On the heels of the release of the American Health Care Act (AHCA), state governors, including Republican state governors, are pushing back. Though many governors have vocally opposed the Affordable Care Act (ACA) that was signed into law in 2010, repeal of the law means losing billions of dollars that have gained residents in their state health insurance coverage. To date, thirty-one states have opted to expand their Medicaid program to cover low-income individuals that prior to the ACA were not included. States that expanded received an enhanced federal match of at least ninety percent for the expansion population. The health care legislation released by Republican House leaders last week would end federal funding for Medicaid expansion as of 2020, and convert the Medicaid program to one of per capita caps, with the goal of saving billions of Medicaid dollars. If states wish to continue to cover the expansion population, they would have to come up with the funding on their own.
Since before the draft legislation came out, Republican governors have been meeting with and writing to influential Republicans in Congress, expressing concerns over repealing the ACA too quickly, without an adequate replacement plan in place. Some of those letters are available here. More recently, governors are outright opposing the AHCA. Ohio governor and former presidential candidate John Kasich (R-OH) said in a tweet last week, "I have always opposed Obamacare and consistently called for it to be replaced with more conservative, market-driven reforms that actually control health care costs. However, phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug addicted, mentally ill, and working poor who now have access to a stable source of care. The right way to fix Obamacare is by Republicans and Democrats working together."