Four GOP governors come out against ACA budget measure

(Bloomberg) — Four Republican governors told top lawmakers in the U.S. House and Senate that they oppose the current GOP plan to de-fund the Affordable Care Act, and that they want Congress to preserve an expansion of the Medicaid health program for poor Americans.

In a letter Thursday, governors from Ohio, Nevada, Michigan and Arkansas wrote Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan and said the legislation the House is considering “does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.” They said the bill “does not meet” goals set out by President Donald Trump about state flexibility and making sure people are covered.

The governors presented the GOP leaders with an alternative proposal on Medicaid that would keep an expansion of the program and make it available to other states that didn’t expand it under the Affordable Care Act. The House Republican bill would wind down the current Medicaid expansion starting in 2020.

Republicans’ Obamacare replacement is making its way through the House of Representatives, and has been approved by three of four committees it will pass through on the way to a vote, which could happen as early as next week. Yet it’s heading for a collision with the internal politics of Republicans in the House and Senate, where conservatives have been pushing to wind down the Medicaid expansion as soon as next year. Such a move is opposed by Republican moderates whose votes are critical.

Medicaid states

The four governors all run states that expanded Medicaid to people making as much as 138 percent of the federal poverty level. Under Obamacare, the federal government pays for almost all of the cost of that expansion, and the governors want that support to continue. They also say states that had opted against expanding Medicaid should be able to do so in the future, including at a lower income threshold.

The state governors include Ohio’s John Kasich, Michigan’s Rick Snyder, Nevada’s Brian Sandoval and Arkansas’s Asa Hutchinson.

Change to bill

Rep. Phil Roe of Tennessee, a member of the House GOP vote-counting team, told reporters after a meeting of Republicans on Friday on Capitol Hill that the bill will be changed to include a block grant option for states and the option for states to implement a work requirement

The governors say in their letter that they oppose the Affordable Care Act, calling it “unsustainable.” Shoring up the law’s individual markets should take precedence over changes to Medicaid, they said, so that some individuals currently covered by that program could be shifted to private coverage.

“Access to affordable coverage outside of Medicaid for low-income individuals is critical to the effort to reduce reliance on Medicaid,” the governors wrote. “As we embark on this complex effort, we must ensure that individuals are not left without access to care.”