Massachusetts fights latest GOP healthcare overhaul

The health care bill was introduced by Senators Lindsey Graham (left) and Bill Cassidy (center).Alex Brandon/associated press

WASHINGTON — Massachusetts officials warned Tuesday that the latest Republican health care bill to emerge in the US Senate would inflict serious damage to the state’s medical system, adding their voices to another tense congressional skirmish over the future of the Obama-era health law.

The bill, introduced by Louisiana Senator Bill Cassidy and South Carolina Senator Lindsey Graham, would strike a death blow to many of the Affordable Care Act’s most important features, repealing the mandates requiring individuals to buy insurance, eliminating subsidies that lower premiums, and loosening regulations that require insurers to cover people with preexisting conditions.

It also would deeply cut Medicaid spending across the country, with the heaviest pain inflicted on blue states with large cities, including Massachusetts, but also in crucial political battlegrounds like Ohio, according to estimates by outside groups.

Massachusetts would take a hit of around $8 billion in lost Medicaid dollars over the next 10 years, which officials said would devastate insurance for needy people as well as blow big holes in the state’s hospital network. The cuts would be achieved by transforming the huge, open-ended entitlement program into a system of block grants with firm spending caps.

Boston Medical Center, whose patients on Medicaid amount to 45 percent of its total, would be left especially vulnerable, said Melissa Shannon, the hospital’s vice president for government affairs.

“The legislation is particularly damaging to Massachusetts, where we’re a high-cost state and a high-insurance state,” she said. “Moving to block grants is particularly dangerous here.”

Jonathan Gruber, the MIT health policy professor who was a key architect of the Democrats’ Affordable Care Act, said the latest Senate effort “boggled the mind.”

“There’s nothing to recommend this bill,” Gruber said in an interview. “There’s nobody made better off by this. It’s crazy.”

Many Republican senators were initially lukewarm about the legislation, but the bill has recently experienced a swell of support thanks to the endorsement of the Senate Republican leadership and the backing of a Trump administration desperate for a political victory on a core campaign promise. The result is another frenzy at the Capitol, as fellow senators, lobbyists, and opponents increase pressure on critical swing Republican votes such as Alaska Senator Lisa Murkowski and Arizona Senator John McCain.

If it became law, the legislation would shift large portions of money from predominantly Democratic states that expanded Medicaid under the Affordable Care Act to predominantly Republican states that did not, according to the left-leaning think tank Center for Budget and Policy Priorities.

California and New York, which did accept the expanded Medicaid, stand to lose more than $55 billion and $33 billion over 10 years, respectively, the center said.

Republican governors are among the legions of politicians and interest groups urging lawmakers to reject the bill.

Governor Charlie Baker spoke against it in early September testimony to Congress and reiterated his opposition Tuesday. He was among 10 governors from both parties who signed a letter urging senators not to pass the latest proposal and instead find a bipartisan solution.

“Improvements to our health insurance markets should control costs, stabilize the market, and positively impact coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction,’’ the letter from the 10 governors said.

Separately, Baker reiterated his opposition.

“Governor Baker continues to oppose the Graham-Cassidy proposal, which would be damaging to the people of Massachusetts and cost the state billions of dollars in lost federal revenue,” said Elizabeth Guyton, a communications director.

Meanwhile, as part of a lobbying campaign to move the measure through the Senate, President Trump invited Murkowski to lunch and Vice President Mike Pence made calls to other lawmakers.

This is the third time in six months that Republicans have had the Affordable Care Act in their sights, with the last two ending in dramatic public failures. In July, Senate majority leader Mitch McConnell’s Better Care Reconciliation Act failed to secure the necessary 50 votes. A subsequent “skinny repeal” package, a pared-down version, collapsed days later in the wee hours of the morning when McCain joined Murkowski, Maine Senator Susan Collins, and 48 Democrats in opposition.

With the Graham-Cassidy legislation, Republicans are up against another tight deadline, as any health care overhaul passed under the 50-vote threshold would have to be completed by Sept. 30, under Senate rules. Even if it passes the Senate, the legislation would still need to clear the House, before heading to Trump.

“I want to make sure that members of the Senate know the president and our entire administration supports Graham-Cassidy,” Pence said Tuesday in Washington. “We think the American people need this . . . this is the moment, now is the time. We have 12 days.”

That leaves little time for a traditional legislative process including committee hearings and floor debate, and not enough time for a comprehensive study from the nonpartisan Congressional Budget Office, which would normally estimate costs and impacts on coverage and premiums. Still, Senate Republicans are forging ahead.

“My only litmus test is a bill better than Obamacare, and I think this passes,” said Senator John N. Kennedy of Louisiana.

“We first found out about this, in terms of any kind of detail, about a week ago,” said Senator Ron Johnson of Wisconsin. However, he also said he was willing to back the proposal, because he sees it as a means to avert a single-payer, government-run health care system.

“We’re all aware of the fact that the path we’re on leads to a single-payer system,” Johnson said. “This is the best way off that path.”

Republicans again have a small margin for error. Staunch conservative Senator Rand Paul of Kentucky has already said he would vote “no” on the proposal, and Collins, a moderate who is the only Republican senator from New England, has expressed significant concerns. Three GOP defections would mean defeat.

Facing reporters Tuesday, McCain would not commit to supporting the bill in its current form, although he is close friends with Graham, which could tip the balance. He has previously criticized the process by which Senate Republicans have gone about passing major legislation recently.

“I don’t have anything to say,” McCain repeated five times when asked for his position.

Liberal activist groups held rallies outside the Capitol building Tuesday along with Democratic senators.

“The American people breathed a sigh of relief when the future of their health care, of their children’s health care, was safe for the time being,” Massachusetts Senator Ed Markey said in the Senate chamber Tuesday.

“The bill Republicans are supporting today may have a new name, but it has the same mean, devastating policies. It’s a zombie bill, that against best efforts, and the will of American people, will not die.”

Massachusetts Senator Elizabeth Warren called the legislation “cruel and heartless.”

“Senators Cassidy and Graham have plowed through the garbage of various health care bills, and boy, they’ve come up with a real stinker,” Warren said.