Rollback of Medicaid expansion might face GOP opposition

Donald Trump has promised to repeal and replace the Affordable Care Act, and he has Republican support in Congress to do so. But GOP governors in several states may have a differing view about how to proceed regarding a key component of the ACA: Medicaid expansion.

Although most of the 32 states that have expanded Medicaid eligibility have Democratic governors, 10 states approved expansion under Republican governors, and even GOP-dominated statehouses. Getting rid of Medicaid expansion would take away insurance coverage for millions of Americans, and could create a political backlash as a result, the Wall Street Journal reported.

Aside from insuring those millions, Medicaid expansion has also slashed uncompensated care provided by the nation's hospitals by billions of dollars annually. The states that have yet to expand Medicaid have forfeited hundreds of billions of dollars in federal funds.

“Right now a lot of Republican governors expanded Medicaid and they have said they will fight to keep it,” Caroline Pearson, a senior vice president at Avalere Health, told the publication. Prominent Trump supporter and former Arizona Gov. Jan Brewer, for example, told the Associated Press that she is encouraging Trump's administration to look at Arizona's Medicaid expansion model because it is so cost-effective.

It might be even more politically problematic for a Trump administration to roll back the Medicaid expansion given that Vice President-elect Mike Pence oversaw just such an expansion in Indiana. Medicaid expansion in the Hoosier State was a little more restrictive than elsewhere, as enrollees were required to pay nominal premiums.

That gives Brian Tabor, executive vice president of the Indiana Hospital Association, hope for the future of Medicaid expansion, he told NPR. Pence, he said, "understands that with some flexibility, states can be successful at expanding coverage, and that bodes well for states like Indiana."

Republicans' ideas for an ACA replacement, meanwhile, include block grants to states to pay for Medicaid. The Kaiser Family Foundation noted that making that shift would "fundamentally change the current structure of the program."

The changes would eliminate the guarantee of coverage for all who are eligible and the guarantee to states for matching funds, the organization said. While states would get more flexibility to administer their programs, reduced federal funding could shift costs and risk to beneficiaries, states and providers.