In the early morning hours on Thursday, U.S. Senate Republicans jammed a provision through that will speed up the process of repealing the Affordable Care Act (ACA), President Obama's signature health reform law.
Congressional Republicans voted to repeal Obamacare dozens of times throughout the last few years, but the threat of a presidential veto always stood in their way. With Donald Trump's election giving Republicans full control of Congress and the White House, though, the debate has largely become not whether Obamacare will be repealed -- but how quickly the law will be replaced and what will appear in its place.
Of the 31 states that adopted one of Obamacare's biggest provisions, Medicaid expansion, 16 of them have Republican governors. If that provision isn't part of the replacement plan, states would likely lose millions of dollars in federal funding for health care. Even if Medicaid expansion is carried over into the new plan, millions of low-income people could lose health insurance if there's a gap between repealing and replacing the law.
That puts many Republican governors, some of whom have long criticized the ACA, in a tough spot and for many, up against their Republican counterparts in Congress. On Thursday, GOP governors will discuss Medicaid with members of the U.S. Senate Finance Committee.
In the meantime, here’s a rundown of the Republican governors who, as of Friday morning, have been most outspoken about a potential repeal since the election. The list includes governors in states that expanded Medicaid as well as those in states that refused.
Arizona Gov. Doug Ducey
Arizona is a red state that expanded Medicaid, but that isn’t because of Ducey. His Republican predecessor Jan Brewer made it happen with a special session in 2014. Still, Ducey was one of the first GOP governors to urge Congress not to be hasty with a repeal.
“I don’t want to see any Arizonan have the rug pulled out from underneath them in terms of changing this law,” he said earlier this month.
Ducey has called the ACA a "monumental failure," but 400,000 low-income people in his state now have health care because of it, and he said repealing the law without an immediate replacement is unacceptable.
Arkansas Gov. Asa Hutchinson
Like Ducey, Hutchinson inherited Medicaid expansion from his Democratic precedessor, Mike Beebe. He passed it through the legislature with the help of a federal waiver that lets recipients use Medicaid money to buy insurance in the private market.
Since then, several other states adopted Arkansas' "private option" compromise. Now Hutchinson wants even more flexiblility, like the right to impose work requirements and drug tests on recipients.
But, he's also asked Congress to keep the current amount of federal funds for Medicaid expansion in place.
Kentucky Gov. Matt Bevin
Bevin’s current stance on Obamacare is surprising, considering his 2015 campaign hinged on repealing Medicaid expansion in his state.
Earlier this month, he expressed reservations about Congress repealing the ACA without an immediate replacement. Speaking to Fox News, he said that a replacement should come the "same day" as repeal.
“It's unfortunate, but I think that may be the reality. Whether people like it or not, reality does have to come in to play.”
Despite his campaign promises, Bevin didn’t touch Medicaid expansion -- likely because it made more than 600,000 Kentuckians newly eligible for health care.
Massachusetts Gov. Charlie Baker
Under the leadership of former GOP Gov. Mitt Romney, Massachusetts created what became the blueprint for the Affordable Care Act. The state now has the nation's highest insured rate, at 97 percent, and Baker appears to be protecting the legacy that his state helped to create.
On Wednesday, Baker wrote a letter to Congressional Republicans, urging them not to shift more health-care costs back to states and to consider the impact the law has had on Medicaid because it is "an important safety net."
Michigan Gov. Rick Snyder
Like Baker, Snyder is also advocating for Congress to keep Medicaid expansion.
“I hope they carefully look at the success we’ve had in Michigan, because we didn’t just do Medicaid expansion,” he told The Detroit News in December.
Michigan expanded Medicaid through a special waiver that allows the state to charge some recipients income-based premiums. Since its launch in 2014, more than 600,000 residents have enrolled in the program. Congressional Republicans will almost certainly retain, if not increase, the flexibility that states have to operate Medicaid -- something Snyder likes.
Nevada Gov. Brian Sandoval
Sandoval was the first Republican governor to go all-in on Medicaid expansion, and 90,000 residents have gotten coverage because of it. In a letter to Congressional Republicans this month, he warned of the consequences of repealing Obamacare without a replacement plan in place.
New Mexico Gov. Susanna Martinez
In December, it was reported that Martinez, along with the state’s insurance superintendent, sent a letter to Congressional Republicans urging them not to repeal the ACA. However, it eventually came to light that the letter was a draft that neither of them saw.
After that, Martinez -- who expanded Medicaid relatively early, in 2013 -- doubled down:
“The governor opposes Obamacare and believes it needs to be replaced with a system that doesn’t hurt small businesses and doesn’t raise premiums on our families," according to her spokesperson.
Ohio Gov. John Kasich
The former presidential candidate, who was the only GOP candidate to support Medicaid expansion, has been perhaps the most vocal about keeping certain aspects of the law in place -- at least until there's a replacement.
“There’s room for improvement, but to repeal and not to replace, I just want to know what’s going to happen to all these people who find themselves left out in the cold,” he told reporters earlier this month.
More than 700,000 Ohioans received coverage under the expansion, which Kasich enacted without the support of his legislature.
Florida Gov. Rick Scott
Scott, one of Trump's earliest backers, has been one of the most vocal supporters of repealing Obamacare.
He met with President-elect Trump and Health and Human Services Department nominee Tom Price in December where he said he was excited to finally have an ally in the White House on health care. Earlier this month, he penned a letter to House Majority Leader Kevin McCarthy urging Congress to repeal Obamacare as soon as possible.
“For far too long, it has been fashionable in Washington to say Obamacare can only be tweaked,” wrote Scott.
While he didn’t address the gap if the law is repealed without an immediate replacement, he said he wants more flexibility with state Medicaid programs, the requirement to have health insurance removed and more cross-state insurance plans.
Utah Gov. Gary Herbert
Utah didn't expand Medicaid, but that's not because Herbert didn't want to. He pushed hard for it and helped craft a compromise that would have required federal approval. But before it made it to the feds, the legislature voted it down.
Herbert hasn't said much about expansion since then, but he has voiced support for Medicaid block grants, which would let states use Medicaid money virtually however they want and has the support of Trump.
Wisconsin Gov. Scott Walker
Walker has remained steadfast in his opposition to the Affordable Care Act, and he wants Congress to repeal it quickly -- but smartly.
He has proposed a wind-down period with “a proper amount of time to transition people from the current program to a market-driven system,” he wrote in a letter to McCarthy.
Like Herbert, he also expressed enthusiasm for the idea of Medicaid block grants, explaining that “sending funding for Medicaid back to the states will ensure that the program is more effective, more efficient and more accountable to the people.”