Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
March 21, 2017 01:00 AM

GOP governors offer alternative Medicaid reforms, but who's listening?

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    AP Photo
    Ohio Gov. John Kasich

    Governors are analyzing the House Republican bill to restructure Medicaid and phase out the Obamacare expansion of the program, and they don't like what they see.

    That prompted four Republican governors from Medicaid expansion states—John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchinson of Arkansas—last week to offer their congressional colleagues a sharply different Medicaid proposal. In their letter, they wrote that the House bill “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out and shifts significant new costs to states.”

    The letter “does give a little more oomph to nervous senators who say let's not rush into things,” said Joe Antos, a conservative health policy expert at the American Enterprise Institute.

    House GOP leaders seem to have heeded some of their requests, which are partly reflected in an amended bill released Monday to repeal and replace the Affordable Care Act.

    State leaders and advocacy groups are sounding alarms over the likely impact of the American Health Care Act on patients and providers. Arizona's Medicaid agency found that 380,000 residents would lose Medicaid coverage by 2023, and the state would get $2.5 billion less in federal funding.

    By 2030, 600,000 fewer Coloradans would have Medicaid coverage, and the state would lose $14 billion in funding, the Colorado Health Institute reported. Ohio would lose $19 billion to $25 billion in federal Medicaid dollars between 2019 and 2026, according to an independent research group's analysis.

    Prodded by both Republican and Democratic governors, some GOP senators and congressman are urging Republican leaders to change the legislation—which the Congressional Budget Office said last week would reduce federal Medicaid spending by $880 billion, or 25%, over a decade—to mitigate the likely coverage and dollar losses.

    That's why the four Republican governors offered congressional GOP leaders their own detailed proposal last week for how to recraft the program's financing overhaul.

    In their letter, the four governors seemed to be pleading for Congress to slow down and do Medicaid reform right, saying lawmakers should focus first on stabilizing the private insurance market.

    “I do get a sense they're saying let's do this later and more thoughtfully,” said John Corlett, a former Medicaid director in Ohio and now president of the Center for Community Solutions in Cleveland. “I don't know that people thought we'd be tackling this as the first step.”

    Some congressional Republicans are sympathetic to the state leaders' worries. “I also share their concerns about the need to protect the Medicaid expansion population and give governors more flexibility to ensure they can design programs that meet the needs of their states,” Ohio Sen. Rob Portman, whose state has expanded Medicaid to about 700,000 people, said in a written statement. GOP Sen. Dean Heller of Nevada said last week that he could not vote for the current House bill because of the Medicaid concerns raised by the governors.

    But it's unclear whether congressional leaders will fully consider the major changes the governors have proposed, especially given that they want the House to vote on the bill later this week and the Senate to pass it soon after.

    The four governors argued the states should be given the choice of moving to a per-capita cap or block-grant model or keeping the current federal matching structure, with a phase-out of enhanced federal funding for expansion enrollees. The block grant option was included in the amended House bill that came out Monday. But there's no option in the bill to retain the current matching payment system.

    The governors' version of per-capita caps on federal payments would be more flexible and nuanced than the version in the House bill. It would take account of economic downturns and variations in underlying medical costs, rather than being chained to the medical component of the Consumer Price Index. It would phase in spending caps for each beneficiary group, giving states more time to address the complex issues involved. And the funding formula would set a minimum per capita amount and adjustments for relative state poverty levels to promote equity among the states.

    All those features, however, could weaken the constraints on federal spending, which wouldn't make conservatives in Congress happy.

    The amended version of the AHCA released Monday makes another change consistent with what the governors proposed, softening the impact on one highly vulnerable Medicaid beneficiary group. It would set the growth rate of capped federal payments to the states higher for elderly and disabled beneficiaries than for other types of beneficiaries. The governors had urged that federal matching payments to states for the elderly and disabled not be capped.

    The governors also offered a wide range of ideas for giving states greater flexibility in operating their Medicaid programs.

    For instance, under a per-capita grant or block grant model, states could continue to receive enhanced federal funding for Medicaid expansion but would be able to set eligibility at levels below the ACA's current threshold of 138% of the federal poverty level. That's contrary to the amended House bill, which would phase out enhanced federal expansion funding in 2020 and bar any new states from expanding Medicaid coverage.

    Under the governors' proposal, states could choose to block-grant long-term care services and supports and establish it as a separate Medicaid program, with institutional care and home- and community-based care put on a level playing field. If states opt for the block grant model, the federal Medicare program would pick up Medicare cost-sharing for beneficiaries dually eligible for Medicaid and Medicare.

    In transitioning to a per-capita cap or block grant model, the governors urge that states should be given the flexibility to:

    • Establish enrollment caps except for certain populations including aged, blind and disabled people, children and pregnant women

    • Set work requirements for beneficiaries

    • Eliminate temporary and presumptive eligibility

    • Impose cost-sharing and asset tests for eligibility

    • Exclude some Food and Drug Administration-approved prescription drugs from coverage to strengthen states' negotiating clout

    • Limit covered benefits, including early screening and diagnostic services for children

    They also urge giving states sufficient flexibility in designing their own Medicaid programs so that the federal waiver process would be virtually eliminated.

    Corlett expressed concern about some of the governors' proposals, such as setting work requirements, eliminating presumptive Medicaid eligibility and making benefits such as early childhood screening optional. But overall he welcomed their contribution and said it would behoove Congress and the country to have a broader, more deliberate discussion before making big changes in Medicaid.

    “The House GOP plan is, 'We'll take $880 billion out of Medicaid, you governors figure out how to distribute the pain and misery,' ” he said. “I might not agree with all the details of the governors' proposal, but I commend them for putting them down on paper so we can talk about them.”

    But the American Enterprise Institute's Antos said congressional Republicans are not going to pause and debate the governors' Medicaid ideas. He predicts they'll hold their noses and vote for the GOP repeal-and-replace bill.

    “They know every governor is nervous and that many are totally opposed to their bill,” he said. “But the question is, what else is there?”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Abortion clinic
    Idaho hospital halts obstetrical care as abortion laws become stricter
    mh_20160711p29_bills_i.jpg
    State, local governments pay off medical debt relief with COVID funds
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing