As congressional Republicans move forward on plans to quickly repeal and ― less quickly ― replace President Barack Obama’s health care law, a wide variety of industry and political influencers are trying to slow their progress. Among the most persuasive may be a set of Republican governors who are fearful about losing the substantial health and monetary benefits from the law that their states currently enjoy.
On Friday morning, Politico reported on five such GOP governors who have been publicly calling on lawmakers to consider keeping the portion of the Affordable Care Act that supports the expansion of Medicaid in states that choose to.
Behind the scenes, these same governors are also working to persuade lawmakers from their states and those who have purview over the repeal and replace strategy that it would be wise to keep some portion of the federal matching funds for states that have pursued Medicaid expansion.
Ohio Gov. John Kasich (R), for one, is set to meet with Senate Finance Committee Chairman Orrin Hatch (R-Utah) as well as other committee members next week to discuss his concerns about full repeal, a source close to Kasich confirmed. Michigan Gov. Rick Snyder (R), meanwhile, has been in talks with members of Michigan’s delegation as well as President-elect Donald Trump’s transition staff about maintaining his state’s Medicaid expansion program.
“He also has been open to discussing with them other ideas they may have regarding changes to the ACA,” Snyder spokesman Ari Adler said. “Too often, it seems that the ACA gets reported on as an all-or-nothing package, but there are many separate components that exist. In Michigan’s case, we took the idea of Medicaid expansion, made it our own, improved it and made it work better. But, as you know, everything is up for discussion and the Governor is happy to have those discussions.”
Kasich and Snyder aren’t the only Republican governors who run states that have expanded Medicaid under the Affordable Care Act. Nor are they the only ones who have warned about the potential losses in coverage or budgetary holes that might come if the law is repealed. GOP Govs. Charlie Baker of Massachusetts, Asa Hutchinson of Arkansas and Brian Sandoval of Nevada have offered similar concerns.
Democratic governors from Medicaid-expansion states have also been in touch with their congressional delegations in hopes of convincing them to pump the brakes on ACA repeal.
Pennsylvania Gov. Tom Wolf (D) told The Huffington Post that he’s sent individualized letters to each member of the delegation detailing the consequences for their districts and state of taking Obamacare off the books: chief among them being 700,000 Pennsylvanians potentially losing their coverage, community hospitals facing a massive financial crunch and a drop in services for those dealing with substance abuse. For the past few weeks, Wolf has also barnstormed the state, meeting with health care officials and constituents dependent on the law, to discuss what a post-Obamacare landscape would look like. It is those conversations ― and the subsequent ability to convey the real-world impact of repeal ― he said, that made him and other governors effective advocates for trying to keep parts (if not all) of Obamacare in place.
“I think all they [Kasich and Snyder] are doing is what a good lobbyist is supposed to do which is explain the facts,” Wolf said. “We are telling our delegations, ‘Here are the facts. This is what is going to happen. Are you willing to face those consequences if you do this?’”
So far, Republican lawmakers appear to be willing to face those consequences. As HuffPost’s Matt Fuller reported, the House appears poised to have a majority of lawmakers supporting wiping Obamacare off the books. The dynamics in the Senate are less certain, since all Democrats need to do (assuming they vote uniformly) is convince three Republicans to cross the aisle. But with Trump now fully embracing repeal, lawmakers on the Hill feel additional pressure to place their focus on the replacement instead.
Should it get to that point, there is a possibility that some of the Medicaid expansion may be restored, albeit in a reduced size and scope (think: coverage for those up to 80 or 100 percent of the poverty line, rather than 133.). But while that might attract Democratic votes, it wouldn’t be a simple legislative gambit. Lawmakers would need to find a way to pay for it. And keeping items like the reductions in Medicare spending and some of the Affordable Care Act’s tax hikes would prove to be far less politically popular.