It’s all part of the GOP’s long-term plan to dramatically revamp the health care entitlement for the poor in order to cap what they see as runaway federal spending.
But growing the program, even as an act of political expediency, would mark a major break from GOP campaign slogans and conservative orthodoxy on spending.
“Is it possible to avoid a food fight?” said Tom Scully, who ran CMS in the George W. Bush administration. “No. The way to make it equal and fair is to spend more money.”
Medicaid is the nation’s biggest insurance program, covering 69 million people, or more the one in five Americans.
But it remains a patchwork quilt after the Supreme Court upheld the constitutionality of Obamacare’s individual mandate but made its Medicaid expansion optional. Thirty-one states expanded their Medicaid programs to help realize the law's coverage expansion while 19 largely Republican-led ones held out, willing to sacrifice billions in extra federal cash to expand their covered populations.
States of those hold-out governors could wind up the biggest losers if GOP lawmakers make good on their longstanding vow to cap federal spending by giving states lump sums tied to the number of Medicaid enrollees. So congressional Republicans are girding to spend significantly more money — at least in the short term — to effectively reward the non-expansion states for their resistance.
The goal, at the very least, is to ensure funding parity between expansion states that would stand to get more money under a capped program and conservative holdouts like Texas, Georgia and Tennessee.
“States that chose not to [expand] based on conservative principles and opposition to the takeover of health care should not be punished," said Sen. John Cornyn (R-Texas), the chamber's No. 2 Republican. "We’re not going to allow that to happen."
