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Obamacare Debate: Where GOP Governors Stand on Repeal and Replace

This was published as a Wall Street Journal Think Tank column on January 10, 2017. As the Republican Party’s debate over repealing and replacing Obamacare focuses on the Senate, the views of Republican governors have received little attention and will be important to watch. This group doesn’t like the Affordable Care Act,…

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The Health Care Plan Trump Voters Really Want

In a New York Times op-ed, Drew Altman draws on observations from focus groups in rust belt states of people in the Affordable Care Act (ACA) marketplaces who voted for President-elect Trump and say they may not like their coverage under the ACA but could like Republican replacement plans even less.

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Understanding Who Opioid Users Are Underscores Challenges

The 21st Century Cures Act provided a billion dollars in new funding for opioid prevention and treatment. In this Wall Street Journal Think Tank column, Drew Altman looks at the challenges based on a new Kaiser-Washington Post survey of long term opioid users.

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Preexisting Conditions and Republican Plans to Replace Obamacare

In this Wall Street Journal Think Tank column, Drew Altman discusses new data highlighting why pre-exisitng conditions could be a flashpoint issue in the Affordable Care Act repeal and replace debate.

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How the Republican Health Agenda Could Play Out

In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare.

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The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the…

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                    [post_content] => This was published as a Wall Street Journal Think Tank column on January 10, 2017.

As the Republican Party’s debate over repealing and replacing Obamacare focuses on the Senate, the views of Republican governors have received little attention and will be important to watch.

This group doesn’t like the Affordable Care Act, President Barack Obama’s signature health law, and will want to support the Republican effort to repeal and replace it. But for many of the governors the interests of their states could run counter to two central elements of the repeal and replace plans.

One of those elements is the repeal of federal funding for the ACA’s Medicaid expansion, which is expected to be part of the budget reconciliation package. Sixteen states with a Republican governor have chosen to expand Medicaid under the ACA, taking advantage of generous federal matching funds they receive when they do so; a 90/10 match when Obamacare is fully phased in. Nevada’s Republican governor Brian Sandoval warned congressional Republicans in a Jan. 5 letter against cutting off funds for Medicaid expansion without a replacement plan, Politico Pro reported.

As the chart shows, these states have a large stake in their Medicaid expansions. For example, 600,000 people have gained coverage through Michigan’s expansion and the state received $4 billion in federal funding for the expansion group in 2015. In Arizona, 413,000 people gained coverage in 2015 and the state received $3 billion in federal funds. Many of these states have augmented their expansions with waivers enabling them to implement conservative reforms they like and giving them political cover to participate in Obamacare. Indiana’s waiver, which requires newly eligible adults to pay premiums and penalizes some beneficiaries if they do not, has received the most attention.

If this funding were to be repealed, many of the newly covered would return to the ranks of the uninsured. The burden of providing health services for this population would then fall on state and county budgets and safety net health providers. On the other hand, these states do have to put up some of their own money to draw down the generous federal match, and some red state governors may prefer foregoing the federal funding and operating a smaller Medicaid program covering fewer people in order to shrink state spending.

