House GOP floats option to deal with Medicaid expansion

House GOP floats option to deal with Medicaid expansion
© Greg Nash

A key House Republican in the healthcare fight said Wednesday that lawmakers are considering a way to deal with their dilemma on ObamaCare’s Medicaid expansion by increasing payments to states that rejected the expansion. 

Rep. Brett GuthrieBrett GuthrieThe Hill's Whip List: 36 GOP no votes on ObamaCare repeal plan Congress should take a cue from Arkansas’s Medicaid expansion freeze A guide to the committees: House MORE (R-Ky.), the vice chairman of the House Energy and Commerce subcommittee on health, told reporters that one option under consideration is to freeze new enrollment in the 31 states that expanded the program, while increasing certain payments to the 19 states that did not expand. 

The proposal would increase funding known as Disproportionate Share Hospital (DSH) payments in the states that did not expand Medicaid. Meanwhile, expansion states would get to keep the expansion, at least for people currently enrolled. 

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The idea seeks to solve Republicans’ problem of how to satisfy lawmakers from expansion states who do not want to lose out on their extra federal money and coverage, while also not disadvantaging states that did not expand.

Differences on Medicaid expansion are one of the main obstacles for Republicans to overcome as they look to repeal ObamaCare. Some conservatives simply want to repeal the expansion altogether. 

“One of the proposals was, do you allow states to freeze who's already on the expanded [population]?” Guthrie, who chaired a Medicaid task force started in 2015, told reporters. “So no new members, but nobody is removed, and then the states that didn't expand, how do you make that fair?”

He noted that ObamaCare cut DSH payments, which help compensate hospitals that treat the uninsured, to help pay for the law, so the proposal could restore those payments in states that did not expand Medicaid. 

“States will lose their disproportionate share payments, so the question is do you allow those states that didn't expand to not lose their disproportionate share payments?” Guthrie said. 

It is possible the GOP solution would end up actually increasing spending, though a separate idea to restructure Medicaid and cap spending could also be included and save money. 

Guthrie noted that the idea is still just an option, but said House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) could discuss the proposal at a Republican conference meeting on ObamaCare on Thursday. 

“Greg Walden is going to present some of that tomorrow, and we'll see where the conference wants to go,” Guthrie said.