The incoming Trump administration is stirring uncertainty about the future of health care funding for Massachusetts’ most vulnerable residents.
While health care costs and access were not a major focus of this year’s presidential race, as they were during previous campaign cycles, President-elect Donald Trump has indicated a willingness to shake up federal agencies and slash spending to make government more efficient.
Trump’s planned nomination of Robert F. Kennedy Jr., who has made false statements about vaccines and promoted other baseless views, to lead the Department of Health and Human Services alarmed many public health experts. And with Republicans in control of the White House and both branches of Congress, there could be significant impacts on health care funding for the country’s most vulnerable individuals and families.
On Tuesday, Trump announced that television personality Dr. Mehmet Oz would be his pick to oversee Medicaid and Medicare.
Gov. Maura Healey said she is bracing for disruptions during the next administration, including potential cuts to the health care dollars states receive.
“All states rely on federal funding, so I hope they don’t do that,” Healey told reporters recently. “I hope they don’t take that away, because you’re putting lives at risk — not just in Massachusetts, but around the country.”
A major chunk of federal funding for states supports Medicaid, the health insurance program for people with low or no incomes, and people with disabilities.
Medicaid is run jointly by the federal government and states, and coverage benefits can vary across state lines. In Massachusetts, the Medicaid program, called MassHealth, insures about 2 million residents, more than a third of them children.
The taxpayer-funded program costs Massachusetts about $20 billion a year, with about half of those dollars coming from the federal government and half from the state.
Massachusetts and other states have sought to use Medicaid funding to provide housing and food assistance aimed at preventing people from getting sick, said Donald Berwick, a former administrator of Medicare and Medicaid under President Obama. “That is not the philosophy of the Republicans,” he said.
During Trump’s previous time in office, his administration approved limiting Medicaid eligibility for people in some states — for example, by adding work requirements. Republicans also tried, unsuccessfully, to cap Medicaid funding.
Larry Levitt, executive vice president for health policy at KFF, a national nonprofit health research organization, said “the inescapable math is that Medicaid cuts are absolutely on the table” to fund other aspects of Trump’s agenda.
“If there is pressure to cut spending to finance tax cuts,” Levitt said during a recent call with reporters, “Medicaid will have a big target on its back.”
Should Massachusetts see a decline in federal Medicaid funding, state officials would have to find other sources of revenue, or take significant steps to cut costs.
Under former Gov. Charlie Baker, the state negotiated a five-year funding deal with federal officials, known as a waiver, which provides money for hospitals to reduce racial and ethnic disparities in health care. This includes gathering more data about health outcomes for different groups of residents, and improving accommodations for people who speak languages other than English.
Earlier this year, the Healey administration received federal approval to expand Medicaid coverage for people who are homeless or incarcerated.
Massachusetts’ funding deal expires at the end of 2027, which means state officials will have to negotiate a new agreement with the Trump administration. (The last two waivers were approved under Presidents Biden and Obama).
“Medicaid waivers are very wonky,” Levitt said, “but they’re an area where an administration can make its imprint on health care without Congress.”
It’s unclear whether the Trump administration will back Massachusetts’ goals for improving health care, including for Black, Hispanic and Indigenous residents. Trump has often touted states’ rights — but he and his allies also have derided programs that promote diversity, equity and inclusion.
“That is certainly something that could be under threat in a Trump administration,” said Amy Rosenthal, executive director of the Boston-based consumer advocacy group Health Care For All. “We’re going to have to buckle down and continue to advocate for why we need to continue the successful programs that we’ve had here in Massachusetts.”
When it comes to health care access, Massachusetts consistently ranks among the top states in the nation. Over 98% of Massachusetts residents have some form of health insurance coverage — Medicaid, Medicare or private plans they buy from insurance companies — far above the national average.
One difference from Trump’s previous election win: repeal of the Affordable Care Act no longer seems to be a top priority. Republicans tried, and narrowly failed, to repeal it during Trump’s last term. Health policy analysts say the law’s provisions, including state marketplaces where individuals can buy discounted insurance plans, are now more popular and more ingrained into the U.S. health care system, making a full repeal less likely.
However, billions of dollars in subsidies that help offset the cost of health insurance premiums are set to expire next year, unless the Republican-led Congress takes action to extend them. Without Congressional action, many Americans will be hit with higher costs. This includes about 300,000 people in Massachusetts, who could face premium increases of more than $1,700 per person per year, according to the Massachusetts Health Connector.
For now, state health officials are taking a wait-and-see approach as Trump prepares to take office. They don’t know if health policy will be an early focus; many political analysts expect Trump’s administration to focus, at least at first, on campaign promises related to mass deportations of immigrants and tax cuts.
Mike Levine, assistant secretary of the Massachusetts Medicaid program, said in a statement that his office will “use every tool available” to serve its members, “like we have in every prior federal transition.”
During the previous Trump administration, dozens of Massachusetts hospitals, health centers and health care industry groups formed a coalition to protect the state’s high rate of health insurance coverage. The group was dormant during the Biden administration, but after this month’s presidential election, it was revived.
“It is going to be a tough time in the next few years when it comes to health care,” said Rosenthal, of Health Care For All. “We need to make sure that we’re doing everything we can to protect what we’re so proud of here in Massachusetts.”
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