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 GrahamGOP divide in Congress over Rosenstein's future Sanders: Kavanaugh accusers 'have risked their lives to come forward' Rosenstein fiasco raises the stakes in midterms for DOJ’s future MORE (R-S.C.) and Bill CassidyWilliam (Bill) Morgan CassidyOvernight Health Care: Bill banning 'gag clauses' on drugs heads to Trump's desk | Romney opposes Utah Medicaid expansion | GOP candidate under fire over ad on pre-existing conditions Overnight Health Care: GOP plays defense over pre-existing conditions | Groups furious over new Trump immigration proposal | Public health advocates decry funding transfer over migrant children Overnight Health Care: Opioids package nears finish line | Measure to help drug companies draws ire | Maryland ObamaCare rates to drop 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 McConnell GOP leaning toward Arizona sex crimes prosecutor to question Kavanaugh accuser: report GOP confidence grows on Kavanaugh Senate panel schedules Friday morning vote for Kavanaugh 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 McCainUpcoming Kavanaugh hearing: Truth or consequences How the Trump tax law passed: Dealing with a health care hangover Kavanaugh’s fate rests with Sen. Collins MORE (R-Ariz.) cast the deciding vote against it.