Gop surgical strike

Jan. 14--It's prognosis negative for Obamacare after Congressional Republicans yesterday passed a budget that sets the stage for a repeal of the controversial health care act.

"The 'Unaffordable' Care Act will soon be history!" proclaimed President-elect Donald Trump on Twitter, just days before he's sworn into office.

House Republicans approved a budget blueprint that allows lawmakers to tear down the Affordable Care Act and devise an alternative. It also removes Senate Democrats' ability to filibuster forthcoming health care legislation, which makes it easier for Republicans to pass whatever plan they come up with. Senate Republicans on Thursday had approved the same budget, which doesn't require presidential approval.

While their actions this week did not amount to an actual repeal of the ACA -- yet -- Republicans stand poised to quickly demolish President Obama's landmark legislative achievement as one of their first items of business. "We have to step in before things get worse," said House Speaker Paul Ryan. "This is nothing short of a rescue mission."

It's still unclear exactly what the impact will be in Massachusetts, which implemented its own health care reform in 2006. But one area that could take a hit is MassHealth, aka Medicaid, said Joshua Archambault, a health care expert at the Pioneer Institute.

"A lot of our coverage is funded by federal taxpayers," said Archambault. "If the funding structure for subsidies and the Medicaid system changes, that's a huge budgetary implication for the commonwealth."

Among the story lines to watch in the weeks ahead will be whether Republicans themselves can unify around a common replacement for Obamacare. The GOP will also have to one-up the public-relations battle with Democrats, who are sure to publicize stories of Americans who have benefited from Obamacare or would lose their health coverage through a repeal.

Then Republicans will have to decide whether to devise a federal or state replacement for Obamacare. "Ultimately the big question is: Can we get a federal program that deals with the complexities of our health care system," said Archambault, "or does Washington step back and send a framework to reform and let the flexibility happen at the state level?"

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