GOP Governors Worried About Obamacare Repeal

GOP Governors Worried About Obamacare Repeal
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Lawmakers aiming to repeal Obamacare are facing cautions from some unlikely sources: Republican governors.

On the eve of Donald Trump’s inauguration, nearly a dozen Republican state executives traveled to Capitol Hill to share with GOP senators their concerns about the impact repealing the health care law would have on the poorest beneficiaries in their states.

More than a dozen Republican governors accepted, to varying degrees, federal funds offered under the Affordable Care Act to expand Medicaid coverage in their states. Among them: incoming vice president Mike Pence, who as governor of Indiana added more conservative alterations to require some buy-in from beneficiaries. While the governors generally oppose the law, and support having more flexibility over policy in their home states, several have noted successes under the Medicaid provision and are now grappling with how to handle the hundreds of thousands of residents benefiting from the program.

“Thirty-one states—more than half of them with Republican governors—extended Medicaid coverage,” wrote Ohio Gov. John Kasich in a letter to Senate Finance Chairman Orrin Hatch. “Those that did are experiencing significant positive benefits.” The governor argued that beneficiaries in his state have found the coverage has enabled them to find or keep a job and avoid costly hospital trips.

But the governors at the meeting Thursday also discussed ways to curb the costs of Medicaid in their states – namely, by getting more flexibility from the federal government. One proposal, from Kasich, would have provided Medicaid to those at 100 percent of the federal poverty level – Obamacare allowed it up to 138 percent – and putting the remaining beneficiaries on the health exchanges.

“How do you get this package in such a place that you’re really covering people and their real needs?” Kasich said. “Flexibility will help."

The meeting showed some of the issues GOP lawmakers confront as they push toward a swift repeal of the ACA and debate ideas for a replacement. Though they’ve aimed to repeal the law since its inception, they’re now facing the political and policy complications of dismantling it.

As Trump prepares to make good on his campaign promise to roll back the law, he and his party are running into entrenched Democratic opposition and nuanced divisions inside their own party.

When it comes to Medicare, the federally subsidized insurance for seniors, Trump and Republicans are farther apart, as the incoming president has pledged not to touch the so-called entitlement program that House Speaker Paul Ryan has been desperate to reform.

But on Medicaid, insurance for the low-income earners, Trump and party leaders are on the same page. Repeal plans suggested by both the new president and Ryan include distributing Medicaid to the states in block grants, a conservative proposal intended to give governors more flexibility in administering the program but which will also likely include fewer federal dollars than the current law provides. But Republican governors who have accepted the expansion under Obamacare are worried about kicking recipients off their Medicaid rolls.

Governors from Arkansas, Florida, Idaho, Iowa, Kansas, Michigan, Ohio, South Dakota, Texas, and Utah attended a roundtable discussion hosted by the Senate Finance Committee. Committee chairman Hatch said it was “paramount” to hear from governors on the issue, and most of the lawmakers leaving the meeting said they didn’t explain plans for reform, but rather spent the time listening to executives’ concerns.

Some GOP governors inherited the Medicaid expansion in their states when they took over from their Democratic predecessors, and some are supportive of block grants for the program. “GOP governors want to be given the reins and to innovate in the states," said Jon Gilmore, a former deputy chief of staff to Arkansas Gov. Asa Hutchison. “The appetite is for a repeal, but repeal and replace, and the hope they will listen to the governors."

Kasich and Michigan Gov. Rick Snyder have been among the most vocal in their concerns about repealing the Medicaid component of the health care law. The expanded programs in Ohio and Michigan insure 700,000 and 640,000, respectively.

Complicating the issue is the fact several of these governors represent states Trump won in November. Ohio and Michigan in particular played a key role in electing Trump. Neither governor endorsed him.

“When Congress is looking at ways to devolve federal power and put it in the hands of states, that’s a good thing,” said Jenny Beth Martin, co-founder of the Tea Party Patriots, a group advocating for, among other items, a swift repeal of the health care law. “I would remind [Republican governors] that voters in their states just elected Donald Trump, and he ran on a pledge to repeal Obamacare.”

Kasich touted his support of the Medicaid expansion provision during his own unsuccessful run for the presidency. He defended his position in religious terms during the campaign, evoking the gates of heaven and St. Peter asking those who would enter “what you did for the poor.”

Trump, meanwhile, campaigned on repealing the health care law in its entirety, and criticized Kasich, who he said “expanded Obamacare in Ohio.”

The two candidates never reconciled. Kasich boycotted the nominating convention and refused to support Trump, as many of his former rivals ultimately did. And earlier this month, Trump actively campaigned against Kasich’s choice for chairman of the Ohio GOP, Matt Borges, by backing eventual winner Jane Timken.

While Trump is unlikely to be swayed by Kasich or the other governors, lawmakers on Capitol Hill are more compelled to be on the same page as their constituents. Twenty GOP senators represent states that have expanded Medicaid under the current law, and some of those same senators have been vocal with their concerns about repealing it before a replacement is agreed upon.

“The vast majority of people that got insurance under President Obama's Obamacare, the Affordable Care Act, got it through Medicaid," Sen. Rand Paul of Kentucky told CNN last weekend. "What we have to decide is what can be kept and what can't be kept. And that's going to be part of repeal."

A Politifact assessment determined that among the 20 million people who gained coverage under Obamacare, approximately 14 million received coverage through Medicaid, though maybe as many as half of those beneficiaries would have already been eligible for the program. Under the law, the federal government subsidized 100 percent of the coverage for the first three years of the program, starting in 2014. By 2017, the government will pay roughly 95 percent, and 90 percent by 2020. Those earning 138 percent of the federal poverty level are eligible under the law.

Along with their concerns about reducing costs, governors and lawmakers worry about the millions of people who gained coverage over the ACA and the uncertainty of whether those individuals will retain coverage under a Republican plan. Those concerns were amplified this week when Trump promised “insurance for everyone,” while most lawmakers have said their hope is for “access” to insurance for everyone.

Kasich wouldn’t claim that everyone in Ohio who gained coverage would retain it, telling reporters, “I can’t guarantee anything. I’m down here trying to do my best to make sure we have a good plan."

Sen. John Cornyn, the Republican whip, however, was more optimistic in his assessment of coverage under a GOP plan.

Americans will not be left without health insurance, Cornyn said. “We’re all concerned, but it ain’t gonna happen. Will you write that down? It ain’t gonna happen,” he said after leaving the meeting. “Nobody is going to lose coverage."

Caitlin Huey-Burns is a national political reporter for RealClearPolitics. She can be reached at chueyburns@realclearpolitics.com. Follow her on Twitter @CHueyBurnsRCP.

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at jarkin@realclearpolitics.com. Follow him on Twitter @JamesArkin.

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