Portman, Toomey tasked with Medicaid talks

Portman, Toomey tasked with Medicaid talks

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellGOP political operatives indicted over illegal campaign contribution from Russian national in 2016 McConnell privately urged GOP senators to oppose debt ceiling hike On The Money — Dems dare GOP to vote for shutdown, default MORE (R-Ky.) has asked Sens. Pat Toomey (R-Pa.) and Rob PortmanRobert (Rob) Jones PortmanTrump takes shot at new GOP candidate in Ohio over Cleveland nickname Centrist state lawmaker enters Ohio GOP Senate primary Emboldened Trump takes aim at GOP foes MORE (R-Ohio) to discuss a way forward on the issue of Medicaid, according to Senate GOP aides.

Portman and Toomey are tasked with discussing how quickly to wind down ObamaCare's Medicaid expansion and how quickly a cap on Medicaid payments should grow.

While both senators represent states that accepted the expansion of Medicaid under the healthcare law, they have different positions.

Portman is more protective of Medicaid expansion, while Toomey is opposed to the expansion.

The decision came after the Senate healthcare working group’s Tuesday meeting.

It is unclear what, if anything, will come out of the discussions. A Senate GOP aide cautioned that they are not formal negotiations.

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The three main areas of discussion on Medicaid, the aide said, are how quickly to wind down ObamaCare’s expansion of the program, what flexibility to grant states on areas like work requirements and how quickly a new cap on overall Medicaid payments should grow.

The thorniest issue appears to be the Medicaid expansion. On the other two issues, the Senate is working off the assumption that there will be a cap on federal Medicaid payments, known as a per capita cap, according to lobbyists and aides. And Republicans in general are in favor of granting states more flexibility.

As for the expansion, 31 states have accepted the widened eligibility for the program, which has provided coverage for about 11 million people. Some Republican senators from states that accepted the expansion are wary of abolishing it, at least too quickly.

The debate is over the extra federal funding for the Medicaid expansion, not over whether newly-enrolled people will continue to be eligible. Some Republicans say some states would keep the expansion even with a lower level of federal funding. 

"Senator Portman continues to talk with many of his colleagues regarding his concerns about protecting the Medicaid expansion population, both in expansion states and non-expansion ones," Portman spokesman Kevin Smith said in a statement. 

Portman told reporters earlier in the week that he is in favor of eventually getting rid of the extra federal funds that allow for the expansion as long there is a gradual process that leads to a “soft landing.” That could mean pushing the date the expansion ends farther back from 2020, where it is in the House bill.

Sens. Shelley Moore CapitoShelley Wellons Moore CapitoOvernight Energy & Environment — Presented by Climate Power — Senate Democrats ding Biden energy proposal Capito grills EPA nominee on '#ResistCapitalism' tweet GOP senators unveil bill designating Taliban as terrorist organization MORE (R-W.Va.) and Bill Cassidy (R-La.), though, have said they want to maintain the expansion, though they have given wiggle room by saying it does not need to be in the same form.

Cassidy on Thursday mentioned Ohio Gov. John Kasich’s (R) idea to provide tax credits to some people currently on the Medicaid expansion to help them buy private coverage instead.

Many Republican senators are looking to make the tax credits that help people afford insurance more generous for low-income people than they were in the House bill.

“We will for sure take a different approach here than what the House did in terms of designing that credit,” Sen. John ThuneJohn Randolph ThuneThis week: Democrats face mounting headaches Senate parliamentarian nixes Democrats' immigration plan Manchin keeps Washington guessing on what he wants MORE (R-S.D.), who is leading the tax credit discussions, told The Hill on Tuesday.

On Medicaid, some conservatives are worried that the end of the Medicaid expansion funds, set for 2020 in the House bill, will keep getting pushed off by lawmakers and never actually take effect. Some conservatives therefore want a gradual phase-out of the Medicaid expansion funds to begin much sooner.

Conservatives are also pushing for a lower growth rate in the overall cap on Medicaid payments. Some conservatives have mentioned a trade where a lower cap could be exchanged with moderates for a slower phase-out of Medicaid expansion, or vice versa. It is unclear, though, whether moderates would go for such a deal.

In another meeting of the Senate’s working group on Thursday, senators discussed repealing ObamaCare’s insurance regulations, such as the essential health benefits, which mandate that insurance plans cover a range of services, like mental healthcare and prescription drugs.

Sen. John CornynJohn CornynDemocrats up ante in risky debt ceiling fight Senate parliamentarian nixes Democrats' immigration plan Democrats make case to Senate parliamentarian for 8 million green cards MORE (R-Texas) said lawmakers are looking at whether those rules can be repealed under Senate rules governing the fast-track process of reconciliation.

“I think we're going to leave it up to consumers to decide what they want to buy and what they need,” Cornyn said.

- This story was updated at 7:12 p.m.