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GOP at odds over Medicaid overhaul

Associated Press

WASHINGTON -- The House GOP health care bill has competition from other Republicans, a group of governors who've made their own proposal about how to overhaul Medicaid for low-income people. They're hoping GOP senators will find their ideas more persuasive.

It's a gradual approach, with additional options for states. It's likely to involve more federal spending than the House bill, but also keep more people covered. In the end, though, the governors are still talking about fundamental change.

Four GOP governors are pushing the plan, saying they represent most of the 33 Republican state chief executives. There's no inkling of any involvement by Democratic governors, and it's hard to conceive of such major changes without them.

Medicaid is a federal-state program that covers more than 70 million low-income people, about 1 in 5 Americans. Beneficiaries range from elderly nursing home residents to newborns. Former President Barack Obama expanded the program in his health care law, to mainly help low-income adults with no children living at home. About half the 31 states that accepted the expansion have Republican governors.

The House Republican bill would start by repealing Obama's Medicaid expansion. More significantly, it would limit overall federal spending on Medicaid going forward. The nonpartisan Congressional Budget Office says the proposal would result in a cut of $880 billion from projected Medicaid spending from 2017 to 2026. By that year, 14 million fewer people would have Medicaid coverage, and program spending would be about 25 percent lower than what's currently projected.

The House approach "provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states," Republican Govs. John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada, and Asa Hutchinson of Arkansas said in a recent letter to congressional leaders.

The future of Medicaid could become a pivotal issue as the health care debate moves to the Senate.

Kevin Smith, a spokesman for Sen. Rob Portman, R-Ohio, said his boss "shares (governors') concerns about the need to protect the Medicaid expansion population and give governors more flexibility to ensure they can design programs that meet the needs of their states."

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