Medicaid directors issue warning on new ObamaCare repeal bill

The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states.

The bill, sponsored by Sens. Lindsey GrahamLindsey Olin GrahamSenate panel advances three spending bills Trump says he will sign executive order to end family separations Trump backs narrow bill halting family separations: official MORE (R-S.C.) and Bill CassidyWilliam (Bill) Morgan CassidyOn The Money — Sponsored by Prudential — Trump floats tariffs on European cars | Nikki Haley slams UN report on US poverty | Will tax law help GOP? It's a mystery Overnight Health Care — Presented by the Association of American Medical Colleges — House passes opioid bill | Planned Parenthood sues over teen pregnancy program | Azar to face Senate next week On The Money — Sponsored by Prudential — Supreme Court allows states to collect sales taxes from online retailers | Judge finds consumer bureau structure unconstitutional | Banks clear Fed stress tests MORE (R-La.), would eliminate ObamaCare's Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants.

It would also change the federal government's funding of the traditional Medicaid program from an open-ended commitment to the states to a per capita cap on each enrollee.

"Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history," the NAMD's board of directors wrote in a statement Thursday.

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The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

The GOP bill would also require states create their own health-care programs by 2020, which the directors argue is a massive undertaking.

"The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated," the directors said. 

"States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

The directors also hit Senate Republicans for not having a full Congressional Budget Office score before a possible vote on the bill, "which should be the bare minimum required for beginning consideration." 

"With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms," the directors said. 

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellPolitical figures pay tribute to Charles Krauthammer Charles Krauthammer dies at the age of 68 Overnight Energy: EPA declines to write new rule for toxic spills | Senate blocks move to stop Obama water rule | EPA bought 'tactical' pants and polos MORE's (R-Ky.) office has said the intention is to have a vote next week on the measure. 

However, it's unclear if Republicans have the 50 votes needed for it to pass, with Vice President Pence casting a tie-breaking vote. Lawmakers are also under pressure to secure the votes, since the legislative vehicle Republicans are using for the bill expires at the end of September.

The last GOP effort to repeal ObamaCare failed in July, when Sen. John McCainJohn Sidney McCainDon’t disrespect McCain by torpedoing his clean National Defense Authorization Act Meghan McCain rips Trump's 'gross' line about her dad Trump's America fights back MORE (R-Ariz.) cast the deciding vote against it.