dawsjrepublican-expansion-states-slide_spending-and-enrollment-rounded
The second element of repeal and replace Republican governors will think hard about is the proposal to transform Medicaid into a block grant program giving states greater flexibility and control of Medicaid in return for reduced federal funding for their states in the future. Greater flexibility through a block grant will appeal to Republican governors, but they know they can get the same flexibility from the Trump administration through federal Medicaid waivers without sacrificing federal funding for their state now or in the future.
They can also advocate for broader and more flexible waiver rules for the states than the current ones–for example, eliminating the time limit on waiver programs, or the requirement that they be conducted for research and demonstration purposes. Some governors may feel that a waiver runs the risk of being reversed if Democrats take the White House in four years. As a former Human Services commissioner overseeing Medicaid for a Republican governor, I would have preferred my own waiver to a block grant with less federal funding. But some Republican governors may prefer to run their own Medicaid programs and reap one hundred percent of the savings from any decisions they make about how they operate their Medicaid programs. It remains to be seen what role the Republican governors play in the repeal and replace debate. Some may support repeal of the Medicaid expansion and a Medicaid block grant, but many will no doubt see their interests running counter to those of Republicans on Capitol Hill. [post_title] => Obamacare Debate: Where GOP Governors Stand on Repeal and Replace [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => obamacare-debate-where-gop-governors-stand-on-repeal-and-replace [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:15:45 [post_modified_gmt] => 2017-01-19 23:15:45 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=205864 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 205438 [post_author] => 36621681 [post_date] => 2017-01-05 08:04:56 [post_date_gmt] => 2017-01-05 13:04:56 [post_content] =>
In The New York Times op-ed, “The Health Care Plan Trump Voters Really Want,” Drew Altman draws on observations from focus groups in rust belt states of people in the Affordable Care Act (ACA) marketplaces who voted for President-elect Trump and say they may not like their coverage under the ACA but could like Republican replacement plans even less. “The Washington debate is disconnected from the concerns of working people,” he says.
[post_title] => The Health Care Plan Trump Voters Really Want [post_excerpt] => In a New York Times op-ed, Drew Altman draws on observations from focus groups in rust belt states of people in the Affordable Care Act (ACA) marketplaces who voted for President-elect Trump and say they may not like their coverage under the ACA but could like Republican replacement plans even less. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-health-care-plan-trump-voters-really-want [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:16:27 [post_modified_gmt] => 2017-01-19 23:16:27 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=205438 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 204903 [post_author] => 36621681 [post_date] => 2016-12-19 10:35:52 [post_date_gmt] => 2016-12-19 15:35:52 [post_content] => This was published as a Wall Street Journal Think Tank column on December 19, 2016. As deaths from opioid overdoses continue to rise, the 21st Century Cures Act has provided a billion dollars over the next two years to states for opioid prevention and treatment programs. The new funding is sorely needed. To really be effective, the solutions to this epidemic, as with any drug epidemic, need to deal both with the suppliers and the users: in this case physicians who irresponsibly overprescribe painkillers and the people who get hooked on painkillers. A new survey of long-term opioid users by the Kaiser Foundation and the Washington Post underscores how challenging the problem is. The users may not be who you think they are. You may know a 16-year-old skateboarder who ripped up his knee, has surgery, got some Vicodin from a physician or his parent’s medicine cabinet, and got hooked. But the typical long-term opioid user is not a kid getting high. The Kaiser-Washington Post survey found that six in 10 long-term opioid users were between 40 years old and 64 years old. Less than a quarter worked full time and 33% were on disability or retired (20%). Seventy percent of long-term users said they have a debilitating disability or chronic disease. Long-term users are slightly more likely to live in rural areas; the problem of opioid overdoses is especially acute in rural America, where treatment is scarce and Emergency Rooms and jails can’t handle the problem. Almost all long-term users of painkillers – 97% – received them from physicians, and both states and the federal government are taking steps to address overprescribing. Virtually every long-term user  –  98% –  said they use opioids to relieve pain. More than four in 10 long-term users say they started taking painkillers for chronic pain, another 25% started because of pain after a surgery, and 25% because of pain after an accident or injury. But a third (34%) of them said they also use them to get high, and another third (34%) said they also use them to deal with stress or relieve tension. Significant percentages say the painkillers they take have had a positive effect on their health (42%) and on the quality of their lives (57%). Opioids won’t simply disappear. If they did, you’d have to wonder how many long-term opioid users would turn to something else—either more or less harmful—just as some opioid users turn to heroin.
It is hoped that the new funding from the 21st Century Cares Act will enable states to do more both to clamp down on physicians who overprescribe opioids and to save the lives of people who overdose on painkillers.
