Several GOP senators represent states that have opted to expand Medicaid under the ACA, and stripping their constituents of health care coverage could be dangerous politically—but the president’s veto threat assures that won’t happen.
“Well, it’s going to be vetoed,” said Sen. Dean Heller, a Nevada Republican, when asked about the Medicaid provision. Nevada has expanded Medicaid.
Yet, a vote for reconciliation lets GOP members campaign on the fact that they voted to repeal major parts of Obamacare—that Congress did its part but ultimately it was the president who didn’t sign the bill.
“The whole purpose of this was to give our members an opportunity—many of whom committed to their voters when they ran this year that they would do everything they could to repeal Obamacare—and so this is an opportunity for our members to be on record in favor of repealing and replacing Obamacare and put a bill on the president’s desk that accomplishes that,” Sen. John Thune, the Senate’s No. 3 Republican, told reporters Monday night.
While a two-year phase-out of the Medicaid expansion gives those senators from expansion states some wiggle room, it’s unclear what options are available as alternatives to provide health insurance to that newly-covered population.
“I have really no idea, when they say they’re going to phase out the expansion, what that actually means,” said Diane Rowland, executive vice president at the Kaiser Family Foundation. “You could obviously extend coverage on the marketplace … but that doesn’t seem to be very popular on the Republican side of the aisle either.”
The transition period was fought for by senators from expansion states, including Sen. Shelley Moore Capito of West Virginia. Capito said she will support the version of the bill that includes the two-year delay.
“I fought to make sure that we had some kind of transitional period for those, certainly in my state, that are on Medicaid, to have a transition,” she said. “I’ve always advocated for a repeal and replace. Two years gives you time to work those out with the states.”
Sen. John Hoeven of North Dakota, a state that has gone forward with Medicaid expansion, said that right now, under Obamacare, some states have received permission from the Centers for Medicare and Medicaid Services to create nontraditional Medicaid-expansion programs tailored to their state. "So that goes more in the direction that we want to go to, where there's coverage but you have the ability to have a state-led program,” he said. “We think that would be more responsive and better for people."
CMS has approved waivers for seven states, four of which are currently operating, according to a Kaiser Family Foundation issue brief released Nov. 20.
It’s unclear whether senators from expansion states will be punished at the polls if they vote for the bill and, by proxy, repeal Medicaid expansion, whether a two-year delay is built into it or not.