As Republicans enter the second month of total control of thefederal government, there is little evidence they are any closer tofulfilling their campaign promise of repealing the Affordable Care Act.

|

One of the many stumbling blocks to “repeal and replace” hasbeen the Medicaid expansion which accounts for roughlyhalf of the more than 20 million people who gained coverage throughthe ACA.

|

Many Republicans in Congress come from states thatembraced the expansion, which is almost entirely federally fundedand extends coverage to those with incomes up to 133 percent of thefederal poverty level.

|

Some of them naturally want to preserve the program that many oftheir constituents enjoy. But their goal comes into conflict withother Republicans, including conservative hardliners who areagainst the program in principle, as well as those from states thatdid not choose to expand and don’t want to see other statescontinue to receive more federal assistance.

|

In an attempt at compromise between the two camps, a GOPlawmaker has proposed a solution that will keep the expansion inplace in states that have already pursued it and offer additionalfederal funds to states that rejected it.

|

The extra money for the non-expansion states would come throughthe Disproportionate Share Hospital program, which is set up toassist states to offset what hospitals spend treating theuninsured.

|

However, the proposal, which has been put forth by Rep. BrettGuthrie, R-Ky., would also freeze the expansion of Medicaid,meaning that those who would be eligible under current rules maynot be eligible in the future.

|

For years, leading Republicans have called for turning Medicaidinto a block grant program, under which states would be allocated acertain amount of money and be given discretion over who that moneyshould provide coverage for. That idea has been embraced byPresident Trump and has been championed by Secretary of Health TomPrice.

|

Guthrie has also floated a variation of the block grant ideacalled “per-capita caps,” under which states would get a set amountof money per enrollee, as opposed to state block grants, which donot take into account the number of enrollees, but rather theoverall state population.

|

Democrats are bound to oppose all of the GOP proposals, arguingthey will lead to reduced benefits for those in greatneed.

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.