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Mass. ‘not immune’ to ripple effect of health care law ruling

“This isn’t good for us,” Dr. Donald M. Berwick of the Institute for Healthcare Improvement said of a Texas judge’s ruling.Jonathan Wiggs/Globe Staff/file

A Texas judge’s ruling late last week to throw out the Affordable Care Act could have far-reaching consequences, threatening health coverage for millions and insurance markets nationwide — even in Massachusetts, which has its own universal health care law.

The Massachusetts law, which went into effect more than a decade ago, has bipartisan support and was the model for the sweeping federal health care overhaul approved under President Obama in 2010.

But Massachusetts relies on billions of dollars in federal funding every year to provide coverage to lower-income residents, and the state’s health care system is deeply entwined with the federal system. So major disruptions to the federal law would extend here, several health care experts said Monday.


If the decision issued Friday were to stand, “it would be a disaster” said Dr. Donald M. Berwick, senior fellow at the Institute for Healthcare Improvement in Boston and a former administrator of Medicare and Medicaid under President Obama.

“This isn’t good for us,” Berwick said. “I cannot imagine a scenario where people all over the country are damaged and Massachusetts emerges unscathed — that’s not going to happen. We’re not immune to the damage that would be done should this opinion prevail.”

Critics of the Texas lawsuit — including Massachusetts Attorney General Maura Healey — plan to appeal the decision as soon as possible, and the case could go to the US Supreme Court.

The Massachusetts health care law, approved under then-Governor Mitt Romney, mandates that all residents obtain health coverage. The state depends on federal funding to help cover low-income residents in the $16 billion-a-year state Medicaid program, as well as individuals who receive subsidized health plans on the Massachusetts Health Connector.

Suzanne Curry, associate director of policy and government relations at Health Care For All, a Boston-based consumer advocacy group, described the Massachusetts health care law as “a partnership with the federal government.”


“If that were to go away, we know that more people would become uninsured,” she said.

The Affordable Care Act — or Obamacare — has long been a target of conservatives who argue it represents government overreach and has failed to make health coverage affordable.

Republicans in Congress tried and failed to repeal the law last year, but they successfully gutted one key element: the federal penalty for individuals who don’t get covered.

The Trump administration has also sought to weaken the law, for example, by halting federal payments to insurers that help subsidize coverage for lower-income Americans and by allowing sales of cheaper and less comprehensive health plans.

But many parts of the Affordable Care Act remain popular, including protections for people with preexisting conditions.

Judge Reed O’Connor of the US District Court in Fort Worth, Texas, struck down the law on the grounds that its mandate requiring people to buy health insurance is unconstitutional and that the rest of the law cannot stand without it.

Health care experts stressed there is no immediate change to coverage. While the deadline for residents in many states to buy 2019 health coverage has ended, Massachusetts residents still have time to sign up. The enrollment period for coverage beginning Jan. 1 ends Dec. 23, and individuals have until Jan. 23 to sign up for coverage that goes into effect in February.

In the current enrollment period so far, 262,459 have enrolled in health plans on the Massachusetts Health Connector, a 10 percent increase from the same time last year, officials said. (Most people in Massachusetts get their insurance through an employer or Medicare or Medicaid).


The Massachusetts mandate that all residents obtain adequate health insurance is still in effect. Individuals who don’t get covered could have to pay a penalty of up to $1,428 per person for the year.

“Our concern is that people understand the state law is still in effect, the federal law is still in effect, and people should still be enrolling in health coverage,” said Lora M. Pellegrini, chief executive of the Massachusetts Association of Health Plans. “We still have our [state] individual mandate.”

Republican Governor Charlie Baker has bucked others in his party to defend key aspects of the federal law, particularly when Congress tried to ax it.

“The Baker-Polito administration is proud that Massachusetts provides quality health care coverage for nearly every resident and Governor Baker will keep working with state and federal officials to protect and improve health care options for the Commonwealth,” a Baker spokesman, Brendan Moss, said in an e-mail Monday.

Administration officials said Baker has held many conversations over the past several years with governors and members of Congress about Massachusetts’ health care concerns.

Several health care and legal experts believe the Texas ruling is politically motivated and based on shaky logic.

“The court [says] if the individual mandate is unconstitutional, then the entire Affordable Care Act must fail, because we can’t see how anything could work without the requirement to have insurance,” said Wendy K. Mariner, a health law professor at Boston University.


One hitch in that argument: Even though Congress stripped away the penalty for those who don’t get covered, the law is still working, Mariner said. Millions of people across the country this year continued to sign up for coverage made possible by the Affordable Care Act.

Also, much of the law, more than 900 pages long, has little or nothing to do with the individual mandate. It pertains to Medicaid expansion, Medicare payments, health care quality, chronic disease prevention, and other broad topics. Hospitals and insurers have spent the past several years working to comply with the vast law and all its regulations.

If a higher court decides that the entire Affordable Care Act is unconstitutional and individuals lose health coverage as a result, hospitals and insurers would suffer financially, Moody’s Investors Service warned Monday.

“In a normal universe, a preposterous case like this would have never gotten out of a district court level — but these are not normal times,” said John E. McDonough, professor at the Harvard T.H. Chan School of Public Health.

Unless the Texas ruling is overturned, “there’s no way Massachusetts could escape severe damage,” said McDonough, who played a key role in the creation of the Massachusetts law. “We would be at risk here.”

Material from The New York Times was used in this report. Priyanka Dayal McCluskey can be reached at Follow her on Twitter @priyanka_dayal.