Medicaid directors all warn of GOP bill to repeal Obamacare


The National Association of Medicaid Directors added its voice to the chorus of criticism of the GOP’s latest version of an Obamacare repeal bill, saying it would place a massive burden on states.

Championed by Republican Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) the bill would eliminate all Medicaid expansion and subsidies beginning in 2020, and instead fund states with block grants.

Furthermore, it would end Medicaid’s funding status as open-ended, and in turn, place a per-capita cap on each enrollee.

“Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history,” NAMD’s board of directors wrote in a statement Thursday.

Graham and Cassidy have preached state flexibility in marketing the bill, but NAMD says it doesn’t provide the language necessary, “commensurate with proposed funding reductions.” In other words, it takes away most funding and doesn’t provide guidelines for states to get that money themselves. It merely implores states to set up their own healthcare systems by 2020.

“The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated,” the directors said.

“States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities.”

NAMD is formed by a coalition of state Medicaid directors, who also hit on the fact that the GOP is trying to bring the bill to the floor without a score from the Congressional Budget Office, “which should be the bare minimum required for beginning consideration.”

Senate Majority Leader Mitch McConnell has said it’s his intention to vote on the bill next week, although it is unclear if Republicans possess the 51 votes needed. An analysis by nonpartisan consulting firm Avalere Health found that by 2026, 34 states and D.C. would see funding shrinkage. This would include red states such as Arizona and Alaska, about which GOP Sens. John McCain (R-Ariz.) and Lisa Murkowski (R-Ala.) have been critical of GOP versions of healthcare legislation.

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