Understand how we got here — and how to move forward.


February 28, 2017

At national meeting, governors split sharply on health care

Daily Briefing

Republican and Democratic governors in Washington D.C. this weekend for their national meeting said a key health reform issue for them is how federal lawmakers should handle health care reform.

The National Governors Association's winter meeting took place amid ongoing conversations among Republican lawmakers and the Trump administration on how to attempt to repeal and replace the Affordable Care Act (ACA). Republican lawmakers have proposed changing Medicaid into a block grant or per capita cap program, which would give states a lump sum of money along with greater flexibility to run their programs—rather than the current policy model in which the federal government pays a percentage of the costs of providing Medicaid coverage.

Governors discuss switching Medicaid to a block grant model

Virginia Gov. Terry McAuliffe (D), chair of the National Governors Association, said, "Health care was probably the biggest topic we discussed." He added, "We agree: We do not want any citizen to lose access to quality health care. We actually want to expand so everyone has access to quality health care."

Both McAuliffe and Maryland Gov. Larry Hogan (R) signaled openness to GOP proposals to change the way the federal government pays for Medicaid, but said they would need to know the funding details before they could support the idea.

Michigan Gov. Rick Snyder (R), whose state expanded Medicaid to an additional 625,000 residents under the ACA, said he would welcome a block grant proposal. "What we need to show them is how we can do it more effectively than the federal government," he said.McAuliffe said, "We're not close to an agreement that we can live with at the moment," adding, "But the devil is in the details."

Republican, Democratic governors divided on how to handle Medicaid expansion states

Utah Governor Gary Herbert (R) noted that a key question on governors' minds is how to allocate Medicaid funding between states that expanded their programs under the Affordable Care Act (ACA)—and thus received additional federal funds—and other states, such as Utah, that did not. "[W]e need to get as close to fairness as we can," Herbert said.

Meet the Republican governors who want to save Medicaid expansion

Alabama Gov. Robert Bentley (R), who governs a state that has not expanded Medicaid, said he was open to finding a solution that helps states that expanded their programs—provided the solution does not come at the expense of those that opted not to expand. "There were 18 governors that fought the ACA and we actually need to be rewarded for that, not punished," Bentley said.

Governors of expansion states also are concerned about the fate of their newly insured residents. Nevada Governor Brian Sandoval (R) said the conversations at Monday's meeting made him "feel good" that people who gained coverage under the expansion would be able to keep it. "My baseline is to protect the 300,000 people [in Nevada] that were part of the expansion and make sure that they continue to have coverage," he said.

But Kentucky Governor Matt Bevin (R), there has been too much focus on the number of insured people and not enough on the quality of the coverage or overall population health. He argued the ACA "has not been successful anywhere, including in Kentucky," according to Bloomberg.

Ohio Gov. John Kasich (R), who opted to expand Medicaid in his state, is reportedly trying to convince other governors to support a compromise in which states agree to pare back eligibility and funding to residents under the poverty level, the Wall Street Journal reports. Under such a proposal he said residents above the poverty level would lose Medicaid, but likely would get subsidized private coverage.

Republican governors' outline policy stances in draft documents

Republican views on Medicaid expansion were further outlined in draft policy documents from the Republican Governors Public Policy Committee that were obtained by Vox.

As GOP aims to 'repeal and replace,' new poll shows rising support for ACA

According to Vox, the documents suggest that Republican governors are open to GOP congressional lawmakers' proposals to turn Medicaid into a block-grant or per capita cap program. However, the documents said that in exchange for receiving a fixed set of funding rather than uncapped matching funds, the governors would want greater flexibility to run their programs.

The documents also suggest the Republicans are largely undecided about how to address Medicaid expansion. The Republican Governors Public Policy Committee document posed the question of whether states should "propose reducing the upper limit for the enhanced match ... and if so, what are the conditions that need to be in place before making a change?" (Johnson/Eilperin, "Wonkblog," Washington Post, 2/27; Radnofsky/Hackman, Wall Street Journal, 2/26; Kliff, Vox, 2/25; Tracer et al., Bloomberg, 2/27; Leonard, U.S. News & World Report, 2/27; Sullivan, The Hill, 2/27).

The 2017 State of the Union: Health care reform beyond the ACA

The new administration and Republican-controlled Congress have big plans to repeal and replace the ACA, causing tremendous uncertainty in the health care industry.

To help navigate this uncertainty, this webconference will focus on what we know now about the repeal and replacement plan, as well as what we can expect in the weeks and months to come. Additionally, at this critical juncture point for the future of the ACA, it is only fitting to pull up and reflect on the successes and failures of the ACA as a whole across the past eight years.

Register now

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.