The larger challenge is to address the causes of dependency among opioid users who, the survey shows, are turning to painkillers to cope with complex and very real challenges in their lives. [post_title] => Understanding Who Opioid Users Are Underscores Challenges [post_excerpt] => The 21st Century Cures Act provided a billion dollars in new funding for opioid prevention and treatment. In this Wall Street Journal Think Tank column, Drew Altman looks at the challenges based on a new Kaiser-Washington Post survey of long term opioid users. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => understanding-who-opioid-users-are-underscores-challenges [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:16:58 [post_modified_gmt] => 2017-01-19 23:16:58 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=204903 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 204468 [post_author] => 36621681 [post_date] => 2016-12-09 19:22:08 [post_date_gmt] => 2016-12-10 00:22:08 [post_content] => This was published as a Wall Street Journal Think Tank column on December 9, 2016. As debate about Obamacare’s future moves from people’s general, mostly partisan views of the Affordable Care Act to details and consequences of plans to repeal and replace the ACA, one of the biggest flash points is likely to be how people with pre-existing medical conditions are affected. Across the U.S., people who have cancer, heart disease, diabetes, or other serious conditions will want to know whether they or their sick family members will be able to get and afford coverage in the future. Their partisan views about Obamacare are likely to quickly be supplanted by these more practical concerns. And a substantial number of people could be affected. A Kaiser Family Foundation analysis to be released next week found that almost 30% of U.S. adults younger than 65 have health conditions that would have left them uninsurable in a pre-ACA world. Many more people have conditions with which they could still qualify for coverage before ACA protections took effect–but only at premiums they could not afford. Many people with conditions over which coverage could be declined before the ACA live in big red states (there are more than 4 million in Texas, for example) and in blue states (nearly 6 million in California). As the chart above shows, however, the 11 states with the largest shares of adults who have pre-existing conditions are all controlled by Republicans, and most are in the South. These states have higher rates of residents with conditions over which coverage was declined before the ACA, such as obesity and diabetes. Still, even more Americans may feel that they have a stake in policies regarding pre-existing conditions. Kaiser’s monthly health tracking poll found in August that 53% of Americans said that they or a family member had a pre-existing condition after being read a definition of the term. Most people with pre-existing conditions are insured at any given time through employer plans or public programs such as Medicaid. Before the ACA, however, they would have been unable to get coverage again if they lost their insurance through a change in circumstances. Because so many people with a pre-existing condition have to worry about whether their circumstances might change someday, a much larger share of the public is likely to be interested in this issue than the number of people who stand to be affected immediately by policy changes. President-elect Donald Trump has said that he wants to protect people who have pre-existing medical conditions. Details of Republican health-care plans are not yet known, but they are expected to involve establishing high-risk pools within states, among other measures. Without the plan details it is hard to say how strong protections will be. Tens of millions of people with pre-existing medical conditions and the influential groups that represent them will be interested in details of legislative plans to change the ACA and how they might be affected. It’s sometimes said that this has become a post-factual world. But as health care moves from a campaign issue to the legislative agenda, people will want to know how changes would affect them, and details and facts will matter more again. [post_title] => Preexisting Conditions and Republican Plans to Replace Obamacare [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses new data highlighting why pre-exisitng conditions could be a flashpoint issue in the Affordable Care Act repeal and replace debate. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => preexisting-conditions-and-republican-plans-to-replace-obamacare [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:17:42 [post_modified_gmt] => 2017-01-19 23:17:42 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=204468 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 203871 [post_author] => 36621681 [post_date] => 2016-12-02 13:07:45 [post_date_gmt] => 2016-12-02 18:07:45 [post_content] => This was published as a Wall Street Journal Think Tank column on December 2, 2016. The worm is about to turn in health policy and politics when Republicans shift from throwing stones to owning the problems of the health system and the Affordable Care Act or its replacement, as President Barack Obama and Democrats have for the past eight years. It’s hard to predict how events will play out, but it’s likely that grand plans to repeal and replace Obamacare, convert Medicaid to a “block grant” program, and transform Medicare into a premium support program could be whittled down or delayed as details of such sweeping changes, and their consequences, become part of the debate. Republicans and the president-elect are on the hook for election promises to repeal the ACA or major parts of the law. If the GOP repeals the ACA but delays a replacement plan until after the 2018 midterms, the degree of political fallout is likely to depend a great deal on what happens in the non-group insurance market. (This includes people who buy their own coverage on the ACA exchanges and outside of them, all of whom are subject to the same premium increases.) If Republicans cannot make deals with insurers to keep the non-group market functioning for the roughly 19 million people who rely on it, and the market becomes unstable or collapses, public reaction could affect the entire GOP health-care agenda. The chances of this happening stand to grow if Republicans move quickly to eliminate major provisions of Obamacare that directly affect marketplace stability, such as the individual mandate. The budget reconciliation process–which can be used to address revenue and spending measures that have been scored by the Congressional Budget Office–is the fastest and most likely route to such changes. The big Republican “reform” idea most likely to be delayed until after 2018 is fundamentally altering Medicare by converting it to a premium-support, voucher-like program. That could be delayed