Massachusetts advocates fear Trump's bill will unravel health safety net
in Obamacare's model state
[July 03, 2025]
By LEAH WILLINGHAM
BOSTON (AP) — 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.
In Lawrence, a mill community of around 90,000 people on the Merrimack
River, where more than 80% of the population is Hispanic or Latino,
Kesia Moreta said she's already seeing people slip out of the state's
health care network because of the Trump administration's aggressive
effort to crack down on illegal immigration.
Moreta, who manages a program created under the ACA that helps people
sign up for coverage, said clients have been missing meetings out of
fear that being enrolled for health insurance will harm their effort to
stay in the U.S. legally.
Recently, a father of a U.S.-born teenage son with epilepsy deleted
every email related to his health plan and stopped answering calls from
the Connector after watching reports about deportations on social media.
When his son’s medication ran out, Moreta said the father finally
reached out, whispering over the phone, “Is this going to get me
deported?”
“That breaks our hearts,” Moreta said.
Proposed changes
More than 98% of Massachusetts residents have health insurance, the
lowest rate of uninsurance in the country, according to the
Massachusetts Health Insurance Survey.
Vicky Pulos, an attorney for the Mass Law Reform Institute who helps
low-income people gain access to health care, said Republicans who tried
and failed to repeal the Affordable Care Act during the first Trump
administration have decided to take it apart incrementally despite its
growing popularity.
“It really seems like this is just a less transparent way of effectively
dismantling the accomplishments of the Affordable Care Act in both
Medicaid and the marketplace,” Pulos said.
The changes, she added, “will massively drive up the number of uninsured
but without openly repealing the ACA.”
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Massachusetts Health Connector Executive Director Audrey Morse
Gasteier poses for a portrait in the state health insurance
marketplace's office Tuesday, July 2, 2025, in Boston. (AP Photo
/Leah Willingham)
 Another provision included in both
the House and Senate bills would require people applying for or
renewing coverage to provide more documentation of their income,
household size and immigration status to be eligible for premium tax
credits when the state marketplace already has that information,
which Morse Gasteier said would cause “friction, red tape and
delays.”
The Trump administration has said the proposals will “put a stop” to
immigrants “stealing taxpayer-funded health care benefits meant for
American citizens.”
No states use federal money to provide health insurance to people
who are in the U.S. illegally. Some, like Massachusetts, use state
tax dollars to do so to provide basic primary care services for a
small population of vulnerable residents, like children.
No undocumented immigrants receive insurance through the state
marketplace.
Of the 400,000 enrolled in the state marketplace, around 60,000 are
noncitizens who are in the U.S. legally and would lose access to
federal premium tax credits if either chamber's version of the bill
becomes law. The number includes domestic violence and human
trafficking victims, refugees, people granted asylum or humanitarian
parole, temporary protected status and other work-authorized
immigrants.
Without the credits, premiums will cost upwards of $500 or $600 — an
increase many people can't afford, Morse Gasteier said. Around half
are green-card holders with an annual income of $15,000 a year or
less.
The remaining 40,000 people expected to lose coverage are U.S.
citizens Morse Gasteier said could be stymied in applying or
recertifying coverage by provisions like the increased documentation
requirements.
Fears of trust lost
Morse Gasteier said Massachusetts' marketplace worked “tirelessly”
to enroll vulnerable and hard-to-reach populations after the state
program — formed under the leadership of then-Gov. Mitt Romney and
known as “Romneycare" — was created.
She worries that if people hear help is no longer available, “entire
populations will just sort of give up on health insurance.”
In addition to affecting residents' health, that could have an
economic impact in the state.
Immigrants with legal status enrolled in the state marketplace tend
to be younger than the rest of the population, Morse Gasteier said.
Their presence brings premiums down for others because they tend to
be healthier.
In Lawrence, advocates who help people obtain insurance coverage
though the ACA marketplace say the burden would fall
disproportionately on people with chronic health issues like
diabetes and chronic heart disease.
The Greater Lawrence Community Action Council assists around 10,000
people a year with either signing up for or renewing health
insurance.
“If you’re not healthy, let me tell you, you can’t work. If you
can’t work, you can’t pay your bills. It’s just as simple as that,”
said GLCAC CEO Vilma Martinez-Dominguez.
Moreta said one man who called her from the emergency room recently
said he discovered his health insurance had lapsed. Moreta said she
could help him renew it, and urged him to wait at the hospital.
He told her not to do anything. He was leaving the hospital. She has
no idea what became of him.
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