GOP hopes to abandon ‘conservative principles’ for ACA replacement
Being dead set against the Affordable Care Act, also known as Obamacare, proved to be very politically successful for Republicans. Now that the party controls both chambers of Congress, it might become a liability from a policy standpoint.
Take for example this excerpt from Politico:
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 №2 Republican. “We’re not going to allow that to happen.”
The GOP is now hoping to reward states that rejected Medicaid expansion due to “conservative principles” by “girding to spend significantly more money.” Apparently the “conservative principle” in question means opposing legislation passed by the opposite party and not cutting down on spending.
Under the ACA, 32 states have adopted Medicaid expansion, while 19 states have not. The federal government paid the full cost of expansion for three years and will cover 90 percent of the cost following that. According to the Health Policy Center, states that accepted Medicaid expansion have a 7.3 percent uninsured rate, while states that did not have a 14.1 percent rate. Per Families USA the 19 states that did not expand have left an estimated 6.5 million people without health insurance.
One of the few Republican ideas to replace the ACA is turning Medicaid into a block grant program. Currently, the cost of Medicaid is a shared cost between the states and the federal government. The funding is open ended and covers everyone with Medicaid. As a block grant, the states would receive a large grant of funding in advance based on the number of Medicaid enrollees. If the federal money runs out, states will either have to cover the entire cost or cut benefits for citizens who are already on the lowest end of the economic scale.
Obviously states that did not expand Medicaid have many fewer enrollees, and therefore would receive smaller block grants. This means that governors, representatives and senators from Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming would need to answer when their home state runs out of federal funding while other states remain flush with funding.
Of course, Republican politicians running these states already put politics in front of their constituents when they refused Medicaid expansion under ACA. At the time, they had a president to blame, but now that blame will fall squarely on them. That is why they appear to be abandoning their “conservative principles” in order to spend.