Policy tussles between the moderate Republican administration of Gov. Charlie Baker and the Democrat-controlled Legislature have been few and far between during Baker's first two and half years in office, but the disagreement over cuts to health care is beginning to spill out of the State House and into the 2018 governor's race.
The governor's legislative and spending priorities generally skate through the House and Senate, but partisan attitudes are shifting as the national health care debate hits Beacon Hill and Democratic hopefuls eye the corner office for themselves.
U.S. Senate Republicans spent the week charging forward with multiple attempts to repeal or alter the 2010 Affordable Care Act. Baker has sided with numerous other governors opposing the national GOP's plans, saying the repeal efforts will greatly harm Massachusetts' ability to provide health care for the needy.
In Massachusetts, local Republicans would say, it's not about policy as it is in Washington where national Republicans are essentially skeptical to opposed to government health care. The issue is the need to balance the budget while minimizing hurt to the poor and disadvantaged. With no deficit spending allowed on Beacon Hill accounting can be an unforgiving measure.
For the most vocal Democrats, that is a distinction without a difference.
It's the governor's attempt to rein in MassHealth enrollment, which exploded after the ACA was passed, that is rankling Democrats and giving possible candidates hope of tripping up Baker on the campaign trail next year.
Throughout this year's budget season, Baker has offered up a two-pronged strategy for slowing the growth of MassHealth, the state's Medicaid program that pays for health services for children, the elderly and the poor. The plan calls for increases to how much employers pay into the MassHealth system while also granting Baker the authority to shift some enrollees from the program onto subsidized plans through the health connector.
Democrats in the Legislature signed on to the the employer increases this week, a move most agree is necessary to raise around $200 million in revenue and to balance this year's state budget. Baker's plan to shore up the rolls of MassHealth, and shed some benefit recipients he says should be ineligible, has struck many Democrats as similar to the way Congressional Republican leaders are attempting to dismantle the ACA.
Jay Gonzalez is one of the Democrats seeking to replace Baker. The former Patrick administration budget chief accused Baker of "complete hypocrisy" last week for opposing national GOP plans for the ACA while looking for eligibility changes for Medicaid in Massachusetts. After meeting with legislative leaders, Gonzalez told the state House News Service that Baker's pan will increase the cost of health care for poor families.
Legislative Democrats stopped short of approving Baker's requests for eligibility changes, instead sending just the employer fee increases back to the governor's desk. Lawmakers agree the the cost of MassHealth is a problem, but they plan to hear other potential solutions before taking action.
Rep. Jeffrey Sanchez, who as Ways and Means Committee chair is House Speaker Robert DeLeo's point person on the budget, told his colleges this week that an hours-long hearing on the MassHealth problem yielded multiple strategies on how to tackle costs.
"One thing that was abundantly clear from yesterday's testimony is that there is considerable uncertainty around the effects that this plan will have on low income individuals, the elderly and the disabled.... This is not the end of our health care debate."
Baker has not announced if he and Lt. Gov. Karyn Polito will seek reelection, but the pair have continuously raised funds consistent with a ticket hoping to earn a second term.
Health care costs are the biggest part of state spending, taking up around 40 percent of the annual budget, over $16 billion this fiscal year. The program affects around 1.9 million Massachusetts residents, over one quarter of the state's population.
