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With Supreme Court to hear ACA case, 422,000 Massachusetts residents could lose coverage

‘The timing couldn’t be worse,' says president of the BCBSMA Foundation

The Supreme Court building on Capitol Hill in Washington. The court will hear arguments on the constitutionality of the Affordable Care Act, starting on Tuesday.Anna Moneymaker/NYT

The percentage of people without health insurance would soar and Massachusetts would lose billions in critical federal funding if the US Supreme Court overturns the Affordable Care Act, a new report warns.

The latest legal challenge to the decade-old law known as Obamacare goes before the court Tuesday. A new analysis from the Blue Cross Blue Shield of Massachusetts Foundation estimates that 422,000 Massachusetts residents would lose their coverage in the extreme scenario that the law is struck down. These people are insured through subsidized private plans on the Massachusetts Health Connector, or through MassHealth, the state Medicaid program that serves low-income individuals.


The number of Massachusetts residents without health insurance would more than double, and the rate of uninsured people younger than 65 would jump from 4.4 percent to 12 percent. That would be worse even than 2006, when the state passed its own health care reform law, according to Audrey Shelto, president of the Blue Cross foundation.

Additionally, Massachusetts would lose $3.3 billion in annual federal funds that allow the state to provide subsidized health coverage — a blow to the state budget.

“If the court decided to overturn the ACA, we would be starting from a very bad place at a very bad time — the worst time — in the middle of a once-in-a-lifetime pandemic, when so many people . . . are relying on public coverage. The timing couldn’t be worse,” Shelto said.

If Massachusetts reverted to the level of coverage in the state before the ACA went into effect, 69,000 people who became eligible for MassHealth through the federal law still would lose coverage, and state costs would have to rise substantially — as much as $2.1 billion a year — to make up for lost federal aid, according to the analysis.


The Supreme Court will hear arguments for and against the health law just days after a dramatic election. President-elect Joe Biden has said he would work to preserve the law — unlike President Trump — but the makeup of Congress remains uncertain, with the Senate likely to remain under Republican control.

“If the Supreme Court were to invalidate the law, the impact could be pretty catastrophic not just for Massachusetts, but across the country,” said Tom Croswell, chief executive of Tufts Health Plan, which covers hundreds of thousands of people on public and subsidized health plans. “It would remove protections for the most vulnerable portions of our population.”

The ACA increased health coverage by providing subsidies for people to buy private health plans and by expanding eligibility for Medicaid coverage. Nationally, if the law were overturned, an additional 21.1 million people would become uninsured, and federal health care spending would decline by $152 billion per year, according to the Urban Institute in Washington.

The law also includes protections for people with preexisting health conditions.

Trump and other Republicans have repeatedly attacked and sought to dismantle Obamacare, which they characterize as a failure. A group of states, led by Texas, is suing to strike down the law, arguing that the mandate to obtain insurance is unconstitutional and therefore the rest of the law must be thrown out. Massachusetts is among the states defending the health law.

Governor Charlie Baker has bucked others in his party to defend the ACA against previous challenges.


The governor “is proud that Massachusetts is a national leader in ensuring access to health care and is proud to have advocated against federal efforts to repeal the ACA,” his spokesman, Terry MacCormack, said in a statement. “Massachusetts continues to protect access to care at the state level, and the Administration will continue to take steps to ensure all residents have access to the health care coverage they need,” MacCormack added — but he did not detail what steps the governor would take.

Massachusetts passed a 2006 law promoting universal health coverage, but that law, signed by then-Governor Mitt Romney, doesn’t fully insulate the state from what happens at the federal level. The state relies on a partnership with the federal government, which includes significant federal funding, noted Amy Rosenthal, executive director of the Boston consumer advocacy group Health Care For All.

The state budget is already stressed amid the coronavirus pandemic, and it would be hard-pressed to find more dollars to fund health coverage if federal money evaporates.

“We can’t really stand alone without the federal government,” Rosenthal said.

“The Affordable Care Act did amazing things for people across the country and people across Massachusetts,” she said. “While no law is perfect, the gains that we made in covering people, in reducing racial disparities in terms of coverage — it helped us move forward.”

If thousands of people lose health coverage, hospitals such as Boston Medical Center likely would see more uninsured patients, and would treat them without knowing if and how they’ll be compensated for that care.


“It just puts more pressure on us,” said Kate Walsh, chief executive of Boston Medical Center. “In the middle of a pandemic, we should not be having this conversation.”

Priyanka Dayal McCluskey can be reached at Follow her on Twitter @priyanka_dayal.