(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.
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.
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)
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.