As House Speaker Paul Ryan works to satisfy the concerns of conservative and more liberal Republicans opposed to the GOP’s Obamacare replacement plan, more than 180 state lawmakers are joining the chorus of voices with issues with the bill.
The state legislators, who represent 25 states, sent a letter to Ryan and Senate Majority Leader Mitch McConnell last week conveying their concerns with the Medicaid expansion and laid out changes they’d like to see made to the health care bill.
“This bill offers a historic opportunity for reform, but without some changes to the bill we fear the opportunity might slip away,” the lawmakers wrote.
The state lawmakers specifically take issue with the health care proposal’s plan for phasing out the Medicaid expansion.
The House GOP’s bill, called the American Health Care Act, sunsets Medicaid expansion in 2020.
Until then, states can continue enrolling those who are newly eligible under enhanced federal matching rates. But after 2020, states that continue signing up new enrollees under the Medicaid expansion would receive the traditional federal matching rates, which average 57 percent.
But the lawmakers in statehouses nationwide worry that the bill doesn’t go far enough with repealing Obamacare’s Medicaid expansion, which extended the program to individuals making up to 138 percent of the federal poverty line.
“We have this Medicaid expansion that’s growing at an unsustainable rate with money that’s not going to come from Washington,” Ohio state Rep. Wesley Goodman, R-Cardington, told The Daily Signal. “Give us the flexibility to make the program work for people who need it.”
Goodman and fellow lawmakers who signed the letter urged GOP leaders to make four changes to the bill: freeze enrollment in Medicaid expansion, eliminate enhanced federal matching rates for new Medicaid enrollees, prohibit new states from expanding Medicaid, and repeal Obamacare’s insurance regulations.
The letter from state lawmakers comes just days before members of the U.S. House of Representatives will vote on the health care bill—lawmakers are expected to cast their vote on the plan to undo parts of Obamacare on Thursday, exactly seven years after President Barack Obama signed the Affordable Care Act into law.
And Ryan, the House’s top Republican, has been left to walk a fine line between Republicans at different levels of government who oppose the bill for different reasons.
At the federal level, conservatives in Congress have advocated phasing out the Medicaid expansion by the end of the year. They also say they believe the health care bill does nothing to lower the cost of premiums, since the plan leaves in place the insurance regulations conservatives believe have caused premiums to rise over the last three years.
Centrist Republicans, meanwhile, have said they want to ensure those who are newly enrolled in Medicaid expansion are able to maintain their coverage and are pushing for changes to the age-based tax credits the bill creates.
In their own letter to Ryan and McConnell, four GOP governors who oversee states that expanded Medicaid said they want to see the expansion preserved.
But state lawmakers say they want Republican leaders to fully repeal the Medicaid expansion.
“It’s important that we send as clear a message as possible that states and state legislators are paying attention,” Goodman, who previously worked for Rep. Jim Jordan, R-Ohio, said of the letter to Republican leaders.
“We have a lot of skin in the game, and we want them to give us the tools to actually allow a health care marketplace to grow and thrive,” he continued.
At the start of the 115th Congress in January, House Majority Leader Kevin McCarthy, the House’s No. 2 Republican, said he and other Republican leaders would be soliciting advice from governors and stakeholders at the state level.
Already, the Trump administration is attempting to give states more control over their health insurance markets.
Last week, Health and Human Services Secretary Tom Price sent a letter to governors urging them to apply for Section 1332 State Innovation waivers, which allow states to pursue new approaches to health care.
Goodman said Ohio will likely pursue such a waiver this year, but said he is also hoping Congress turns Medicaid into a block grant program, which the House GOP’s health care plan proposes.
“Give us the flexibility to spend that money,” he said.
Though the House is just days away from voting on the health care bill, Goodman said he believes changes can still be made to the legislation that satisfies his and other state lawmakers’ concerns.
“I’ve been around long enough and watched enough of these federal debates to know this is a long way from over,” Goodman said. “There’s still a lot of moving parts. Lawmakers in Washington need to hear from their counterparts in the states saying we can do better than this and we will do better than this. That’s the message we have, and we’re going to keep up with that message until it’s on the president’s desk.”