Opinion | Tom Croswell

Mass. would not be immune from damage caused by repealing the Affordable Care Act


If the Trump administration and the Justice Department succeed in invalidating the Affordable Care Act in a New Orleans courtroom, the damage will be staggering. Millions of Americans — including the elderly, the poor, and those with cancer, diabetes, and other preexisting conditions — face the loss of their health care coverage.

Massachusetts is certainly not immune from these adverse impacts. Hundreds of thousands of Massachusetts residents will lose health care coverage or some sort of protection provided directly by the ACA. The case is likely going to end up before the Supreme Court again.

For too long the back-and-forth on the ACA has been couched as a political debate. But the consequences of repeal extend far beyond politics and have real-world consequences in just about every segment of the market. For example, more than 282,000 people signed up for coverage through the Massachusetts Health Connector this year, an all-time high. Nearly three out of four of those people receive subsidies from the ACA to help them afford coverage and lower their out-of-pocket expenses.

If the ACA goes away, so do those subsidies, leaving people without coverage. Tens of thousands more in the state are enrolled in the Medicaid Expansion program created by the ACA. Without the law, this population would almost certainly lose coverage and have no other options to continue seeing their doctors or therapists, to continue filling their prescriptions, and to continue caring for their families.


The ACA also provides financial security where none existed previously, by limiting out-of-pocket expenses and removing lifetime-benefit limits. Without these protections, thousands would face financial peril and potential bankruptcy in the event of a catastrophic medical incident. While the ACA is not perfect, it would be shortsighted to ignore the substantial coverage and health gains made under this law.

There is a persistent myth that because Massachusetts was the first state to commit to universal coverage, and because we cover the most people of any state, we would somehow be immune to damage if the ACA were repealed. Wrong. The Economic Policy Institute estimates that Massachusetts’ uninsured rate could jump as much as 273 percent if the ACA were repealed. The state would also lose billions of dollars of federal funding associated with the ACA, putting a strain on the state budget and its ability to fill the coverage gap.


There are steps that can be taken now to strengthen the ACA so that it works better for everyone. Lowering the costs of prescription drugs and stopping surprise medical bills are issues with bipartisan support.

Instead of working to invalidate the ACA, or being distracted by Medicare for All, Congress should focus on these areas where real improvements can be made. Every American, regardless of their income, age, or circumstances, deserves this type of coverage. As the CEO of the only health plan in Massachusetts that serves all segments of the population regardless of income, age, or health, we embrace this as our mission.

In 2006, when Massachusetts was creating its own health care reform, lawmakers and other stakeholders agreed on one key principle: Every resident of the Commonwealth should have access to high-quality health care coverage. Almost 15 years later, we have achieved near universal coverage and have taken important steps to address health care costs. Our work is far from over, but we are making headway.


We must work hard to protect the health and economic gains our state has achieved under the ACA. We can and should continue to pursue measures that result in lower costs while preserving our primary goal — coverage for all. Let us, together, continue to set the example for the nation.

Tom Croswell is president and CEO of Tufts Health Plan.