Healthcare

Key GOP centrists open to ending Medicaid expansion

GOP moderates in the Senate are open to ending federal funding for ObamaCare's Medicaid expansion, but want a longer deadline for ending the additional funding than their leadership has proposed.

Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.) have proposed a seven-year phase-out of federal funding for the Medicaid expansion, beginning in 2020 and ending in 2027.

Senate Majority Leader Mitch McConnell (R-Ky.) proposed a shorter, three-year phase-out that would end in 2023 at the Senate lunch on Tuesday.

Portman's and Capito's willingness to end the program is significant, in that it suggests centrists will not demand that the Medicaid expansion be permanent, and that Republicans may be able to find common ground on the critical issue if the additional federal funds are phased down more slowly.

Portman told reporters Wednesday that a "significant glidepath" is needed, saying "we have a proposal out there for seven years, and we'll see where we end up."

Capito indicated that she wants to ensure those on Medicaid expansion are covered - though that doesn't necessarily mean the program needs to stay in the same form as ObamaCare.

"I want to keep the expansion," Capito said. "I want to make sure that the 184,000 West Virginians on expanded Medicaid are going to have access, whether it's Medicaid as we know it at this point or whether it's something in the formulation of what Indiana has with other options with some flexibility."

Capito didn't mention the seven-year phase-out proposal specifically when asked if she was open to the Senate phasing out ObamaCare's Medicaid expansion and having a longer glide path than the House bill, which halted extra federal payments to Medicaid expansion states in 2020.

"My hope is that a longer glidepath with flexibility will give the states and the governors the ability to extend the coverage to the population," Capito said. "I think that's one of the goals I would see."

She said she has to see if the "glide path is too steep."

Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) have also made positive comments toward Senate healthcare discussions this week, in a sign that other moderates could come around and vote for the bill.

"From the outline of the Senate bill that I've seen - and there are a lot of specifics that I'm not yet aware of - it is a far more thoughtful and appropriate bill than the House version," Collins said, "but there are a lot of unanswered questions yet."

Cassidy has said any bill he supports must pass what he calls the "Kimmel test," a reference to an impassioned speech the ABC talk show host Jimmy Kimmel gave on the need to protect those with pre-existing conditions. On Tuesday, the senator said the options GOP leadership laid out on Tuesday were "very cognizant of pre-existing conditions."

"We haven't seen the final details, but simple answer ... yes," Cassidy said when asked if he could support the proposal.

Republicans' proposals would gradually phase down the higher federal Medicaid funding in ObamaCare that helped states expand the program, but would still allow states to keep the expansion if they put in much more of their own money.

Democrats argue that ending the extra federal funding, even over a slow timeframe, would make it very difficult for states to keep expansion and eventually take away coverage for many of the 11 million people who have gained it under Medicaid expansion.

The Congressional Budget Office found that the House bill, which puts a ceiling on Medicaid spending and ends the expansion funding, would result in 14 million fewer people being insured through Medicaid over a decade.

Sen. Mike Rounds (R-S.D.) said there have been discussions among senators about adding funding to the bill specifically for substance abuse and opioid treatment. That move could help allay moderate concerns about Medicaid cuts.

Another sticking point is how quickly the new cap on Medicaid payments will grow. Conservatives are pushing for a slower growth rate than the House bill, which would lower Medicaid spending more, but moderates, including Portman and Collins, have pushed back on that idea.

One Senate GOP aide said the moderates appear to be winning the debate, but that the cap is unlikely to grow any more than the House bill.

Some moderate GOP senators, meanwhile, are simply declining to explain their views on Medicaid expansion.

Sen. Lisa Murkowski (R-Alaska) told her state legislature in February that she would not vote to repeal the Medicaid expansion if the state wanted to keep it.

Asked about her stance on the issue on two separate occasions on Wednesday, and whether she would agree to phasing out the expansion gradually, Murkowski declined to give her view.

"We're still working through all the specifics on Medicaid," she said.

Sen. Jeff Flake (R-Ariz.), who is up for reelection next year, likewise said the bill is still being drafted and he is waiting to comment.

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