Republican efforts to repeal and replace (or even fine tune) Obamacare keep running into a seemingly insurmountable object; the desire among many Americans to maintain at least some parts of the ACA, according to STAT. Allowing grown children to stay on their parents’ health plan is one that’s gotten a lot attention. Now, four Republican senators from states that allowed Medicaid expansion under Obamacare are decidedly wary about the GOP’s plans to restructure the program.
Rob Portman of Ohio, Cory Gardner of Colorado, Lisa Murkowski of Alaska, and Shelley Moore Capito of West Virginia yesterday released a letter they sent to Senate Majority Leader Mitch McConnell, saying that, “We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals. Any changes made to how Medicaid is financed through the state and federal governments should be coupled with significant new flexibility so they can efficiently and effectively manage their Medicaid programs to best meet their own needs.”
Portman and Capito are particularly concerned about the fate of substance abuse programs that the ACA helped to bolster. Their states are struggling mightily with the opioid and heroin abuse epidemic.
“As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure,” the senators wrote in their letter.
This puts pro-repeal and replace GOP legislators in a bind because their efforts need full Republican support to succeed, because the GOP controls the Senate by a slim margin of 52 votes.
Medicaid expansion, begun in 2014, allows eligibility to include people under 65 with family incomes up to 133% of the federal poverty level, according to CMS. In addition the federal government paid 100% of state expenditures for newly enrolled Medicaid beneficiaries through 2016. The matching rate will gradually drop to 90% by 2020. The ACA also improves services to beneficiaries, in part by supporting home and community-based care settings.
Republicans have proposed ditching the percentage system and replacing it with block grants. The size of the grants would be based on some specified base year and would presumably be adjusted from year to year to take inflation into account. A variation on block grants would allocate the federal money on a per-Medicaid-beneficiary basis and cap that amount.
The GOP plan would have states receive a set amount from the federal government for each eligible beneficiary. Costs above that cap would be covered by the states. “States would receive a different amount for different populations; they would receive more money for each blind and disabled person, for example,” STAT reports. “The federal spending cap would increase ever year through a formula that is based on overall health care costs.”