U.S. Sen. Cory Gardner joined three other Republican senators Monday in signing a letter to Senate Majority Leader Mitch McConnell expressing concerns about the Republicans' draft health care plan.
The letter, signed by Gardner, Rep. Rob Portman of Ohio, Sen. Shelley Moore Capito of West Virginia and Sen. Lisa Murkowski of Alaska said the Feb. 10 draft plan from the House does not do enough to protect families and individuals covered by the Medicaid expansion or to provide flexibility to the states.
"We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals," the letter says. "Any changes made to how Medicaid is financed through the state and federal governments should be coupled with significant new flexibility so they can efficiently and effectively manage their Medicaid programs to best meet their own needs. We also believe a gradual transition is needed to ensure states have the time to successfully implement these new changes."
That draft plan called for big cuts to federal spending on Medicaid and also calls for a per capita cap on Medicaid spending. States could get in trouble for spending more per patient but could keep the savings if they spent less per patient. That's a big change from the way the current system works, which is that the feds and the states split the cost of care for people who qualify for the program based on income. The draft plan likely would mean states would have to reduce benefits or cover fewer people. An estimated 453,000 people in Colorado have health insurance under the Medicaid expansion.
Republicans introduced the text of the replacement bill not long after the letter was sent. It ends the Medicaid expansion as of Jan. 1, 2020, but allows states to keep enrolling people up until then. At that point, enrollment would freeze and presumably go down over time as some people earned more money and no longer qualified.
It's not clear if this meets the request of the senators for a "gradual transition." I've reached out to Gardner's office for clarification.
The replacement bill introduced Monday keeps the idea of a per capita cap for Medicaid spending, but it's not clear how deep the cuts would be.
There are significant changes to Medicaid in the American Health Care Act outside of the expansion, too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee.
This is different from current Medicaid funding. Right now, the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.
Previous analyses of different version of this proposal suggest it could lead to very deep cuts to Medicaid. It’s unclear, at this point, how much this new version of the policy would reduce Medicaid spending.
Gardner originally opposed the Medicaid expansion and has previously voted yes on Obamacare repeal bills that would have phased out the Medicaid expansion, though those bills were never going to become law while Obama was president.
The senators don't propose a clear alternative to the House plan, and they reiterated their position that the Affordable Care Act needs significant reforms. However, their opposition seems significant as Republicans are under increasing pressure to pass their own plan. They have just 52 votes in the Senate.
Democrats at the grassroots level have made concerns around ACA repeal the centerpiece of their opposition to the Republican agenda, and in a telephone town hall last week, several constituents asked pointed questions about health care access.
Here's the full text of the letter.
Dear Majority Leader McConnell,
As you know, Medicaid covers more than 72 million Americans and is the core of the health care safety net for individuals across the country. The Affordable Care Act destabilized the private insurance market and created an unsustainable path for both the states and the federal government in Medicaid. While we support efforts to repeal and replace the Affordable Care Act and make structural reforms to the Medicaid program, we are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.
We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services. The Medicaid population includes a wide range of beneficiaries, many of which cycle on and off Medicaid due to frequent changes in income, family situations, and living environments. The Department of Health and Human Services reports that nearly one-third of individuals covered under the Medicaid expansion have a mental health or substance use disorder. As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.
We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals. Any changes made to how Medicaid is financed through the state and federal governments should be coupled with significant new flexibility so they can efficiently and effectively manage their Medicaid programs to best meet their own needs. We also believe a gradual transition is needed to ensure states have the time to successfully implement these new changes. The Affordable Care Act is not working for states or the federal government and must be repealed and replaced with a plan that reforms Medicaid and protects individuals and their families over the long term. However, the February 10th draft proposal from the House does not meet the test of stability for individuals currently enrolled in the program and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.
Update: This article has been changed to reflect that Republicans introduced an ACA replacement bill Monday afternoon and to add information about Gardner's past votes.
