July 17, 2017

On health care bill, Baker says he can't support "takeback"

Governor Charlie Baker said he can't support a takeback of financial support to Massachusetts that's possible through the GOP health care bill in Congress.

As details of the latest rewrite of an Obamacare repeal bill filtered among governors in Rhode Island Thursday, Gov. Charlie Baker would not rule supporting an overhaul that capped Medicaid payments to states, but said he could not support a "takeback" of financial support to Massachusetts.

Baker attended the first day of the National Governors Association Summer Meeting in Providence where governors spent hours huddled in closed-door meetings and participated in public panels on trade and opioid addiction.

Health care, as it did at the winter meetings of the NGA in Washington, D.C., will take on a higher profile as the conference gains steam this weekend. Vice President Mike Pence is expected to address the conference Friday and Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma will speak with governors Saturday.

"I would say, for the most part, governors are anxious to make sure that they have the capacity and ability to make sure they can serve their populations, their constituents, in the best way they can," Baker told reporters in the afternoon. "For a state like me and Massachusetts that means I want to protect the waiver and I want to protect our current relationship financially and programmatically with the feds."

Massachusetts has a valuable Medicaid waiver agreed to late last year with the former Obama administration that Baker wants "honored" with elements that help the state pursue individualized strategies to improve behavorial health and addiction treatment.

The governor said his understanding of the revisions made in the latest U.S. Senate reform bill was only "cursory" and he looked forward to getting a full analysis from his team in Boston and the scoring of the bill from the Congressional Budget Office expected soon.

"Our fundamental objective is to make sure that Massachusetts can continue to provide coverage, nearly universally, to the people of Massachusetts and that the waiver we worked for two years to negotiate with the federal government and got signed last fall continues to be in effect," Baker said.

The redrafted bill unveiled by Senate Republicans Thursday would make available an additional $70 billion for state's to help control the cost of health plans, and an additional $40 billion over 10 yearS to fight the opioid epidemic. The bill would also allow insurers to charge more for plans for people with pre-existing conditions, and sell plans that don't meet all the coverage mandates under the Affordable Care Act.

Many of the fundamentals of the bill, however, remained unchanged, including an $800 billion cut over 10 years to Medicaid under a new system that would put a per-capita cap on reimbursements to states.

Baker said he didn't know enough about the bill yet to say whether it met his litmus tests, but when asked whether he could ever support a bill that capped Medicaid reimbursements he said, "I hate to say no to things because you just never know."

"I said at the beginning of the conversation that I was willing to discuss a per-capita cap if they were willing to go down that road in a way that adequately and properly funded the program. The House version certainly didn't do that, and neither did the original Senate version and I'm not going to support anything that translates into a taking, literally just a takeback from the federal government with respect to the commitment they've already made to support health care in Massachusetts," Baker said.

Baker in late June co-wrote a letter with Virginia Gov. Terry McAuliffe, the chair of NGA, urging Senate Majority Leader Mitch McConnell to make sure governors have "adequate time" to review any changes to the health care bill.

McAuliffe didn't need much time Thursday, however, offering a far less circumspect take on the Senate's efforts than Baker.

"Hocus pocus, honestly," McAuliffe told the News Service. "I think if you dig deep into it there's not a lot there."

The governor said his office's analysis found it would cost Virginia $1.4 billion in federal funds over the next seven years that he "can't come up with" without cutting spending in other areas, such as education.

"They're trying to buy people off with hoped for promises of money in the future. That doesn't do me any good as governor of Virginia. I have to worry about people's health crises today and, cutting people today with the promise of money down the road, this is just a gigantic shift from the federal government to the state government," McAuliffe said.

Later in the day, Gov. Baker headlined a panel discussion with North Carolina Gov. Roy Cooper, Rhode Island Gov. Gina Raimondo and acting director of the Office of National Drug Control Policy Richard Baum.

Baker was tapped in March by President Donald Trump to sit on a new White House opioid commission led by New Jersey Gov. Chris Christie. That panel, which was due to report interim recommendations to the White House by June 27, gave itself an extension to July 17.

Baker confirmed reports that the commission would miss its second July 17 deadline as well.

"I think it's mostly what I would describe as an emphasis issue," Baker explained when asked about the delay. "We've been through a whole series of what I think are very strong and positive recommendations, many of which could be implemented without going back to Congress to get laws changed, which can be done through partnerships with states, and it's my hope we can get the rest of this wrapped up pretty quickly."

Baker said he would love to see other states, as Massachusetts has, put a limit on first-time opioid prescriptions and require medical school students and other health professionals to take pain management courses.

At the panel discussion, Dr. Michael McGinnis, from the National Academies of Medicine, said medicine should be prioritizing non-opioid strategies for clinical pain management.

Raimondo also said Rhode Island has had some success with using peer counseling as part of addiction treatment by making recovering addicts available to help those new to treatment.

Cooper, who also sits on the White House opioid commission with Baker, said states need to focus on the causes of addiction as well as the treatment aspects of the crisis, but compared efforts in his state to "squeezing a balloon" as some addicts have moved from opioids to heroin.

"The first thing we have to realize is we can't have millions of Americans lose access to their health coverage and expect to have an effective strategy to combat opioid addiction," Cooper, a Democrat, said.

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