Senators want governors involved in health talks

Republican senators from states that expanded Medicaid enrollment under ObamaCare are pressing for their home-state governors to be involved in the Senate talks over a new healthcare bill.

The senators are skeptical of language in the bill approved by the House that cuts Medicaid by nearly $900 billion and ends the expansion of federal funding to states in 2020.

Republican senators want governors from their home states, who would have to deal directly with a cap on federal spending, to give their conference an analysis of the potential impact.

“There are obviously concerns because we’re impacted big time,” said Sen. Jeff Flake (R), of Arizona, where Medicaid enrollment under ObamaCare has expanded by more than 400,000 people.

“Twenty-eight, 29 percent of the population is on Medicaid, it’s a big number,” said Flake, who is considered to be a Democratic target in next year’s midterm elections.

ObamaCare gave states the option of expanding Medicaid with federal help.

Thirty-one states and Washington, D.C., decided to accept the federal help and expand Medicaid. Sixteen of those states have Republican governors, and would now see federal support for the expansion drop in 2020.

A number of the states, such as Arizona, also backed President Trump in the 2016 presidential election.

Sen. John Hoeven (R) of North Dakota, another state that supported Trump and expanded Medicaid under ObamaCare, has urged his governor, Doug Burgum, to tell congressional negotiators what he and other governors think about proposed reforms.

Hoeven, who served as governor of North Dakota for 10 years, said there’s been “some” input form the states “but we want more and I think we’ll see that.”

“I talked to him. My guy’s working with his staff and then I have been talking about him working with other governors,” he said of Burgum, who was elected last year.

In pushing for the House bill, Speaker Paul Ryan (R-Wis.), a champion of Medicaid reform, argued the program “works better” when states have more flexibility to run it.

But Flake argues that his state has worked to improve Medicaid, but would now be injured with a quick reduction in federal help.

He talked with Arizona Gov. Doug Ducey shortly before the Memorial Day recess to get on the same page.

“One of the concerns initially is that those states that have run the inefficiency already out of it might be penalized,” Flake said.

Burgum and Ducey, who was elected in 2014, came to office after their respective states opted to expand Medicaid. Their allies in Congress say it’s unfair to penalize them for the decisions of previous state administrations.

The issue of Medicaid has long been dicey in the Senate, where 20 Republicans represent states that expanded the program.

A Kaiser Family Foundation poll released Friday showed that 71 percent of Republicans surveyed said that is important to allow states that receive federal funds for Medicaid expansion be allowed to continue doing so.  

Factoring in Independents and Democrats, the survey showed that 82 percent of people in Medicaid expansion states represented by Republican governors favor continued funding for the Medicaid expansion.

It showed Republicans are evenly divided over the question of whether Medicaid should be changed to a block-grant system. 

Four Republicans from states that expanded Medicaid, John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchinson of Arkansas, wrote to Ryan and Senate Majority Leader Mitch McConnell (R-Ky.) in March warning the House bill did not meet the needs of their state Medicaid populations.

They argued the House bill provided “almost no new flexibility for states” and did “not ensure the resources necessary to make sure no one is left out.”

The governors laid out a set of guiding principles that called for letting states decide whether to opt for a per capita cap on Medicaid spending, as envisioned by the House healthcare bill, or sticking with the current structure but with reduced federal funding.

Another group of governors who primarily represent states that did not opt of the Medicaid expansion have become influential in the Senate talks. They are Wisconsin Gov. Scott Walker, Georgia Gov. Nathan Deal, Tennessee Gov. Bill Haslam and Massachusetts Gov. Charlie Baker.

Of those four states, only Massachusetts expanded Medicare.

Walker, the chairman of the Republican Governors Association, in April rolled out a new proposal to reform Medicaid in Wisconsin.

He called for limiting benefits for childless adults, screening applicants for illegal drug use and even charging some adults without children who have income as little as $200 to $1,000 per month premiums of between $1 and $10.

Walker has claimed that his changes to the state’s Medicaid program has allowed it to cover everyone living in poverty without grabbing additional federal dollars.

“I’m proud to say the state of Wisconsin, for the first time in our history — first time in our history — everyone living in poverty is covered under Medicaid,” he said in a 2015 speech while running for governor.

Politifact later rated the claim “mostly true.”