Views of Governors and Insurance Commissioners on ACA Repeal and Changes to Medicaid: Responses to a Congressional Request for State Input on Health Reform

Appendix B: Summary of Responses from Associations

Four associations (American Academy of Actuaries, Democratic Governors Association, National Governors Association, and the Republican Governors Association) responded to Congress’ request for input. Key takeaways from the associations include:

American Academy of Actuaries. The American Academy of Actuaries urges Congress to consider the potential adverse consequences of repealing provisions of the ACA, including the individual mandate and enrollee subsidies, without also enacting a replacement approach at the same time. They express concern that a repeal of major provisions of the ACA would lead to loss of enrollment, affordability challenges, and market instability. They note that offering pre-existing condition protections requires incentives for enrollment; eliminating provisions that encourage enrollment would threaten sustainability; and increasing risks or eliminating cost-sharing reduction reimbursements could cause an increase in insurer withdrawals from the market.

Democratic Governors Association. The Democratic Governors Association opposes a repeal of the Affordable Care Act, including its Medicaid expansion, citing concerns over financial stability and health of states. They note that repealing the ACA would result in loss of coverage, shift of costs to state governments, economic uncertainty, loss of consumer protections provided under the ACA, and increases in uncompensated care. The letter also highlights the role of Medicaid and its expansion on increased coverage and combatting the opioid use epidemic.

National Governors Association. The National Governors Association highlights the need to work in a bipartisan manner to build a more efficient health care system, put patients first, and address the underlying issues of unsustainable health care spending. They urge Congress to consider incorporating Governors’ suggestions throughout the legislative process; consider reforms to private health insurance that provide meaningful state flexibilities; maintain a meaningful federal role in the Medicaid financing partnership that does not shift costs to states; protect states from unforeseen financial risks; maintain predictability in health reform legislation; and support the continuation of innovative state health care programs that rely on federal funding.

Republican Governors Association. The Republican Governors Association seeks to advance alternatives to the ACA. They also highlight concerns about the quality and sustainability of the Medicaid program. The Republican Governors Association seeks to reflect on state flexibilities gained in recent years and factors inhibiting state innovation to respond to the unique needs of Medicaid beneficiaries.