made false statements about vaccines and promoted different baseless views, to guide the Division of Well being and Human Providers alarmed many public well being consultants. And with Republicans in command of the White Home and each branches of Congress, there might be vital impacts on well being care funding for the nation’s most susceptible people and households.
On Tuesday, Trump introduced that tv character Dr. Mehmet Oz can be his choose to supervise Medicaid and Medicare.
Gov. Maura Healey stated she is bracing for disruptions throughout the subsequent administration, together with potential cuts to the well being care {dollars} states obtain.
“All states depend on federal funding, so I hope they don’t try this,” Healey instructed reporters not too long ago. “I hope they don’t take that away, since you’re placing lives in danger — not simply in Massachusetts, however across the nation.”
A significant chunk of federal funding for states helps Medicaid, the medical health insurance program for folks with low or no incomes, and folks with disabilities.
Medicaid is run collectively by the federal authorities and states, and protection advantages can fluctuate throughout state traces. In Massachusetts, the Medicaid program, referred to as MassHealth, insures about 2 million residents, greater than a 3rd of them kids.
The taxpayer-funded program prices Massachusetts about $20 billion a yr, with about half of these {dollars} coming from the federal authorities and half from the state.
Massachusetts and different states have sought to make use of Medicaid funding to supply housing and meals help geared toward stopping folks from getting sick, stated Donald Berwick, a former administrator of Medicare and Medicaid underneath President Obama. “That isn’t the philosophy of the Republicans,” he stated.
Throughout Trump’s earlier time in workplace, his administration accredited limiting Medicaid eligibility for folks in some states — for instance, by including work necessities. Republicans additionally tried, unsuccessfully, to cap Medicaid funding.
Larry Levitt, government vice chairman for well being coverage at KFF, a nationwide nonprofit well being analysis group, stated “the inescapable math is that Medicaid cuts are completely on the desk” to fund different features of Trump’s agenda.
“If there may be strain to chop spending to finance tax cuts,” Levitt stated throughout a current name with reporters, “Medicaid could have a giant goal on its again.”
Ought to Massachusetts see a decline in federal Medicaid funding, state officers must discover different sources of income, or take vital steps to chop prices.
Underneath former Gov. Charlie Baker, the state negotiated a five-year funding deal with federal officers, referred to as a waiver, which supplies cash for hospitals to cut back racial and ethnic disparities in well being care. This consists of gathering extra knowledge about well being outcomes for various teams of residents, and bettering lodging for individuals who converse languages aside from English.
Earlier this yr, the Healey administration obtained federal approval to develop Medicaid protection for people who find themselves homeless or incarcerated.
Massachusetts’ funding deal expires on the finish of 2027, which suggests state officers should negotiate a brand new settlement with the Trump administration. (The final two waivers had been accredited underneath Presidents Biden and Obama).
“Medicaid waivers are very wonky,” Levitt stated, “however they’re an space the place an administration could make its imprint on well being care with out Congress.”
It’s unclear whether or not the Trump administration will again Massachusetts’ targets for bettering well being care, together with for Black, Hispanic and Indigenous residents. Trump has typically touted states’ rights — however he and his allies even have derided packages that promote range, fairness and inclusion.
“That’s definitely one thing that might be underneath risk in a Trump administration,” stated Amy Rosenthal, government director of the Boston-based shopper advocacy group Well being Care For All. “We’re going to must buckle down and proceed to advocate for why we have to proceed the profitable packages that we’ve had right here in Massachusetts.”
In the case of well being care entry, Massachusetts constantly ranks among the many high states within the nation. Over 98% of Massachusetts residents have some type of medical health insurance protection — Medicaid, Medicare or non-public plans they purchase from insurance coverage corporations — far above the nationwide common.
One distinction from Trump’s earlier election win: repeal of the Reasonably priced Care Act now not appears to be a high precedence. Republicans tried, and narrowly failed, to repeal it throughout Trump’s final time period. Well being coverage analysts say the regulation’s provisions, together with state marketplaces the place people should buy discounted insurance coverage, at the moment are extra fashionable and extra ingrained into the U.S. well being care system, making a full repeal much less seemingly.
Nevertheless, billions of {dollars} in subsidies that assist offset the price of medical health insurance premiums are set to run out subsequent yr, except the Republican-led Congress takes motion to increase them. With out Congressional motion, many People will likely be hit with greater prices. This consists of about 300,000 folks in Massachusetts, who may face premium will increase of greater than $1,700 per particular person per yr, in keeping with the Massachusetts Well being Connector.
For now, state well being officers are taking a wait-and-see method as Trump prepares to take workplace. They don’t know if well being coverage will likely be an early focus; many political analysts anticipate Trump’s administration to focus, not less than at first, on marketing campaign guarantees associated to mass deportations of immigrants and tax cuts.
Mike Levine, assistant secretary of the Massachusetts Medicaid program, stated in a press release that his workplace will “use each instrument out there” to serve its members, “like we have now in each prior federal transition.”
In the course of the earlier Trump administration, dozens of Massachusetts hospitals, well being facilities and well being care trade teams fashioned a coalition to guard the state’s excessive price of medical health insurance protection. The group was dormant throughout the Biden administration, however after this month’s presidential election, it was revived.
“It’ll be a tricky time within the subsequent few years with regards to well being care,” stated Rosenthal, of Well being Care For All. “We have to be sure that we’re doing every part we will to guard what we’re so happy with right here in Massachusetts.”
