GOP's Obamacare civil war may have saved Medicaid expansion

House Republicans unveil Obamacare replacement bill after four GOP senators refuse support

By Sophia Tesfaye
March 7, 2017 4:51AM (UTC)
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Mitch McConnell, David Koch, Paul Ryan (AP/Reuters/J. Scott Applewhite/Paul Vernon/Kevin Lamarque)

House Republicans released their long-awaited replacement plan Monday evening, after seven years of shouting for repeal of what they derisively dubbed Obamacare. But in a move meant to preempt the bill's unveiling, Republican senators Rob Portman of Ohio, Cory Gardner of Colorado, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia wrote a letter to Senate Majority Leader Mitch McConnell of Kentucky Monday afternoon making clear that they won't support the bill.

The senators cited a leaked version of the House bill to argue that it "lacks key protections" for those on Medicaid, which was expanded under Obamacare. The move puts Republicans' entire plans to pass a repeal bill this month in jeopardy.


"The February 10th draft proposal from the House does not meet the test of stability for individuals currently enrolled in the program and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states," the senators wrote to McConnell.

House Republicans want to replace the Medicaid expansion with block grants to the states, which could still cover their expansion populations but would get much less federal money to do so. The draft would also cap Medicaid payments to states based on the number of enrollees. Republicans in the Senate, however, have called for a "gradual transition" to ensure states have the time to implement changes. All four senators represent states that opted to expand Medicaid coverage under Obamacare.

Nearly nine out of 10 Medicaid beneficiaries recently told Morning Consult that they were satisfied with the coverage and benefits in 2016. Furthermore, another recent Kaiser Health Tracking Poll found that only 12 percent of Americans support cutting Medicaid.


Monday's letter comes after three other Republican senators said they would not back the House draft bill. Republicans only have a 52-seat majority in the Senate, so they can only afford to lose two votes from their caucus.

Conservative House Republicans in the “Freedom Caucus” and groups pushing for a full repeal of Obamacare are also opposed to new tax credits to help consumers buy individual policies. Conservatives complain that people would qualify even if they don’t owe as much in taxes as the credits are worth. But if the credits are not refundable, the number of people who could afford insurance would decline further.

According to the Washington Post, "the member of Congress who was briefed on changes to the proposal over the weekend said that drafters were not only moving toward capping the tax credit, but were also exploring how to avoid taxing employer-provided plans for the first time — something that could provoke a fierce response from conservatives."

Heritage Action for America COO Tim Chapman said, “that [the GOP's] approach has left a lot of conservatives scratching their heads.” Chapman wrote in an op-ed last week that “the draft repeal plan…replaces parts of Obamacare with a plan that centers on a refundable tax credit—a new program that conservatives fear could cost nearly as much as Obamacare itself.” The Post reported that the cost of the House GOP's plan would be offset by savings gained by rolling back Obamacare's Medicaid expansion.


Big GOP donors like the Koch brothers are also getting nervous about the hopes of Republicans coming together to pass a repeal of Obamacare.

“We’ve been patient this year, but it is past time to act and to act decisively,” Tim Phillips, president of Americans for Prosperity (AFP), which is coordinating the push with other groups across the Kochs’ political network, recently told the New York Times. “Our network has spent more money, more time and more years fighting Obamacare than anything else. And now with the finish line in sight, we cannot allow some folks to pull up and give up.”


Along with the Club for Growth and FreedomWorks, the Koch-backed AFP is gearing up for a multi-million dollar nationwide campaign to pressure Republican lawmakers, titled, "You Promised.”

Compounding troubles for the House GOP's plan are new reports that the Congressional Budget Office recently informed Republican leadership that their plan could also boot 10-20 million from employer-based coverage.

Sophia Tesfaye

Sophia Tesfaye is Salon's senior editor for news and politics, and resides in Washington, D.C. You can find her on Twitter at @SophiaTesfaye.

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Gop House Gop Medicaid Obamacare Repeal Republicans The Koch Brothers