GOP governors fight uphill battle to save Medicaid expansion

An effort by Republican governors in Medicaid expansion states to show the expansion is worth keeping is unlikely to influence congressional Republicans in their drive to repeal the Affordable Care Act and its expansion of coverage to low-income adults, Republican experts say.

Instead, congressional Republicans are expected to push ahead to repeal the Medicaid expansion and convert Medicaid from an entitlement to a capped program of federal contributions to the states, said Jon Gilmore, a Republican strategist in Arkansas.

That would give state officials far greater leeway to set eligibility and benefit levels but likely would sharply reduce federal contributions over time. Critics say this type of block grant or per capita grant approach would lead to states reducing enrollment, trimming benefits and cutting payments to providers. Democrats are expected to strongly oppose this initiative.

But Medicaid expansion advocates hope the governors' lobbying will cause congressional Republicans to think twice before wiping out the coverage extension that has brought billions of federal dollars into their states.

Last week, Ohio Gov. John Kasich said expansion has been key to battling opioid addiction in his state, where about 700,000 people have gained Medicaid coverage. “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,” Kasich said.

His administration recently released survey data showing 75% of the people who gained Medicaid coverage were uninsured before becoming eligible for Medicaid, and that more than 1 in 4 have been diagnosed with at least one chronic condition. The report said expanding Medicaid has reduced emergency department use, improved self-reported health, and supported employment and job-seeking.

“Let's say (Congress) got rid of it and didn't replace it with anything. What happens to those 700,000 people?” Kasich told reporters Wednesday. “What happens to drug treatment? What happens to mental health counseling?”

Republican Michigan Gov. Rick Snyder also has urged congressional Republicans to think twice about repealing it. The expansion is projected to cover 620,000 Michiganders by 2020. “I hope they carefully look at the success we've had in Michigan,” Snyder told the Detroit News. “We're seeing a huge increase in coverage.”

Michigan gained than 30,000 jobs and $2.3 billion in economic benefits since expansion, according to a new study from the University of Michigan Institute for Healthcare Policy and Innovation.

In Arkansas, Republican Gov. Asa Hutchinson last week said he asked the incoming administration of President-elect Donald Trump to let states continue to receive enhanced federal funding for expansion. He also asked the Trump team to give states freedom to set stricter eligibility standards and impose new employment requirements.

In North Carolina, new Democratic Gov. Roy Cooper announced he'll seek to expand Medicaid in his state, though Republican legislative leaders there say they will block that move.

Despite these efforts by governors, congressional Republicans seem determined to roll back Medicaid expansion, arguing it's unaffordable for both the federal government and the states. Under the ACA, the federal government will pay 95% of the cost of expanding Medicaid to adults with incomes up to 138% of the federal poverty level. That will phase down to 90% by 2020.

A proposal by Republican House Speaker Paul Ryan to repeal and replace the ACA would reduce the federal contribution for the expansion population to each state's standard federal Medicaid matching rate, which would be closer to 60% on average. Many states likely would end their expansions if they had to come up with the billions of dollars to replace the lost federal funding.

Medicaid spending by the federal and state governments rose 13.9% to $532 billion in fiscal 2015, the first full year of implementation of expansion, according to the Kaiser Family Foundation. The expansion is estimated to have added about 12 million low-income adults to the Medicaid rolls in the 31 states that have implemented the law's expansion.

“It's not sustainable to continue the existing federal match no matter how much the governors getting it are liking it,” said Brad Todd, founding partner of On Message, a Republican media strategy firm.

The nonpartisan Committee for a Responsible Federal Budget has estimated that ending Medicaid expansion would save the government $1.1 trillion by 2027.

Among Democrats, however, there is some optimism that efforts by Republican governors to highlight the benefits of Medicaid expansion could stall congressional repeal efforts. Already, some Republican senators from expansion states, such as Shelley Moore Capito in West Virginia, have expressed reservations about rolling back the coverage extension.

“Votes could change when lawmakers hear from their constituents the benefits they are losing,” said Robert Weiner, a Democratic strategist.