Republicans are worried that more states expanding their Medicaid programs under Obamacare could make future efforts to repeal the law more complicated.
In the wake of the House GOP leadership pulling its Obamacare repeal bill on March 24 and Speaker Paul Ryan declaring that Obamacare is the “law of the land,” swing states and Republican-led states such as Virginia and Georgia are considering expanding Medicaid.
Last week Ryan and several House Republicans said they remained committed to repealing Obamacare but haven’t agreed on a timeline for bringing up a new bill.
Some Republicans are wary of states’ expanding Medicaid in the interim. Nineteen have not expanded the health insurance program for low-income residents under the Affordable Care Act.
“The problem is it’s always about the money,” said Rep. David Schweikert, R-Ariz. “Every time you do this type of expansion you build another constituency that wants the money, whether it be hospitals or medical providers.”
Rep. Trent Franks, R-Ariz., added that there is a “good chance some states will try to outrun anything that we do here.”
Franks said there is an “incentive for us to be expedient” and that he worries about the sustainability of the Medicaid program and funding the extra states.
Other Republicans said they want states to hold off on making any decisions until Congress moves on an Obamacare repeal.
“I wouldn’t make any rash moves,” said Rep. Phil Roe, R-Tenn. “I would wait and see what this legislature does first.”
House Freedom Caucus Chairman Mark Meadows, R-N.C., also said that states need to wait and see what happens.
However, no firm timetable has been set for if and when Obamacare will be repealed. After the bill was pulled Friday because of insufficient support from both conservatives and moderates, House GOP leadership and the White House said they would move on to tax reform.
While Congress tries to figure out its next step, states are revisiting the idea of expanding Medicaid.
Georgia Republican Gov. Nathan Deal said last week he is open to expansion as long as Obamacare remains in place, according to several reports.
Virginia Gov. Terry McAuliffe, a Democrat, signaled he wants to try again to expand Medicaid, having been unsuccessful several times in his tenure.
Kansas’ state legislature passed an expansion last week, but Republican Gov. Sam Brownback vetoed it Thursday, and the legislature doesn’t have enough votes to override the veto.
Maine voters will hold a ballot referendum this year on the expansion, as Republican Gov. Paul LePage has fiercely resisted the move.
In a twist, states could see more flexibility from the federal government if they do decide to expand their programs.
Health and Human Services Secretary Tom Price and Seema Verma, head of Centers for Medicare and Medicaid Services, sent a letter to states saying that the Trump administration will work with states on waivers and on any changes they want to make to their programs. Verma helmed Indiana’s Medicaid program, which received a federal waiver.
Medicaid expansion likely will play a key role in any future repeal effort, just as it did in this go around.
The Republican repeal bill, the American Health Care Act, drew concern from GOP moderates in states that expanded Medicaid about the fate of their residents who received the coverage. For instance, four GOP moderates in the Senate wrote to GOP leadership calling for the expansion enrollees to be protected.
Additional state expansions of Medicaid would lead to more GOP lawmakers who have a vested interest in the future of those enrollees.
The GOP repeal bill kept the Medicaid expansion in place until 2020 in an effort to assuage concerns from lawmakers from the expansion states. After that it would have converted Medicaid funding from fee-for-service to a per capita limit, which caps federal funding per Medicaid beneficiary.
States that didn’t expand Medicaid would have received bigger federal payments for charity care, which were cut under Obamacare.
House leadership later agreed to amend the bill to prevent new states from expanding and added a work requirement and optional block grant funding to appease conservatives.
