In the days since House Republicans unveiled a replacement to the Affordable Care Act, some GOP governors have a message: Not so fast.
The proposed legislation, which is supported by President Trump, would, among other things, make significant changes to Medicaid programs that have been expanded under the Affordable Care Act, also commonly referred to as Obamacare.
The current healthcare law has provided hundreds of billions of dollars of new federal aid to states in order to help them expand Medicaid coverage to low-income adults, who were not previously covered.
So far, 31 states — more than half overseen by Republican governors — have voluntarily signed on to expand their Medicaid coverage. But under the new Republican proposal, the federal funds currently available would be phased out starting in 2020. Moreover, the new proposal would cap how much federal aid is provided to states for Medicaid.
Ohio Gov. John Kasich was among the Republican governors voicing discontent with the proposal that's drawn fire from liberals and conservatives.
"Phasing out Medicaid coverage without a viable alternative is counter-productive 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," Kasich said in a statement Wednesday.
Nearly 700,000 Ohioans have benefited from Medicaid expansion under Obamacare. It's a statistic Kasich widely touted on the campaign trail in his failed quest for the Republican presidential nomination last year. (Many Republicans scoffed at his support for tenets of Obamacare.)
In January, Kasich sent letters to Republican leaders, including House Speaker Paul D. Ryan of Wisconsin, urging them to allow states to keep funds for Medicaid.
"We strongly recommend states be granted the flexibility to retain the adult Medicaid coverage expansion," he wrote.
In Nevada, the number of people covered by Medicaid has doubled since the implementation of Obamacare — from 320,000 to 640,000.
Gov. Brian Sandoval wants lawmakers to seek more input from governors in crafting the replacement legislation and has expressed some skepticism about the new proposal. He's asked the state's Department of Health and Human Services to assess the statewide fiscal impacts of the Republican-led House proposal.
"My priority is to protect those who now have access to healthcare and ensure they are able to maintain coverage," Sandoval said.
Illinois Gov. Bruce Rauner, a Republican who represents a state that tilts heavily Democratic, told the Chicago Tribune when talking about the new healthcare proposal that his constituents "won't do very well under the changes that they're recommending, which is a big concern to me."
"I want to make sure that people in Illinois are not left in the lurch or that, you know, there's a lot of pressure to reduce insurance coverage for people in Illinois," he said. "I'm very concerned about that."
In Illinois, about 3 million are on Medicaid, with about 650,000 people insured under the Medicaid expansion. According to the state's Department of Human Services, Illinois will receive an estimated $14.1 billion in federal money this year to support Medicaid expansion.
For both Kasich and Sandoval, supporting Medicaid expansion under Obamacare, a politically polarizing topic that Democrats widely support and Republicans denounce, has proven beneficial. Both won reelection in 2014 in states that are perennially battlegrounds after backing components of Obamacare. Republican governors from states that have eschewed Medicaid expansion widely support replacement legislation.
Democrats, who have assailed the new legislation as stripping healthcare from the most needy, insist the current proposal is flawed.
"It's clear and you see it — Democratic and Republican governors alike believe this is a bad deal for states," said Jared Leopold, a spokesman for the Democratic Governors Assn. "Now is the time for a lot of these Republicans to speak up and say where they stand on this extremely important issue."
Some of those Republicans, such as Maryland Gov. Larry Hogan, who is seeking reelection next year, have not come out in opposition to the new bill. In letters similar to those penned by Kasich, he's touted the success of Medicaid expansion in his state, where 260,000 Marylanders have healthcare coverage as a result of the current healthcare law.
He said his office is assessing the new measure.
Still, some Maryland Democrats, such as Rep. John Sarbanes, whose district spans Annapolis, called on the governor to speak up.
"The residents of Maryland are looking to you for support in preserving the important ACA reforms that have allowed so many of them to access affordable, accessible and high quality health care," he wrote in an open letter to Hogan this week.