GOP governors confront Medicaid divide

GOP governors confront Medicaid divide
© Greg Nash

Governors are descending on Washington this weekend as Republicans wrestle with the future of ObamaCare's expansion of Medicaid. 

GOP lawmakers say they are looking to governors for advice on what to do about the program, which is one of the toughest issues Republicans face as they look to repeal and replace the healthcare law.

Many of the lawmakers representing states that accepted the Medicaid expansion are looking to keep it. But they are at odds with conservatives and Republicans from states that rejected the expansion, who are pushing for full repeal. 

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It will be hard for any repeal and replace bill to pass Congress unless Republicans can bridge that divide, and they are looking to the governors, who help run Medicaid as a joint federal-state program, for help.

“We're in extensive discussions with them and we'll talk with them more when they get here and then move ahead on both Medicaid and the individual market,” Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderGovernor's race grabs spotlight in Tennessee primaries A single courageous senator can derail the Trump administration GOP worries trade wars will last as Trump engages in temporary tiffs MORE (R-Tenn.) told reporters earlier this month, speaking of the governors meeting.

Republican governors are almost evenly divided on the Medicaid issue, with 17 hailing from states that rejected the expansion and 16 hailing from states that accepted it. 

States that took the expansion broadened eligibility for Medicaid — the government healthcare program for the poor and disabled — up to 138 percent of the federal poverty line. About 11 million people have gained coverage because of the Medicaid expansion.  

The healthcare plan that House Republicans outlined last week calls for eventually eliminating the extra federal funding for the Medicaid expansion. If states wanted to continue covering the additional people, they would have to spend more of their own money.

Some Republican governors from states that accepted the expansion have been vocal about wanting to protect it — and none more so than Ohio Gov. John Kasich.

Over the weekend Kasich called the House GOP plan “a very, very bad idea, because we cannot turn our back on the most vulnerable.” 

Kasich is not alone among Republican governors in fighting to keep expansion. Nevada Gov. Brian Sandoval (R) defended his decision to expand Medicaid in a letter to Congress in January. 

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

However, on Thursday at the Conservative Political Action Conference, Rep. Michael BurgessMichael Clifton BurgessOvernight Health Care: Trump officials move to expand non-ObamaCare plans | GOP fails to block DC individual mandate | Ebola returns to Congo Republican chairman wants FTC to review mergers of drug price negotiators Overnight Health Care: Official defends suspending insurer payments | What Kavanaugh's nomination means for ObamaCare | Panel approves bill to halt employer mandate MORE (R-Texas) indicated that the expansion would be repealed, with some sort of transition period to help the states adjust.

“It does do away with the Medicaid expansion, and we are in the process of trying to figure out right now how to minimize the disruption in expansion states, but still achieve the goal, and how not to punish non-expansion states,” said Burgess, who is a key player on healthcare as chairman of the Energy and Commerce health subcommittee.

Still, the pressure from governors and state leaders who want to keep the expansion appears to be having an effect on some lawmakers.

In a significant move, Sen. Lisa MurkowskiLisa Ann MurkowskiThe Hill's Morning Report: Dems have a majority in the Senate (this week) Senate gets to work in August — but many don’t show up Trump nominee won't say if he supports funding agency he was selected to run MORE (R-Alaska) said Wednesday that she would not vote to repeal the expansion if her state wanted to keep it. 

"So as long as this Legislature wants to keep the expansion, Alaska should have that option," Murkowski said. "So I will not vote to repeal it." 

Republicans have 52 seats in the Senate, so they can only lose two Republican votes on a repeal and replace bill, assuming all Democrats vote against it.

Governors will be meeting on healthcare on Saturday afternoon to confront the divide.

“ObamaCare repeal and replace is going to be the top discussion point, because governors will be at the tip of the spear on that,” Kansas Gov. Sam Brownback (R) told reporters at CPAC on Thursday. “You’ve got to do it in such a way that you are repealing but you’re not kicking people off, so that’s the tricky piece of it.”

Officials from states that did not expand Medicaid are also looking to make sure that they are not treated unequally in any replacement. One idea, put forward by House Republicans, is to bring back federal payments for hospitals treating the uninsured in states that did not expand Medicaid.

“They feel that they were left out when this stuff was created eight years ago,” Burgess said of the governors. “They are anxious to participate in our solutions.”