On February 24, Politico held its Seventh Annual State Solutions Conference, which featured eleven governors from across the country, who each engaged in a half hour session with a moderator and in some cases, Q&A with the audience. The Politico event takes advantage of governors being in town for an annual National Governors Association meeting. Governors discussed issues ranging from Puerto Rican statehood, to renewable energy, to workers being replaced by robots. A common topic was healthcare and Medicaid reform, which was discussed at length by many governors. ANCOR staff attended the conference, and the following notes were taken by Grassroots Manager Doris Parfaite-Claude.
Governor Hickenlooper (D-CO): While the ACA exchange in his state had a rough start, he stated it is now successful enough that he is hoping for a regional exchange with neighboring states. He used this to emphasize the need to allow time for the ACA to mature and improve. He expressed concerned that block grants or per-capita caps will push costs on states. His opening line captured his position best: "Almost every governor will say you do not want to throw the baby out with the bathwater."
Governor Walker (I-AK): Given Alaska's higher health expenses, geographic challenges and $3 million deficit following the decrease in oil/gas prices, Gov. Walker thought block grants would be harmful to the state. The rest of the conversation centered on the oil economy and environmental concerns.
Governor Herbert (R-UT): The Governor was optimistic about the new opportunities governors would have for input in federal policy. He informed the audience that all governors received a questionnaire from the Trump administration on ACA reform so they could explain what they wanted to be seen. He was supportive of block grants, stating that states can adapt to them and save more money, but that the window of opportunity to make them happen would likely expire within a year. When asked by ANCOR staff how he wanted Congress to protect Medicaid-funded disability services, he answered that he was a "Reagan conservative" who believed in safety nets, but that he believed individuals with disabilities deserved opportunities for jobs and self-sufficiency, citing that one of his health agency directors was blind as an example of that. He believes these opportunities can be created through the private sector and charities.
Governor Brownback (R-KS): Governor Brownback was also optimistic about per-capita caps, but with more caveats than Governor Herbert. He thought that if states received a fixed rate, they would need a commitment from the federal government that they would receive that rate for a set amount of time in order to plan. Additionally, he thought the federal government would have to lay out a clear expectation of how long states would have to offer types of coverage before they could change it.
Governor Scott (R-FL): Speaking of his experience with Donald Trump prior to the presidency, Governor Scott was confident that ACA repeal/replace would be beneficial to his state because the administration would take into account state concerns. He discussed his belief in the importance of market competition, and states' need for flexibility to design coverage that best suit their population and budgets. He explained that it was the states' responsibility to design something that works for their populations. If Floridians were not happy with how he structures the exchanges and what comes next statewide after the ACA, he thought they could express that by voting him out of office.
Governor Hutchinson (R-AK): As a Republican who inherited his state's expansion, the governor believed any new plan by Congress should not penalize states because they did or did not take the expansion. He thought that intensity in politics matters and that while state voters largely supported the GOP agenda, he believed the party should pay attention to the intensity of protests around the healthcare debate. He supported ACA repeal but stated "you have to know where you're going after that." Specifically, he wanted a clear idea of the federal financial commitment and work incentives for the able-bodied.
Governor Sununu (R-NH): This discussion centered more on the future of the party in the state, but Governor Sununu did express excitement about Vice President Pence's experience as a governor and knowledge of Medicaid. He thought that assuming that states got actual flexibility, they could work within a block grant set-up.
Governor Otter (R-ID): While skeptical that replace/repeal would happen as rapidly as Congress hopes, Governor Otter expressed interest in seeing a plan that would allow individuals more flexibility as to what they purchased in their health plans. He decided he would wait and see what is coming out of reform proposals before proposing a new state plan. Otherwise this conversation centered more heavily on public lands.
Governor Malloy (D-CT): This conversation centered largely on his turbulent relationship with the administration and the future of the Democratic Party, but Governor Malloy did mention his opposition to block grants, because they seek to fit healthcare into a set budget as opposed to covering need. He also mentioned that he believes conservative governors are under a lot of pressure from the national party to state that block grants will work for their states in order to present a united front.
Governor Bullock (D-MT): The Governor expressed concern that all the uncertainty surrounding repeal/replace were wrecking havoc. He stated his belief that per-capita caps would not work for the states because it would cut funding. While he believes the system needs innovation, he stated that such innovation would need to be funded enough to meet realities on the ground. He also mentioned that given that most of his state's Medicaid expansion population are working, what they need in addition to coverage are opportunities to earn more through additional professional training.