Moderate Republican senators from Medicaid expansion states are dropping their opposition to ending the Affordable Care Act's enhanced federal funding for expansion as they embrace the idea of winding down that funding over several years.
Sens. Dean Heller (R-Nev.), Shelley Moore Capito (R-W.Va.), and Rob Portman (R-Ohio) all previously said they wanted to preserve expansion funding, and all indicated last week that they could go along with killing the extra funding if the cutoff was delayed. The three reportedly are pushing to start phasing out expansion funding in 2027, seven years later than House's proposed 2020 start date in the American Health Care Act.
But extending the ACA's expansion funding could create major budget headaches for Senate GOP leaders when the Congressional Budget Office scores its financial impact. Senate reconciliation rules require the bill to produce the same savings as the House bill—$119 billion over 10 years.
"A delayed phaseout of the enhanced (federal contribution) is marginally less harmful than what is currently included in the" AHCA, said Greg Vigdor, CEO of the Arizona Hospital and Healthcare Association, whose state expanded Medicaid. "However, phasing it out whether in 2020 or 2027 will create big problems for Arizona's patients, healthcare system and local economies."