The House Republican plan to phase out the Obamacare Medicaid expansion by 2020 may be a nonstarter for some Senate Republicans—and could potentially threaten the larger repeal-and-replace process.
Shortly before House lawmakers revealed a revamped version of their Obamacare repeal-and-replace bill Monday evening, four Republican senators sent a letter to Majority Leader Mitch McConnell saying they would not support an earlier draft from Feb. 10 that repeals Medicaid expansion because it “does not meet the test of stability for individuals currently enrolled in the program.”
The Medicaid reforms are part of a reconciliation package that would repeal the Affordable Care Act taxes and mandates. It requires only a simple majority to pass the Senate, but Republicans hold only a 52-seat majority, so any three Republican senators can kill the bill. The Medicaid expansion has provided coverage to more than 10 million people in 31 states, about half of which are run by Republican governors.
Sen. Rob Portman of Ohio, who signed the letter, took particular issue with provisions that would not allow new beneficiaries to come in at the higher match rate between now and 2020.
“Our big concern is that between now and 2020 … that you're going to have a real gap,” Portman said Monday, shortly before the House unveiled its legislation. “And so, during this transition period, we were concerned about that House approach.”
The new language repeals the enhanced match rate for newly eligible beneficiaries on Dec. 31, 2019. According to a House Energy and Commerce Committee summary, states can keep the enhanced match for newly eligible expenditures that occur before Jan. 1, 2020. But the language also amends the formula for expansion-state matching so that the matching rate stops phasing up after 2017 and the transition percentage would remain at the 2017 level for each subsequent year.
A spokesperson for Portman’s office said after the new language was released that the senator would review the text and consult with expansion-state governors and policy experts in Ohio before making decisions.
The new bill also retains the plan to reform Medicaid into a per capita cap structure. Fiscal year 2016 would be used as the base year to set targeted spending for each enrollee category.
Sen. Lisa Murkowski of Alaska, who also signed the letter, told reporters on Monday that she was trying to figure out a way forward that treats people in a “fair and humane manner.” She told her state’s legislature last month that she would not vote to repeal the expansion as long as they wanted to keep it.
“I’ve got a situation where in Alaska we’ve got 27,000 people that are now eligible for coverage that didn’t have it before—that really have no place else to turn,” she said.
Portman also said that many of the Republican governors have told him and other senators that they’re interested in transitioning Medicaid to a per capita cap so long as there is “real flexibility.”
Energy and Commerce Committee Chairman Greg Walden told Fox News Channel’s Special Report that lawmakers want to restore power to the states and put Medicaid on a budget.
Sen. John Cornyn of Texas said the senators’ concerns were being heard and that a “good middle ground” could be struck between expansion states and non-expansion states.
The House legislation requires states with Medicaid-expansion populations to redetermine expansion enrollees’ eligibility every six months. It also provides $10 billion in safety-net funding for non-expansion states over five years starting in 2018.