Congressional Republicans are facing a slight problem in their drive to send an Obamacare repeal bill to the president's desk that bypasses the Senate filibuster process: Some Senate Republicans from states that have expanded Medicaid under the law don't want to repeal its big Medicaid expansion, .
The House, mostly on party lines, passed a reconciliation bill last month that would repeal much of the ACA but leave the Medicaid expansion intact. Now more conservative Senate Republicans, including presidential candidates Ted Cruz and Marco Rubio, are calling for a . But they are facing pushback.
“I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included,” said Sen. Shelley Moore Capito (R-W.Va.), who's otherwise opposed to the Affordable Care Act.
Sen. Steve Daines (R-Mont.) told the Hill, “I respect the decision of our legislators and our governor on Medicaid expansion.”
The Hill quoted another Senate Republican, speaking on condition of anonymity, who raised the concern that state leaders who expanded Medicaid would face the loss of billions of federal dollars and be in the position of yanking coverage from millions of people. “I don't want to stick the state with the bill,” the senator said.
About a third of the 30 states that have expanded Medicaid to adults with incomes up to 138% of poverty are led by Republican governors, and GOP leaders in several other states, such as Alabama Gov. Robert Bentley, are discussing expansion. Two GOP presidential candidates, Gov. John Kasich of Ohio and Gov. Chris Christie of New Jersey, have supported expansions in their states.
The state expansions, backed by the hospital industry and by many state and local business groups, have brought billions of federal dollars into those states, significantly reduced the uninsured rate and financially boosted the healthcare industry.
GOP leaders in the House and Senate propose to repeal the ACA this year through the so-called budget reconciliation process, which would avert a Senate filibuster by Democrats and require only a simple majority vote in both chambers to pass. Republicans can't afford to lose more than three votes among their 54-member Senate caucus.
But voting to repeal the ACA's Medicaid expansion could cause major political headaches for incumbent Republican senators facing tough re-election campaigns in Illinois, New Hampshire, Ohio and Pennsylvania. Their Democratic opponents undoubtedly would run campaign ads saying they voted to take away people's healthcare.
If Republicans try to repeal the law but save the Medicaid expansion, however, that presumably would require keeping the taxes that support the expansion, which is projected to cost the federal government $931 billion between 2014 and 2022, according to .
Taking a position in support of maintaining at least part of those ACA taxes while killing the rest of the law would be a dicey political position for members of the anti-tax party who want to keep the expansion. In addition, they would be voting to preserve federally subsidized health insurance for poor people while yanking it away from working- and middle-class people who receive premium subsidies for private exchange plans. That's highly problematic for politicians who tout their support for the hard-working middle class.
Nevertheless, the anonymous senator told the Hill that “repealing the Medicaid expansion is not going to be in (the budget reconciliation bill) because it's too problematic for many Republicans.”
As they say, be careful what you wish for.