GOP Senators Cry Foul Over Medicaid-Expansion Repeal

House Republicans unveiled their Obamacare repeal-replace legislation, just after four Republican senators expressed concern about plans to repeal Medicaid expansion.

Sen. Rob Portman
AP Photo/Alex Brandon
March 6, 2017, 8:53 p.m.

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.

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