Republicans Push Plan to Renege on Medicaid Promise

WASHINGTON, DC - AUGUST 01: House Ways and Means Committee members U.S. Rep. Paul Ryan (R-WI) (R) and U.S. Rep. Tom Price (R-GA) visit before a committee hearing in the Longworth House Office Building on Capitol Hill August 1, 2013 in Washington, DC. During a hearing titled, 'The Status of the Affordable Care Act Implementation,' the committee questioned representatives from the Centers for Medicare and Medicaid Services and the Internal Revenue Service responsible for implimenting the ACA.  (National Journal)

During the nasty campaign for Virginia governor last month, House Budget Committee Chairman Paul Ryan, R-Wis., tried to poke a hole in Democratic candidate Terry McAuliffe's pledge to tap the full federal funding promised to states for expanding their Medicaid programs.

"The notion that the federal government is going to keep matching Medicaid spending at this level is a notion that is just a faulty premise. It's going to get cut," Ryan said on a conference call with Republican gubernatorial candidate Ken Cuccinelli in late October.

Now Ryan's right-hand man on the Budget Committee, Rep. Tom Price, and other House Republicans are pushing a plan that would ensure those federal dollars do not come through.

Price, a Georgia doctor, brought up the issue during a meeting of the budget conference committee on Wednesday, arguing that by forcing states to pay for at least a portion of their expanded Medicaid programs, Congress could mitigate some of the sequestration cuts — a key goal for Democrats on the committee.

Currently, the federal government has promised the states that it will kick in 100 percent of funding for a Medicaid expansion over the first three years. After that, the government will pay for at least 90 percent of the program indefinitely. So far, 25 states and the District of Columbia have expanded the program under those terms, while another four are considering an expansion. McAuliffe, who narrowly defeated Cuccinelli on Nov. 5, has made it a top priority when he assumes Virginia's governorship in January.

Price suggested Friday that the federal contribution should be dropped to 90 percent immediately. While the issue is not currently under "official" consideration in the budget conference committee, he said, many House Republicans are discussing such a proposal.

"Many states didn't expand," Price told National Journal Daily. "So all citizens are subsidizing the states that expanded. So the fair thing to do, from my perspective and many individuals' perspective, is to have the same, at least the same "¦ 10 percent match by the states."

Such a move would pull the rug out from those governors who have already agreed to the expansion, and it would have an outsize effect on Democrats. Seventeen of the 25 states that have expanded are controlled by Democratic governors, including in Rhode Island, where Gov. Lincoln Chafee recently changed his party affiliation from independent.

The Obama administration has bent over backwards to reassure states that they can count on full federal funding. The administration went so far as to change its position and oppose Medicaid cuts it had proposed — a move explicitly designed to send a signal to states that were worried about the federal commitment to Medicaid funding.

The GOP proposal to renege on the commitment isn't new. Republicans have been saying for months that the full federal funding was unlikely to come through, while the concern about the government's commitment to its promise was a key argument in many states' decisions not to accept the expansion.

Asked whether Republicans had set themselves up for a self-fulfilling prophecy, given their earlier warnings that states shouldn't rely on the federal funding, Price said: "We're $17 trillion in debt. At some point you've got to get fiscally responsible."

The proposal is another in a series of Republican efforts to undermine aspects of President Obama's health care law.

"Republicans trying to scare people across the country with lies about the Medicaid expansion would be a bit more credible if they didn't come back to D.C. and fight to shift the costs onto states and families themselves," one Senate Democratic aide said Friday.

Democrats on the budget conference committee strongly oppose Price's idea, saying the issue is a nonstarter. "That's not going anywhere," said House Budget Committee ranking member Chris Van Hollen, D-Md., on Friday.

"Rather than try and reduce the amount [the federal government is giving], those states that are not allowing people to participate should allow them. Right now, they're denying 5 million Americans affordable health care. Five million people. And they somehow want to be rewarded for that," Van Hollen added.

Asked whether he thought he could get significant numbers of Democrats on board with the idea, Price shook his head. "Oh, probably not.... Their ability to embrace positive solutions is limited," he said, laughing.

But the discussion alone could convince some of the states still considering an expansion to back away from the idea. "I think they join at their own peril. There's no guarantee that that money's going to be there," Price said.

"What I'm trying to do is what's fair and appropriately represent my constituents, yeah," he said.

Sam Baker contributed contributed to this article