Key Republican: GOP Eyeing Major Change to Medicaid in ObamaCare Bill

A top House Republican on healthcare said Tuesday that lawmakers are looking to dramatically restructure Medicaid as part of an ObamaCare repeal bill.

Rep. Brett Guthrie (R-Ky.), the vice chairman of the House Energy and Commerce health subcommittee, told reporters that Republicans are looking to include an idea known as “per capita caps” for Medicaid in the fast-track reconciliation bill used to repeal ObamaCare.

The comments suggest that Republicans are dealing not just with ObamaCare, but also with restructuring Medicaid as part of their repeal efforts, adding another level of complication.

Per capita caps have long been a Republican idea and were included in Republicans’ Better Way plan last year, but Guthrie’s comments are the firmest yet that the idea could be included in the fast-track repeal bill.

“We’re looking at both opportunities to do it through per capita allotment and maybe an optional block grant for states that choose to do so,” Guthrie said.

He answered “yes” when asked if Republicans are hoping to include the changes in the reconciliation bill.

It is still an open question, though, how Republicans will handle ObamaCare’s expansion of Medicaid. Some Republicans from states that expanded it are wary of repealing it, so the issue is a thorny one.

Under a per capita cap, also called a per capita allotment, Medicaid’s current open-ended commitment would shift into a capped payment from the federal government to states, as a way to limit federal spending. The payment amount per person would be capped, giving somewhat more flexibility than the similar idea of a block grant, which is a set amount of money regardless of the number of enrollees.

Republicans view per capita caps as a way to limit federal spending and give more power to states, but Democrats warn that by capping spending, harmful cuts to people’s benefits would be inevitable.

House Republicans are discussing Medicaid changes and other ObamaCare efforts with rank and file lawmakers this week.

House Majority Whip Steve Scalise (R-La.) is hosting briefings for GOP lawmakers and chairmen will present ideas at a conference meeting on ObamaCare on Thursday.

Guthrie said House Republicans have “some sense” of what they want to do on Medicaid but “we want to get the feedback [from lawmakers] and then see if we have to correct that.”

What do with the expansion of Medicaid is still a work in progress, said Guthrie, who also chaired a Republican Medicaid task force created in 2015. ObamaCare expanded eligibility for Medicaid up to 138 percent of the poverty line in the 31 states that chose to accept the expansion.

Guthrie noted “we have a lot of members from expansion states.”

“So how do we deal with that and reform Medicaid at the same time?” he asked.

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