In the state that served as the model for Obamacare , advocates and health care workers fear the Trump administration is trying to dismantle piece-by-piece a popular program that has provided insurance, preventive care and life-saving medication to hundreds of thousands of people.
Provisions contained in both the Senate and House versions of the massive tax and spending cuts bill advancing in Congress - a centerpiece of President Donald Trump's agenda - could strip health insurance from up to a quarter of the roughly 400,000 people enrolled in the Massachusetts Health Connector, according to state estimates.
The changes would create anew the coverage gaps state leaders were working to close when Massachusetts in 2006 became the first U.S. state to enact a law requiring nearly every resident to have health insurance, state officials say. Beyond the effect on residents' health, losing care could have broader repercussions - both for the program's finances and residents' ability to make a living.
"The idea of needing to unwind that now and pull back on that promise and commitment is really frustrating and heartbreaking and cruel and counterproductive," said Audrey Morse Gasteier, executive director of Massachusetts' health insurance marketplace.
Trump and Republican supporters in Congress say the changes, which include new documentation requirements and limitations on who can apply for tax credits to help pay for insurance, are necessary to root out what they call fraud, waste and abuse. The Affordable Care Act changes proposed in both versions of the bill, along with massive cuts to Medicaid and other programs, would eliminate roughly 1.1 trillion in health care spending over the next decade, according to the nonpartisan Congressional Budget Office.