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GOP governors forming plan to keep ACA Medicaid expansion

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(Bloomberg) — A group of Republican governors is preparing a compromise plan for their peers in Congress who want to roll back the Affordable Care Act Medicaid expansion benefits, asking them to preserve the law’s expansion of coverage to millions of poor people.

Related: GOP rebrands ACA strategy from ‘repeal’ to ‘repair’

Would-be “Obamacare repealers” have not always been clear about which parts of the ACA they want to “repeal,” or what exactly they mean when they use the word “repeal.”

The current compromise proposal has been initiated by a group including Ohio Gov. John Kasich and Wisconsin Gov. Scott Walker, and would hold on to parts of the ACA expansion of the program. It’s meant to satisfy Republican goals of repealing Obamacare and giving more control of Medicaid to the states, while also maintaining coverage of people such as childless adults and those just above the poverty level. It would also open the door for states such as Wisconsin to broaden Medicaid eligibility.

The compromise plan proposal and the effort to promote it was described by senior state officials, who spoke on condition of anonymity because it isn’t yet public. The group also includes Utah, Arizona, and Tennessee, according to the officials. The proposal was presented to larger groups of governors in the past week during their winter meeting in Washington, according to the officials.

Other state officials spoke on the record about what they’re seeking from Republicans who are crafting changes.

“What we’re trying to do is have everybody be on the same page with something that’ll actually pass and work in the states,” Tennessee Gov. Bill Haslam said Tuesday at a press conference. Haslam said the group has been holding conference calls about every other day.

Jon Thompson, a spokesman for the Republican Governors Association, declined to comment.

Funding choices

Another element of the proposal deals with how the Medicaid expansion is funded. Republicans in Congress have talked about moving to a “block grant,” giving a fixed amount of money to each state. The governors want the option to use a more flexible per-person allotment that would protect their budgets if Medicaid rolls grew quickly, for example in a recession.

Some proposals to replace the ACA would result in “forever restructuring the Medicaid program to cut expansion and cap who receives benefits,” said Andy Slavitt, the former head of the Centers for Medicare & Medicaid Services. “This has governors and care providers rightly up in arms. I for one believe we need an honest debate about limiting the care provided to kids, seniors and people facing addiction to pay for tax cuts.”

Repeal and replace

The proposal comes as Republicans in Congress are trying to coalesce around how to repeal the Affordable Care Act and replace it with a policy of their own devising. Some have called for a total repeal immediately, while others say no effort should go ahead without a program to maintain coverage. Wisconsin’s Walker on Thursday met with Rep. Kevin Brady of Texas, the leader of a key House committee crafting the ACA replacement plans, and discussed health care and taxes.

Thirty-one states expanded Medicaid under the ACA, while some Republican-led states opted not to. Those program expansions brought coverage to about 12 million Americans, and governors have been saying for months that Congress should move carefully. Keeping the coverage expansion intact would benefit companies, including Centene Corp. and Molina Healthcare Inc., which have built big businesses around covering low-income people.

Rob Portman, shown above in a file photo, thinks Donald Trump supports continuation of the Medicaid expansion program. (Photo: Senate)

Rob Portman, shown above in a file photo, thinks Donald Trump supports continuation of the Medicaid expansion program. (Photo: Senate)

Seeking flexibility

Nate Checketts, director of Utah’s Medicaid program, emphasized that there isn’t yet consensus among GOP-led states. But Utah and others like it want flexibility to join the program if it continues, he said.

“If there is a program that’s out there we, as a non-expansion state, and we assume other states like us, want to have access to those funds,” Checketts said.

Rep. Joe Barton, a Texas Republican who sits on one of the committees writing the bills, said he wasn’t surprised by that type of request.

“Governors want more money, longer, with no strings attached,” Barton said Thursday in an interview. “They’ve wanted that for 30 years. They’ll want it 30 years from now.”

‘Workable reforms’

The governors’ proposal was presented to larger groups of governors last week at their winter meeting in Washington, according to the state aides.

“The governor has been pretty clear that he doesn’t want to see the rug pulled out from anyone,” said Christina Corieri, a senior policy adviser to Republican Gov. Doug Ducey of Arizona. “We are willing and at the table to talk about financing reforms to Medicaid, as long as those are workable financing reforms, as long as those are equitable, and as long as we get the flexibility to manage” the program.

States also appear to be coming together around the idea that Congress needs to shore up the individual health insurance market before tackling Medicaid, lest people get shifted into a system where they can’t get affordable coverage. Some Republican proposals in Congress would move some people off Medicaid.

“You can’t move anyone out of the program without some affordable, viable option to move them into,” Arizona’s Corieri said. She said her state is open to the idea of addressing both Medicaid and the individual market at the same time, or separately.

“States do have concerns about what happens to individuals if they’re not covered by Medicaid,” Utah’s Checketts said. “What other options do they have?”

There are signs that President Donald Trump is at least sympathetic. In a Tuesday night address to Congress, Trump said a replacement plan should give governors “the resources and flexibility they need with Medicaid to make sure no one is left out.”

Sen. Rob Portman, an Ohio Republican, interpreted those remarks to mean Trump supports keeping the Medicaid expansion.

“We have to address that population, and that’s what he said,” Portman said in an interview after Trump’s speech. “You can’t leave these people behind.”

—With assistance from Arit John and Steven Dennis.


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