or tabled altogether; Medicare has long been the “third rail” of health-care issues and is the health issue with the greatest potential to influence elections. Advocates of premium support want savings from capping federal contributions to Medicare beneficiaries, but they are likely to be wary of the political fallout if it becomes clear that benefits for future beneficiaries will be eroded if fixed payments don’t keep up with the rising cost of medical care. Phasing in a plan so that it affects only future beneficiaries may soften the impact but is not likely to be enough to side step a political problem over Medicare in 2018, which might prompt some efforts to defer action. Action on Medicaid is the toughest element of the Republican health-policy trifecta to predict. Republicans may face resistance from states over cuts in federal Medicaid funding that are integral to their block-grant plans, as well as resistance from Democrats in Congress. More red states (16) have expanded their Medicaid programs than have blue states (14) at this point, giving these Republican-led states a stake in what happens with the ACA and Medicaid. Many states might see incentives to make their own deals with the new administration through waivers. Republicans might back off broad legislation to convert Medicaid to some form of block-grant program and turn, instead, to a state-waiver program administered by the Department of Health and Human Services. A broader waiver initiative would allow the administration to achieve policy goals state by state but would not accomplish the permanent transformation of Medicaid or across-the-board federal savings a federal block grant could. A lot will depend on details of Medicaid proposals that are not yet known, particularly the details of how a per-capita cap on federal Medicaid spending might work and how many states find it attractive. It’s not clear how much political strife Republicans will be willing to accept in a health-care debate. One factor that could embolden them: The number of GOP Senate seats at risk in 2018 is not significant. Already, however, there is talk of Senate Republicans signaling reluctance. Another unknown is how President-elect Donald Trump will react when debate is joined over detailed legislative proposals and the politics of fundamentally changing the ACA, Medicaid, and Medicare become more real. Will he want to invest a large share of his early political capital in a series of divisive national debates on health care, as President Obama did? Or will he prioritize other issues? The merits of Republican health-care plans aside–they obviously have detractors on the left and advocates on the right–history shows that the burden is always on those who want to make big changes in the health system and its major programs, and that doing so often carries a political price. [post_title] => How the Republican Health Agenda Could Play Out [post_excerpt] => In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-the-republican-health-agenda-could-play-out [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:18:26 [post_modified_gmt] => 2017-01-19 23:18:26 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=203871 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 203309 [post_author] => 36621681 [post_date] => 2016-11-21 18:52:01 [post_date_gmt] => 2016-11-21 23:52:01 [post_content] => This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the ACA, Medicaid and Medicare–all three of health care’s major programs–and in the process, fundamentally alter the direction of the federal role in health and core elements of the social contract. The expected proposals seek to end federal entitlement spending in health as it has been known by capping federal financial exposure through fixed-dollar insurance tax credits, Medicaid block grants, and voucher-like supports for Medicare premiums. Legislative details haven’t been released yet, but Republican plans are likely to shift costs to individuals and states as well as reduce consumer protections–and result in a significant increase in the number of uninsured. Conservatives who have long favored these changes view them positively; they want to reduce government regulation and federal spending, give consumers more choices in the marketplace, drive down costs by promoting high-deductible insurance coverage, and give states greater flexibility to tailor health programs to their own preferences and needs. Whatever the pros and cons, these would amount to the biggest changes in the direction of federal health programs since the passage of Medicaid and Medicare. Each proposal to change these programs contains potential trap-door issues. Would protections for people with pre-existing conditions be eroded in Republican ACA replacement plans, and to what extent? Would states lose money in a Medicaid block grant, and with what consequences? Would the ACA marketplaces break down in confusion if there is an interregnum between repealing and replacing the ACA? How would Medicare premium supports be indexed, and would future Medicare beneficiaries be able to afford the care they need once it is phased in? These are just a few of the subjects to be examined closely. The media, whose credibility Donald Trump undermined in the presidential campaign, will be challenged to explain the stakes involved in such sweeping changes. It will be all the more difficult to inform a meaningful national discussion if a Republican Congress moves quickly, attaches many changes to budget reconciliation bills, and limits political accountability by deferring implementation of an ACA repeal plan until after the 2018 elections and/or a Medicare premium support plan until 2024. Mr. Trump’s reaction to media coverage on these issues and polling about these changes, particularly on popular programs such as Medicare and Medicaid, is an important unknown. Among the critical things to be reported: comparisons of forthcoming plans with current law in ways that show how they would affect people and who the winners and losers will be. It should not be surprising if Republican plans do not achieve the same things Medicare, Medicaid, and the ACA do today because Republicans are pursuing different objectives. During the 2012 presidential campaign, in an admirable act of political honesty, Sen. Orrin Hatch said that “conservatives cannot allow themselves to be browbeaten for failing to provide the same coverage numbers as Obamacare. … [W]e cannot succumb to