Members of the Trump administration are discussing a proposal for Medicaid that they hope will draw more Republican centrists to support efforts to partially repeal and replace Obamacare.
Senators told reporters Thursday that the proposal, being called the Medicaid "wraparound," would allow states to use Medicaid funding toward the health expenses of low-income people who face high healthcare costs but aren't enrolled in the program.
They discussed the plan Wednesday with Centers for Medicare and Medicaid Services Administrator Seema Verma. Under the plan, $200 billion would be added and states also could use funding from tax credits and another $132 billion from the state innovation fund.
Concerns about Medicaid, which covers low-income people, as well as children, people who are disabled, and adults in nursing homes, have been particularly troubling to centrist Republicans as they seek to come to an agreement on a bill that would partially repeal and replace Obamacare. Many senators come from states that expanded the program to low-income people under Obamacare, and some are being pressured by their governors to stand up against the bill, called the Better Care Reconciliation Act.
"It's a positive thing. It's progress," Sen. Rob Portman, R-Ohio, said about the Medicaid provision. Ohio's Republican governor, John Kasich, has fought against the bill's potential changes to Medicaid, even as Ohio's state legislature recently tried to freeze enrollment in the program, saying it had become too costly.
Sen. Bill Cassidy, R-La., suggested he was open to hearing more about the proposal.
"I think there are conversations for more money," Cassidy told reporters. "There has been $200 billion more allocated to resolve this."
It's not clear whether Republicans plan to vote next week to open debate on a bill that would repeal Obamacare and delay implementation of a new plan or another bill that would replace it immediately with other provisions. The "repeal and delay" bill would roll back Obamacare's Medicaid expansion, which funds coverage for low-income people in many states. The replacement plan would take it a step further and over the long term allow states to choose between receiving a fixed amount of federal dollars as a per-capita cap or a block grant. It also reconfigures Medicaid's growth rate to match overall inflation rather than than its current, faster-increasing medical inflation.
The Congressional Budget Office released a report Thursday that estimates the changes in the replacement bill would result in cuts of $756 billion in federal spending on Medicaid and would shed 15 million people from the program.
The CBO score did not include the $200 billion being considered for the wraparound, but it did indicate that the latest draft of the legislation freed up $300 billion more by keeping some of Obamacare's taxes on wealthier people. That means that Senate leadership would be able to allocate the funding to win over the support of senators concerned about Medicaid.
Cassidy was asked why the wraparound proposal hadn't been raised before.
"They put a lot more money into it," he said. "Show me the money, right? If there's another way to make it real, that somebody making a lower income and nonetheless get the assistance she needs to afford insurance, that matters."