A handful of Republican governors are asking President Donald Trump and GOP leaders in Congress to keep in place a key part of the Affordable Care Act that is responsible for extending coverage to more than 11 million Americans.
The governors of Ohio, Nevada, Michigan, Massachusetts and Arkansas say they don't want to see an ACA repeal do away with the expansion of Medicaid that has resulted in free or low-cost coverage for many of their constituents.
Although much of the focus on the ACA has been on the private insurance marketplaces, the health law's greatest impact came through the Medicaid program that 31 states ultimately embraced. The expansion, which is funded almost entirely by the federal government, extended coverage to individuals and families with incomes below 138 percent of the federal poverty level.
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Gov. Rick Snyder of Michigan told The Hill recently that he hopes to maintain the progress the state has made in health care through the expansion of its Medicaid program, Healthy Michigan.
"We have over 600,000 Michiganders, and we have a lot of positive data showing some good things going on in our state with this program," he said. "Healthy Michigan has had a lot of success, both in terms of healthier behaviors and better outcomes helping people."
Ohio Gov. John Kasich, who similarly embraced the expansion in 2014, when most other Republican governors were rejecting the funds, has continued to defend his decision, as he did during his unsuccessful run for president.
"In a nutshell, we don't want to lose coverage for 700,000 people in our state, a quarter of whom have chronic conditions, a third of whom have problems with mental illness and drug addiction," he said in a recent interview with reporters in Washington D.C.
Kasich did float the idea of reducing Medicaid eligibility to those at 100 percent of the FPL and offering a tax credit for those with higher incomes.
"I think it is very possible to reshape Obamacare, still be able to provide coverage for people who are in need, be able to reduce the costs and make it more workable," the Ohio governor said.
That some Republican governors want to keep intact a major part of the ACA complicates the GOP's already unclear "repeal-and-replace" strategy. GOP members of Congress are divided on what should replace the health law and Trump's promise to provide "insurance for everybody" suggests that he may not be interested in the type of market-based approach favored by conservatives.
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