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GOP Conservatives and Moderates Split on Obamacare Repeal

Medicaid-expansion states throw a monkey wrench into “repeal and replace”

Hard-right and more-centrist Republicans are divided over both policy and strategy for repealing and replacing the Patient Protection and Affordable Care Act (PPACA), according to an article posted on the Modern Healthcare website. One of their biggest disagreements is over the future of the PPACA’s expansion of Medicaid coverage. Conservatives want to eliminate it, while several GOP senators and governors want to keep it.

Sixteen states that expanded Medicaid have Republican governors, including Arizona, Arkansas, Indiana, Iowa, Kentucky, Michigan, Nevada, and Ohio. In addition, approximately 20 Republican senators represent expansion states.

According to documents obtained by the Associated Press, the GOP’s plan to “repeal and replace” the PPACA would soften the Medicaid changes for states and health care providers by temporarily providing additional Medicaid funding to the states. But it’s expected that, over time, the amount of federal funding would decline significantly.

House Speaker Paul Ryan (R-Wisconsin) has promised to introduce repeal-and-replace legislation when the House returns from recess on February 27. Ryan also stated that the House will repeal most of the PPACA via a budget-reconciliation bill by early April. He indicated that the bill will include some replacement features, such as expanded health savings accounts and age-based premium tax credits.

The day before Ryan’s announcement, leaders of the conservative House Freedom Caucus, joined by Senator Rand Paul (R-Kentucky), demanded that Republicans quickly repass their 2016 budget reconciliation bill to repeal most of the PPACA. The bill would erase federal funding for Medicaid expansion after two years.

Meanwhile, Senate Republicans lunched with newly confirmed Health and Human Services Secretary Tom Price, hoping to learn about the Trump administration’s plans for dismantling the PPACA. But senators who attended said they heard no specifics from Price.

Senator Mike Rounds (R-South Dakota) said the secretary promised that the administration would work with Congress on legislation, and that it was making PPACA repeal and replacement a top priority. Rounds predicted that crafting legislation would likely take another two months, and that the transition to a new system would take two to three years.

Rounds also said there was discussion during the lunch with Price about equalizing federal Medicaid contributions between the 31 states that have expanded Medicaid and the 19 that have not, including his own state. But the governors of the expansion states would resist taking away the expansion money that has provided coverage to many of their residents, and that could derail the PPACA replacement plan, he explained.

Source: Modern Healthcare; February 18, 2017.

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