“Repeal and replace Obamacare” was a potent campaign slogan for the Republicans that helped make it possible for Donald Trump to claim the presidency at noon on Friday.
But as the new president and congressional Republican leaders have discovered in the aftermath of the historic Nov. 8 election, the challenge of uprooting a major federal health insurance program that covers more than 20 million Americans is a lot harder than they ever imagined.
The day before Trump was sworn in as the 45th president, a group of Republican governors were on Capitol Hill pleading for a sensible overhaul of the Affordable Care Act that won’t strip millions of their constituents of health care coverage, disrupt the insurance market and swamp hospital emergency rooms.
Governors from Ohio, Nevada, Idaho and even Alabama urged “a heavy dose of caution,” in meetings with congressional leaders, according to a report by Bloomberg. “We must be careful not to increase the rate of uninsured, particularly for our most vulnerable citizens,” Utah Gov. Gary Herbert said in a letter “Reforms must be fiscally prudent, but should maintain or improve affordable access to health care for those that are currently covered.”
Herbert and eight other GOP governors were in town Thursday to confer with congressional leaders about the strategy and timing of repealing key portions of Obamacare, including taxes and subsidies, and phasing in a GOP replacement. Trump and House Speaker Paul Ryan (R-WI) have vowed to simultaneously unveil repeal and replacement legislation in the coming weeks, although it is clear the Republicans are far from a consensus on replacement legislation.
Senate Majority Leader Mitch McConnell (R-KY) has counseled a more deliberate pace, in which Congress first votes to repeal Obamacare, and then develops replacement legislation during an extended transition period. However, Trump is impatient to achieve both tasks simultaneously in order to make good on his campaign pledge.
Perhaps one of the greatest concerns of Republican and Democratic governors alike from the 31 states receiving expanded Medicaid coverage for the poor under Obamacare is that the program will be jettisoned as part of the repeal.
Many governors have complained about the Medicaid program more generally, saying that the states should be granted more leeway and flexibility in administering the program and setting eligibility requirements. However, the expanded Medicaid coverage has been a boon for many of their residents, and they don’t want to lose it in a rush to eviscerate the 2010 Affordable Care Act. Expanded Medicaid currently provides insurance for about 11 million low-income able-bodied single people across the country.
“We have over 600,000 Michiganders, and we have a lot of positive data showing some good things going on in our state with this program,” Republican Michigan Gov. Rick Snyder said of the program, according to The Hill.
But Sen. John Cornyn of Texas, the Senate Majority Whip, sought to allay the Republican governors’ concern. “Nobody’s going to lose coverage,” Cornyn told reporters after meeting with the governors. “If there’s one word that came up most, it’s flexibility. One-size-fits all Washington doesn’t take into account the differences between a state like Texas with 28 million people and a state like South Dakota, for example.”