"Not much better." "Counterproductive." "Big concern."
Those are some of the reactions from Republican governors about U.S. House Republicans' bill to repeal and replace the Affordable Care Act (ACA).
After years of calling for an end to the federal health reform law, state GOP leaders find themselves in a tricky balancing act between trying to follow through on their promises and avoiding the political blowback that could happen if their residents lose insurance as a result.
The ACA provided states with funding to make more low-income people eligible for Medicaid. The 31 states that accepted the federal funding -- including many run by Republicans -- have since seen a dramatic rise in the number of residents with health insurance.
But the long-awaited GOP plan to replace Obamacare, which was released on Monday, would likely make health care no longer affordable for those newly-insured and increase expansion states' Medicaid costs.
Starting in 2020, the bill would:
- End federal funds for Medicaid expansion, although states would get $100 billion in grants over several years to stabilize their insurance markets; and
- Shift the decades-old Medicaid funding system to a per-capita cap, which would give states a fixed amount of money for every person who enrolls.
Missing from the legislation is whether states would get more flexibility to do what they want with their Medicaid programs. Many Republican states tried and failed to set Medicaid restrictions like work requirements during the Obama administration. President Trump, however, promised that states would get that during his speech to Congress last month, and that has been a top priority for many GOP states.
The response has been mostly tepid from GOP governors, especially of expansion states, so far. Not a single one has given a full-throated endorsement. The bill also received blowback from some conservative interest groups and GOP members of Congress who have criticized it for keeping too many of the ACA's policies and threatening the loss of insurance for many.
Illinois Gov. Bruce Rauner said that his constituents "won't do very well under the changes that they're recommending, which is a big concern to me."
Brian Sandoval of Nevada, one of the first Republican governors to expand Medicaid, complained that the U.S. House leaders ignored the states' concerns.
"We've said all along, 'Work with the governors,' that it should be a governor-led effort and for the Congress to rely on the governors," he said on Tuesday. "Well, they came out with their own bill, which doesn't include anything that the governors have talked about."
The most vocal opponent of the plan among GOP governors is Ohio's John Kasich, who stood by his decision to expand Medicaid when he caught heat for it during his presidential campaign last year.
“Phasing out Medicaid coverage without a viable alternative," he tweeted on Tuesday, "is counterproductive and unnecessarily puts at risk our ability to treat the drug addicted, mentally ill, and working poor who now have access to a stable source of care."
Other GOP governors in expansion states expressed cautious optimism.
In Vice President Mike Pence’s home state of Indiana, a spokesperson for Gov. Eric Holcomb said the bill is a “correct first step.” However, she acknowledged that if passed as it currently stands, the plan would decrease federal funds for the state’s Medicaid program.
Arkansas Gov. Asa Hutchinson said at a press conference on Tuesday that he "would have liked to have seen more flexibility given to the states." Nevertheless, he introduced a plan this week to narrow the state’s Medicaid eligibility from 138 percent of the federal poverty line to 100 percent and establish a work requirement. If approved, it would remove 60,000 people from the state's Medicaid rolls.
He advised the critics to "remind ourselves that it’s a long process. The announcement is not always the end result."
A spokesperson for Arizona's Doug Ducey on Tuesday said the governor is still reviewing the fine print but “is thrilled a repeal for Obamacare is on the way.”
Even in nonexpansion states that stand to lose less under the plan, some governors are still unhappy.
Maine Gov. Paul LePage, for example, expressed disappointment in the bill, saying it’s “not much better” than the system we have in place now.