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Meeting basic needs under Trump

Fed funds key for landlords, affordable tenants; Trump’s health secretary opposes Obamacare

Jule Pattison-Gordon | 12/7/2016, 1:13 p.m.

As Donald Trump’s White House takes shape, local thinkers anticipate what the president-elect’s federal appointments might mean for a state that voted overwhelmingly for Hillary Clinton. While current practices of individual states and cities may buffer them against some of the impacts, the Trump administration is expected to usher in dramatically different federal policies affecting residents’ basic needs such as health care and housing.

Health

While the Trump administration’s health care agenda has yet to emerge, the selection of Georgia congressman Tom Price for Health and Human Services Secretary provides a clue as to potential direction. In particular, many say his appointment could affect federal funding for MassHealth, or the state’s Medicaid, which provides health care coverage for many people with low-incomes.

Price is known, in part, for his calls to repeal and replace President Barack Obama’s Affordable Care Act. Meanwhile, the ACA has been largely embraced in Massachusetts.

Massachusetts is home to the health insurance reform laws developed during the administration of former Governor Mitt Romney, which were used as a model for the ACA. State leaders also took up optional provisions in the ACA to expand Medicaid coverage to more people and include more benefits. MassHealth provides for optional services such as dental care, speech therapy and psychologists, as well as eyeglasses and hearing aids, according to Ballotpedia.

Medicaid expansion in Massachusetts extended coverage to any non-elderly adult who earns up to 133 percent of the federal poverty level. In 2015, this included individuals earning up to $16,242 or families of four earning up to $33,465. As of September 2016, more than 300,000 state residents received their heath coverage under this expansion, according to Massachusetts Medicaid Policy Institute report. Price’s proposals include reversing the Medicaid expansion, which would push those individuals into the private market.

Price previously proposed replacing the ACA with a system of tax credits to motivate individuals to purchase health insurance policies for themselves or their families. The level of tax credits would be based on the person’s age, not their income. However, the proposed tax savings fall short of the premium and out-of-pocket costs incurred with standard health insurances plans in most of the U.S., according to The Fiscal Times. States would receive grants for subsidizing the purchase of insurance by individuals from high-risk populations, with tax credit limits placed on businesses that provide workers with health insurance.

Randall Ellis, a Boston University professor who specializes in health economics, said that proposals to encourage individuals to be more responsible for setting aside money in savings accounts for their health may help rein in costs on middle- and upper-income workers and those working at large companies. But such a policy poses a burden for low-income individuals, who have fewer funds available to save for future health costs. In part, this is because chronic poor health can make it difficult to hold a steady job, Ellis said. Another factor: Those with lower incomes also have less to invest in resources that promote positive health outcomes, such as gym memberships, health foods and preventive care.