Republicans on the Senate Finance Committee may get an earful Thursday from Republican governors about congressional plans to repeal the Affordable Care Act’s Medicaid expansion and cap the program’s funding.
Finance Committee members have scheduled a roundtable discussion on what governors want to see in a plan to replace the ACA and how to give states more flexibility in running Medicaid. But at least five of the 16 Republican governors of large states that expanded Medicaid to low-income adults have come out against ending the expansion without offering a way to keep millions of their residents insured. Some have said the expansion dollars have helped their states address the opioid addiction and behavioral health crises.
In 2016, the 31 states that expanded Medicaid received $72 billion in extra federal dollars due to the expansion. “Those governors are finding that hundreds of thousands of additional people have come into coverage, and the financing is baked into their budgets,” said Deborah Bachrach, a partner at Manatt Health and former Medicaid director of New York. “After you pull out the funds, you are left with a budget hole.”
House Speaker Paul Ryan wants to sharply reduce the federal contribution for the expansion population. But seven states have laws requiring termination of their expansions if the federal match drops, she noted. The rest would have a tough time keeping their expansions due to budget pressures.
In addition, the GOP governors Thursday are likely to offer cautions about their party’s plan to convert Medicaid from an entitlement to a program of capped federal contributions to the states, either in the form of block grants or per capita payments. That would give states much greater flexibility to set eligibility and benefits.
“All governors would like more flexibility,” Bachrach said. “But the concern that’s starting to emerge is, are the additional flexibilities worth the trade-off of fewer federal dollars?