Republicans divided over how far to go with ObamaCare repeal

Greg Nash

Senate Republicans are divided over how far to go with an ObamaCare repeal bill they plan to send to the president’s desk by year’s end.

Senate GOP leaders have told their members they will repeal as much of the 2010 healthcare reform law as possible, but some Republicans are balking at a proposal to repeal the expansion of Medicaid.

{mosads}“I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included,” said Sen. Shelley Moore Capito, a Republican from West Virginia.

Thirty states have accepted the option to expand their Medicaid rolls under ObamaCare, extending the coverage to millions of people.

Many of the states that accepted the expansion are led by Republicans governors — such as John Kasich in Ohio — and some Senate Republicans are reluctant to countermand them.

Sen. John Hoeven (R), who represents North Dakota, where an estimated 19,000 people gained access to Medicaid after Republican Gov. Jack Dalrymple decided to broaden the program, said he was unsure about repealing the expansion.

“We’ve started to talk about it but we haven’t gotten into it in depth,” he said. “I’m going to reserve judgment until I see exactly what we’re going to do.”

“I respect the decision of our Legislature and our governor on Medicaid expansion,” said Sen. Steve Daines (R) of Montana, which has a Democratic governor. “I’m one who respects their rights and voices.”

More than 5,000 people signed up for Medicaid in Montana after federal officials approved expanded eligibility in the state earlier this month.

Alee Lockman, a spokeswoman for Daines, clarified Thursdaythat her boss “is committed to repealing as much of ObamaCare as possible and replacing it with sustainable solutions that provide Americans with access to quality, affordable healthcare.”

Kasich, who is running for president, defended Ohio’s acceptance of the Medicaid expansion by arguing that “when you die and get to the meeting with St. Peter” at the gates of heaven, “he is going to ask you what you did for the poor.”

Repealing the Medicaid expansion is a dicey proposition for endangered Senate incumbents running in four states: Illinois, Ohio, New Hampshire and Pennsylvania, all of which broadened Medicaid.

ObamaCare expanded eligibility for the program to low-income adults who earn up to 138 percent of the federal poverty line. The Supreme Court ruled that states had the option of whether to accept the expansion or not, and Republican governors have split on that question.

Another Senate Republican, speaking on condition of anonymity, expressed concern that states that expanded Medicaid would be penalized by billions of dollars if Congress repealed the federal assistance.

“Repealing the Medicaid expansion is not going to be in there because it’s too problematic for many Republicans,” said the lawmaker, adding, “I don’t want to stick the state with the bill.”

Under ObamaCare, the federal government covers 100 percent of the costs of expanding Medicaid for the first three years and at least 90 percent of the costs thereafter, according to the Congressional Budget Office.

Several GOP senators from swing states are pushing the idea of stripping down the House-passed package to something that President Obama might be tempted to sign.

“I want to make policy, not a political point,” said one Republican senator.

Democratic leaders have expressed support for repealing the law’s “Cadillac tax” on expensive health plans and the medical device tax.

A few Republican senators think the repeal bill should be narrowed down to reforms that Democrats support so it has a chance of becoming law, but they are a minority within the Senate GOP conference.

Conservatives led by Sen. Ted Cruz (R-Texas) and Sen. Mike Lee (R-Utah) want to repeal as much of ObamaCare as possible, including the Medicaid expansion, according to GOP sources.

They panned a House-passed repeal bill last month for not going far enough.  

Senate Majority Leader Mitch McConnell (R) has signaled support for repealing the Medicaid expansion in his home state of Kentucky, an issue the newly elected Republican governor, Matt Bevin, campaigned on.

He warned that states would take a financial hit in future years when they have to pay for a greater percentage of Medicaid assistance.

McConnell noted Bevin won 106 out of 120 counties after campaigning against the healthcare law.

“You betcha he’s going to take a look at what he can do to deal with the residue of the previous governor, a very liberal Democratic governor who has added an incredible number of people to the Medicaid rolls,” McConnell told reporters Tuesday. 

“And they’re concerned at the state level because, as you know, in a couple of years, they’re going to have a significant financial hit from this,” he said. 

One Republican senator, emerging from a Tuesday policy meeting, said the Medicaid expansion question hadn’t been resolved.

Democrats argue that McConnell may not be able to include language in the bill repealing the mandates on individuals and employers to buy and offer healthcare insurance, citing a ruling Tuesday afternoon by the Senate parliamentarian, Elizabeth MacDonough.

“A provision to repeal the individual mandate or the employer mandate would be subject to a supermajority point of order under the Byrd Rule,” said a Senate Democratic aide.

The ObamaCare repeal package is moving along a special procedural track, known as reconciliation, that will allow Republicans to pass it with a simple majority vote instead of having to clear the 60-vote threshold normally required of controversial legislation.

But to qualify for protection against the filibuster, the legislation must pass a multi-step test known as the Byrd Rule. The key point of that test is to ensure the primary motivation of the legislation is to reduce the deficit by affecting spending and revenues.

Conservatives, who want to expand the repeal package beyond what the House has passed, agree with Democrats that repealing the mandates alone doesn’t comport with the rules for reconciliation because they don’t have much of a budgetary impact.

They want to tie it to a repeal of the ObamaCare subsidies for people who buy insurance from government-run exchanges.

“Repealing the individual mandate may be OK, but you have to tie it more fully to the subsidies,” said a Senate GOP aide.

Senate Republican leadership aides, however, say the language repealing the mandates can be easily fixed with amendments on the floor.

“There was always going to need to be a Senate substitute amendment to take the House policies and accomplish them in a way that is consistent with the Byrd Rule (which only applies to the Senate),” said a Senate GOP leadership aide.

The aide said the parliamentarian’s ruling “provides a roadmap for drafting that substitute.”

Tags John Hoeven Mike Lee Mitch McConnell Shelley Moore Capito Ted Cruz

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