GOP governors defend Medicaid expansion

Several Republican governors are defending ObamaCare’s expansion of Medicaid in their states, highlighting a thorny issue for the party as lawmakers navigate repeal of the healthcare reform law.

Full repeal would mean eliminating the law’s expansion of eligibility for Medicaid coverage, which has provided insurance for about 11 million new people in 31 states.

Many of those states have Republican governors who are wary of their constituents losing coverage and of their state budgets losing the infusion of federal money that came with the expansion of the program, which affects low-income citizens.

Several governors came to Washington Thursday to meet with Republican lawmakers to discuss Medicaid and how to handle the future of the program.

{mosads}Michigan Gov. Rick Snyder (R), whose state has expanded Medicaid, offered a defense of the program there, called Healthy Michigan, upon leaving the meeting.

“We have over 600,000 Michiganders, and we have a lot of positive data showing some good things going on in our state with this program,” Snyder said. “Healthy Michigan has had a lot of success, both in terms of healthier behaviors and better outcomes helping people.”

In a letter to Congress sent Wednesday, Ohio Gov. John Kasich (R) also urged lawmakers in his party to keep the Medicaid expansion.

“We strongly recommend states be granted the flexibility to retain the adult Medicaid coverage expansion,” Kasich wrote in the letter.

In the meeting with lawmakers on Thursday, Kasich floated a proposal to shrink the Medicaid expansion rather than completely scrap it.

Under his proposal, eligibility would decline from 138 percent of the federal poverty level down to 100 percent of the poverty level. People between 100 and 138 percent could get coverage through the insurance exchanges, Kasich said.

It is unclear, though, whether the exchanges would still exist.

Republican senators from states that have expanded Medicaid are in a more delicate position when it comes to ObamaCare repeal. Leaving the meeting, Ohio’s Republican senator, Rob Portman, answered “yes” when asked if he is open to keeping the Medicaid expansion.

Sen. John Cornyn (Texas), the Senate’s No. 2 Republican, mentioned Kasich’s proposal leaving the meeting, but did not weigh in definitively on it.

“Obviously there’s going to have to be some resources to pay for it,” Cornyn said of Kasich’s plan. “But again there’s not going to be another 2,700 page bill.”

Cornyn said that people currently on Medicaid expansion coverage, or any coverage, would not lose it.  

Asked if governors are concerned about people losing Medicaid expansion coverage, Cornyn said, “Sure, we’re all concerned, but it ain’t going to happen.”

“I would say people covered today will continue to be covered,” Cornyn added.

He did not say how he would make sure that this commitment becomes reality, though, after the repeal of ObamaCare. Republicans have not put forward the details of their replacement plan.

A Cornyn aide later added that Cornyn meant no one would lose “access” to coverage. It is unclear what all of the differences between losing coverage and losing “access” to coverage are. 

Sen. Bill Cassidy (R-La.) also acknowledged after the meeting that governors are worried about people losing coverage.

“Several [governors] mentioned the importance of continuing the federal help for either their expansion program, for those who expanded, or for the exchange population,” Cassidy said.

Lawmakers and governors leaving the meeting all stressed the word “flexibility,” meaning that aside from the question of whether to maintain the expansion of Medicaid, Republican governors of all stripes want more freedom to make changes to the program.

Republicans in Washington could loosen up rules so that states are more free to make changes like making Medicaid enrollees pay premiums or establishing work requirements. The Obama administration has allowed some states to charge premiums but has drawn the line and rejected work requirements.

President-elect Donald Trump and his incoming administration say that they are going to propose block grants for Medicaid, meaning states would get a set amount of federal money, rather than the current more open-ended commitment.

Republicans say this approach would give states more flexibility to make changes to how their program works and limit federal spending. But Democrats warn that limiting the federal money would mean damaging cuts to the program, limiting the number of enrollees or the benefits they receive.

Kasich’s letter to Congress warned that block grants have to be done right, and that states need to understand the federal commitment and how it would grow in later years. “The difference between a good block grant and a dangerous block grant is in the detail,” Kasich wrote.

Other governors are also sounding concerns.

“I think there’s a recognition that we do not want to diminish those states that have expanded the coverage, and so I would expect that we want to be able to have confidence that those that have the coverage right now are going to be able to continue on that,” said Arkansas Gov. Asa Hutchinson (R), whose state has expanded the program.

Nevada Gov. Brian Sandoval (R) also defended the decision to expand Medicaid in a letter to Congress.

“These decisions made health care accessible to many Nevadans who had never had coverage options before,” he wrote.

Updated at 7:33 p.m.