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Dismantling Massachusetts’ Health Care Legacy

Originally appeared on Medium.

“Quality care will truly be available and affordable for each and every man, woman and child in our state.” These were the words of Senator Edward M. Kennedy, my former colleague in the U.S. Congress, at the signing ceremony for Massachusetts’ landmark health care legislation in 2006.

Eleven years ago, Massachusetts led the way. State leaders joined together in a bipartisan manner to do what no other state was able to accomplish: universal health coverage for its residents. It would serve as a model for President Obama’s Affordable Care Act in 2010, which I was proud to support.

Today, much of that good work is on the verge of being dismantled. While the Trump Administration is working to quietly gut the Affordable Care Act through executive orders and agency rulemaking politicians in Washington have spent months very loudly debating the merits of the Affordable Care Act, Massachusetts Bay State leaders have quietly taken an equally dramatic step that could move thousands of Massachusetts’ most vulnerable populations off of MassHealth, the Commonwealth’s Medicaid program, and into more costly plans that offer weaker coverage.

The Massachusetts government recently submitted a waiver request (known as a 1115 waiver) to the U.S. Centers for Medicare & Medicaid Services (CMS) to make substantial changes for current MassHealth recipients, cutting health care benefits for so many who need it most.

If CMS approves the Commonwealth’s waiver request, which it could do as early as this month, coverage will be weakened for non-disabled adults with incomes over 100% of the Federal Poverty Level (FPL), which is currently just $12,060 for individuals and $24,600 for a family of four. Under the proposal, approximately 140,000 enrollees would no longer be eligible for MassHealth Medicaid and would generally be moved to private health insurance. The proposal would shift more than 200,000 additional residents from MassHealth Standard into a less comprehensive MassHealth plan.

The intricacies of health care coverage are complex, but here are just a few simple ways access to health care and quality of coverage could be eroded for Massachusetts Medicaid enrollees if CMS approves the 1115 waiver request:

  • Denying access to vital and innovative prescription medicines: The proposed waiver would close the drug formulary under MassHealth, restricting every MassHealth recipient’s access to as few as one drug per therapeutic class. A closed formulary restricts a doctor’s ability to prescribe patients medicines he or she thinks may work best and could lead to more costly treatment over the long-term, such as emergency department visits, hospitalizations and added procedures.
  • Eliminating transportation benefits: Non-disabled adults under 100% FPL would be moved into a plan that would eliminate coverage for non-emergency medical transportation. This would impact patients who rely on transportation benefits to get to-and-from medical appointments, dialysis, cancer treatments and other vital health care services.
  • Higher out-of-pocket costs: Patients moved from MassHealth into private plans may be subject to out-of-pocket costs up to $1,250 annually for an individual and $2,500 for a family — more than double for some of the patients in the plan. It could also dramatically increase prescription drug and doctor visit co-pays. Massachusetts is proposing to lower cost sharing for these plans, but this requires approval by the state Board of Directors.

While the intention is to lower MassHealth’s burden on the Commonwealth’s budget, the waiver could have quite the opposite effect, as more limited services would undoubtedly yield an increase in negative health incidents.

Quite simply, this is not only bad public policy for Massachusetts’ most vulnerable residents, but also for the Commonwealth’s bottom line. It remains to be seen how the Massachusetts Senate’s recently released healthcare reform bill will impact the state of healthcare in the Commonwealth.

Before I joined Congress, I practiced family medicine for more than two decades. While in Congress, I chaired the Health Braintrust of the Congressional Black Caucus for 16 years. From my own experience, I know that prior to MassHealth and then the Affordable Care Act, millions of Americans suffered the health and economic consequences of a health care system that was severely broken. Senator Kennedy declared that Massachusetts “fired the shot heard around the world on health care in America.” Let’s hope this time Massachusetts does not create the wrong kind of roadmap for others to follow.


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