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Massachusetts health care — wonky, with a healthy dose of reality

Some Musings on the Defeat of the Republican Repeal-and-Replace Effort

Some Musings on the Defeat of the Republican Repeal-and-Replace Effort

March 26, 2017

As was noted in the Globe article on Saturday, there were smiles and high-fives at Health Care For All, as we joined together with our partners at Community Catalyst and Health Law Advocates to watch Speaker Ryan declare that the effort to repeal the Affordable Care Act was not going forward. 

We were going all out in the last few days, contacting voters in key districts outside Massachusetts, urging them to call their Representatives. The bill that was pulled would have been devastating to Massachusetts, likely leading to some 600,000 Bay Staters losing coverage over the next 8 years.

A few quick observations, looking back and forwards:

1. Huge thanks to all the members of the state's House Congressional delegation, who unanimously, steadfastly opposed this harmful bill. Congressman Steven Lynch spoke passionately before the vote, saying, “This bill would actually do away with Medicaid as we know it…. It takes all the opioid money that we’re using; we have a major crisis going on in this country, especially in Massachusetts.” Congressmen Richard Neal and Jim McGovern each spoke in opposition during the abortive House debate (we also loved Congressman McGovern's comment on the proposal to axe essential health benefits: “It’s so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night”). Strong statements also came from Representatives Katherine Clark, Bill Keating, and Niki Tsongas, Earlier, Representatives Mike Capuano and Seth Moulton also registered their strong opposition

Following the vote, Congressman Joe Kennedy III spoke at an impromptu celebration outside the Capitol, saying:

This fight is not over…There are still hundreds and thousands and millions of Americans out there that need access to affordable, quality care everywhere for their loved ones. Yes, we had a victory today, but this does not end when you pull a bill. This ends when every single American can wake up in the morning…knowing that our society is there for them…Because I know, uniquely in healthcare, that there will be some point in my life when I will need to draw on that very same safety net that I hope is there for you. And I hope that you are willing to make that same investment in me.

That is what this fight is about, not about actuaries and spreadsheets and numbers, but about the commitment that we make to each other that goes to the very heart of what I believe this nation great, the promise we make to our neighbors and our friends. We had an incredible day today because of the thousands of people who stood up over the past several weeks and told their members that this was a bad bill. It was going to hurt people. And today, America, we won. And tomorrow, we fight on.


Thanks also to Governor Baker and his team, who showed true leadership by letting analysis, not partisanship, guide their approach. We understand he was an effective mostly behind-the-scenes force pushing against the rush to take away MassHealth funds and care from Massachusetts.

2. Much credit goes to the public activism. While the hard-right "Freedom Caucus" grabbed most of the attention, as their demands kept getting met, more and more Republican moderates began peeling away, leading to the bill's demise. Vox dubbed this group the "Coverage Caucus," and they worried about people losing coverage because people in their districts were loudly letting them know how important the ACA was. Many were from states that expanded Medicaid. They were made acutely aware of the political risks of voting for Ryan's bill, starting in the loud town hall meeting protests earlier this year. The stunning growth of explosive grass-roots energy, guided by projects such as the Indivisible movement, and many others, made a real difference. 

3. It's far from over. The Trump administration still has many ways to sabotage the operations of the ACA, particularly for the marketplaces, like our Health Connector. Last week Politico reported on a number of already-moving actions:

The Trump administration has already begun to transform the health insurance market, wielding executive power to rewrite coverage rules, slash Obamacare’s marketing budget and signal an all-out assault on his predecessor’s health care law. And Republicans have high expectations the administration will take additional measures to unwind Obamacare, such as targeting its contraception coverage requirement at the center of two recent religious liberty cases at the Supreme Court. ...

The Trump administration also proposed new rules last month that would tighten up the health law’s special enrollment periods and change certain plans' “actuarial value” — essentially, the share of total costs that the insurer pays — which can push more costs onto patients.

We'll have much more on this in the coming days, but rest assured that Health Care For All will be aggressively continuing our work to defend the ACA in Massachusetts.

4. The Obamacare = Romneycare connection, too. Pundits are finding lots of reasons why the Trump-Ryan effort failed so spectacularly. One intriguing idea is that it was difficult for Republicans to come up with an alternative to the ACA on policy grounds, since it was based on many of their ideas, incubated here in Massachusetts. From Slate's Jim Newell:

The Affordable Care Act made the Republican Party go insane. It occupied the space of what had been the center-right vision for market-based health reform and combined it with a Medicaid expansion popular among progressives, boxing the party out from the area where consensus might be had. With that model—originally designed by a right-leaning think tank and first implemented by one of the party’s former presidential candidates—made unacceptable in order to demonize a sitting Democratic president, though, Republicans had a choice: a coherent far-right free market approach, or some amorphous blob of other. They chose an amorphous blob of other, sliced up into muddled “prongs” in accordance with Senate rules. It failed.

Also worth looking at in the same vein is this somewhat personal reflection by Republican thinker David Frum, who wrote in 2010 that the ACA, based on Massachusetts' reforms, should be embraced by conservatives, and that it would never be repealed.

5. We just can't let a great video go to waste. In anticipation of the House passage of the bill, we were gearing up for a big campaign aimed at the Senate. A few hours before the vote was scheduled, our fabulous communications co-op, Nina Rossiter, produced this amazing video, which we'll have to shelve for now. Still - we urge you to watch it, just for fun:


                                                                                                                       -- Brian Rosman