GOP Senators Can’t Agree On Medicaid Reform

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Robert Donachie Capitol Hill and Health Care Reporter
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A handful of conservative senators are pushing for steep cuts to Medicaid, but face a formidable obstacle from Republican senators in states that participated in Obamacare’s Medicaid expansion program.

Conservative senators are seeking an immediate roll back of the federal money granted to the Obamacare Medicaid expansion program, under the rationale that serious cuts to the program’s funding would force states to make prudent decisions regarding how they choose to spend Medicare funds.

Some 20 Republican senators are in states that chose to expand Medicaid under Obamacare, and many are concerned about the number of Medicaid recipients who would lose coverage under the American Health Care Act (AHCA).

If Republican lawmakers push for any more cuts to Medicaid funding, moderate senators are signaling it could mean the end of the line for the AHCA. “As soon as you move further that direction, you’re going to lose about six or eight people. So I don’t see how that works,” Republican Sen. Shelley Moore Capito of West Virginia told reporters.

The Affordable Care Act funneled hundreds of billions of dollars to states that chose to expand Medicaid. The program brought millions of Americans into the health insurance marketplace, and any funding cuts to that program will lead to some losses in the number of Americans with health insurance.

The Congressional Budget Office (CBO) projected in March that 24 million Americans would lose health insurance if Congress passed the AHCA, with a large portion of the loss stemming from Medicaid consumers. The CBO estimated that the AHCA would cut $839 billion from Medicaid over the next decade.

The AHCA, with the addition of the MacArthur amendment, lets states opt-out of certain provisions of Obamacare through waivers. Critics of the House bill argue that if states were able to obtain a waiver, millions of Americans who get health insurance through Medicaid, especially those who obtained it through Obamacare’s Medicaid expansion program, would lose coverage.

The House bill actually enhances federal funding for the 31 states and the District of Columbia that chose to expand its Medicaid program. As long as a state signed up for Medicaid expansion before 2020, the AHCA does nothing to change its levels of funding.

Some conservatives, like Sens. Ted Cruz of Texas and Rob Portman of Ohio, think the House bill was a “positive step” towards repealing and replacing Obamacare but acknowledge critics’ concerns.

Cruz says that a “number of senators,” including himself, are concerned about the potential loss to Medicaid recipients under the AHCA. Portman said he “couldn’t support the House bill,” because he “didn’t believe it provided adequate coverage for people who are currently being helped by expanded Medicaid.”

One potential compromise for Senate Republicans would be to push the timetable for phasing out Medicaid expansion funding, which would help appease Portman and other senators in expansion states.

Democrats in the Senate are sure to oppose any Republican proposal to repeal and replace Obamacare, as they feel a duty to support former President Barack Obama’s hallmark legislative achievement. A slew of negative coverage surrounding the AHCA and a CBO score that predicts massive losses in insurance coverage have Democrats angling to use Obamacare repeal as a chief campaign issue in the upcoming 2018 mid-term elections.

With Democrats united in opposition, Republican lawmakers will have to reach a consensus to pass the AHCA in the Senate–a task that is proving more difficult by the day. If the Senate passes a bill that guts Medicaid even more than the House proposal, Republican senators in expansion states could face a lot of heat in the 2020 election cycle.

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