the pressure to argue on the left’s terms.” An important point in the coming health policy debate is to clarify objectives in repealing and replacing the ACA and in fundamentally changing Medicaid and Medicare. The deeper issue is not about whether one is for the Republican health-care trifecta or opposes it but understanding that Republicans are not setting out to replace the ACA with something that does the same job “better” or to “reform” Medicaid and Medicare to make the current programs work better. The word “reform” has become a loaded term; it means different things to liberals and conservatives and would probably be inappropriate to most news coverage in this debate. The challenge is to clarify how conservative policy goals differ from liberal policy goals, to describe how Republicans would change the federal role in health, and to explain what the changes would mean for Americans. News cycles are often driven by juicy stories focusing on the most controversial policy changes and the partisan politics they stoke. So among the media’s toughest challenges may be treating the proposed changes to Medicare, Medicaid, and the ACA not only as many separate stories and incremental updates but as one larger story, and to lay out the consequences–potentially good and bad–of such significant change in the federal role in health so people can make informed judgments about it. [post_title] => The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-bigger-story-and-agenda-behind-gop-changes-to-obamacare-medicare-and-medicaid [to_ping] => [pinged] => [post_modified] => 2017-01-09 08:51:14 [post_modified_gmt] => 2017-01-09 13:51:14 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=203309 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 205864 [post_author] => 36621681 [post_date] => 2017-01-10 10:18:54 [post_date_gmt] => 2017-01-10 15:18:54 [post_content] => This was published as a Wall Street Journal Think Tank column on January 10, 2017. As the Republican Party’s debate over repealing and replacing Obamacare focuses on the Senate, the views of Republican governors have received little attention and will be important to watch. This group doesn’t like the Affordable Care Act, President Barack Obama’s signature health law, and will want to support the Republican effort to repeal and replace it. But for many of the governors the interests of their states could run counter to two central elements of the repeal and replace plans. One of those elements is the repeal of federal funding for the ACA’s Medicaid expansion, which is expected to be part of the budget reconciliation package. Sixteen states with a Republican governor have chosen to expand Medicaid under the ACA, taking advantage of generous federal matching funds they receive when they do so; a 90/10 match when Obamacare is fully phased in. Nevada’s Republican governor Brian Sandoval warned congressional Republicans in a Jan. 5 letter against cutting off funds for Medicaid expansion without a replacement plan, Politico Pro reported. As the chart shows, these states have a large stake in their Medicaid expansions. For example, 600,000 people have gained coverage through Michigan’s expansion and the state received $4 billion in federal funding for the expansion group in 2015. In Arizona, 413,000 people gained coverage in 2015 and the state received $3 billion in federal funds. Many of these states have augmented their expansions with waivers enabling them to implement conservative reforms they like and giving them political cover to participate in Obamacare. Indiana’s waiver, which requires newly eligible adults to pay premiums and penalizes some beneficiaries if they do not, has received the most attention. If this funding were to be repealed, many of the newly covered would return to the ranks of the uninsured. The burden of providing health services for this population would then fall on state and county budgets and safety net health providers. On the other hand, these states do have to put up some of their own money to draw down the generous federal match, and some red state governors may prefer foregoing the federal funding and operating a smaller Medicaid program covering fewer people in order to shrink state spending. dawsjrepublican-expansion-states-slide_spending-and-enrollment-rounded
The second element of repeal and replace Republican governors will think hard about is the proposal to transform Medicaid into a block grant program giving states greater flexibility and control of Medicaid in return for reduced federal funding for their states in the future. Greater flexibility through a block grant will appeal to Republican governors, but they know they can get the same flexibility from the Trump administration through federal Medicaid waivers without sacrificing federal funding for their state now or in the future.
They can also advocate for broader and more flexible waiver rules for the states than the current ones–for example, eliminating the time limit on waiver programs, or the requirement that they be conducted for research and demonstration purposes. Some governors may feel that a waiver runs the risk of being reversed if Democrats take the White House in four years. As a former Human Services commissioner overseeing Medicaid for a Republican governor, I would have preferred my own waiver to a block grant with less federal funding. But some Republican governors may prefer to run their own Medicaid programs and reap one hundred percent of the savings from any decisions they make about how they operate their Medicaid programs. It remains to be seen what role the Republican governors play in the repeal and replace debate. Some may support repeal of the Medicaid expansion and a Medicaid block grant, but many will no doubt see their interests running counter to those of Republicans on Capitol Hill. [post_title] => Obamacare Debate: Where GOP Governors Stand on Repeal and Replace [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => obamacare-debate-where-gop-governors-stand-on-repeal-and-replace [to_ping] => [pinged] => [post_modified] => 2017-01-19 18:15:45 [post_modified_gmt] => 2017-01-19 23:15:45 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=205864 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 157 [max_num_pages] => 27 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 527f98ad71f537bc9897743f2fc1d168 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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