NORTHAMPTON — You’ve heard the sound bites. Republicans want to “repeal and replace” Obamacare. Now, the rhetoric is softening. Some in the GOP have started to say they want to “repair” the Affordable Care Act.
Just how remains to be seen. President Donald Trump said in an interview before the Super Bowl that his goal is to have a replacement sewn up by the end of the year — a recognition, to some, that promising to overhaul the American health care system is one thing. Pulling it off is quite another.
“No one is in the know about what the replace is going to look like,” said Dr. Michael Chernew, director of the Healthcare Markets and Regulation Lab in the Harvard Medical School.
On Thursday, an Associated Press analysis showed 12.2 million Americans signed up for health care coverage through federal and state exchanges this year despite a spike in premiums, rising deductibles and dwindling choice of insurers.
The uninsured rate in the United States stands at 9 percent, with some 20 million people gaining health care coverage since the Affordable Care Act passed Congress along party lines in 2010.
Massachusetts groups are lobbying hard against repeal. Massachusetts Coalition for Coverage & Care is leading the charge statewide, educating but not officially lobbying Congress to keep the law in place.
Brian Rosman, director of policy at the Boston advocacy group Health Care For All, said national attention is paying off.
“It seems like opponents are running into a real roadblock in Washington,” he said. “Even partisan Republicans are beginning to see that taking coverage from people would harm them and is not good politics. So we’re actually more optimistic week by week.”
What an Affordable Care Act repeal would mean for Massachusetts is not clear and depends largely on what kind of replacement takes shape.
Chernew said the effect on Massachusetts depends on how much federal funding the state loses.
“A lot of the issue with repeal is ultimately an issue of money,” he said.
For example, before the Nov. 8 election, Gov. Charlie Baker negotiated with the Obama administration a $53 billion, five-year federal Medicaid waiver agreement. That money helps fund the MassHealth program, which delivers coverage to 1.9 million state residents.
Massachusetts has been ahead of the curve in regard to health care access, with bipartisan support for ensuring near-univeral access to health care. Massachusetts’ uninsured rate is just 2.8 percent. Baker, a Republican, has said he will build on that momentum no matter the fate of the Affordable Care Act.
The health care industry is also moving away from fee-for-service models to more value-based approaches — meaning doctors are paid based on patient outcomes and not the quantity of care provided.
“If Medicare cancelled some of the population-based payment models that were a part of the Affordable Care Act, that would be in some ways a setback,” Chernew said. “I don’t think that that is actually likely.
“I actually don’t see repeal of the Affordable Care Act as having a substantial impact on the transition in the state toward alternative payment models,” he added.
Lynn Nicholas, president and CEO of the Massachusetts Health and Hospital Association, said the two biggest concerns would be the loss in federal support and any shift away from new payment models.
“MHA’s greatest concern with repeal is the threat it poses to the coverage expansions that have dramatically reduced the number of uninsured individuals in Massachusetts,” she said in an email, “as well as how repeal would impede the progress underway to reform how healthcare is paid for and delivered.”
Jack Suntrup can be reached at jsuntrup@gazettenet.com. The Associated Press contributed material to this report.