It was not a statement one would expect to come out of the mouth of one of America’s most vocal enemies of “big government” and public sector spending. “You can’t cut Medicaid, there’s just no way about it,” Wisconsin Governor Scott Walker said on Friday, reflecting the reality a lot of top state executives are facing when it comes to the pending Health care overhaul in Congress.
Related: Red states with Medicaid expansion have favorable view of ACA
The health program, which provides federal matching funds to states to cover low-income children, adults, seniors and the disabled, is “the biggest growing part of most states’ budgets,” Walker said at a Washington Post event in downtown Washington. Governors want to help Republicans restructure Medicaid and “slow...the growth curve” in costs, he said.
The reality, though, is that there is a base of people in each state who rely on Medicaid funding, he observed, and slashing spending in Washington would just mean putting more of that burden on state governments. Walker's office did not immediately respond to a request for further details about his preferences for reforming Medicaid.
The Wisconsin governor isn’t the only conservative suddenly embracing federal Medicaid funding. The Kansas House, which has a Republican supermajority, voted Wednesday to take Obamacare funding to expand its Medicaid program. (The state's GOP governor, Sam Brownback, opposes the bill.)
Under Obamacare, states can choose to take additional federal funds to expand Medicaid. Already, 31 states have done so (Kansas would make 32), which accounts for roughly half of those newly insured under the 2010 health law known formally as the Affordable Care Act. Nearly half of those states are now run by Republican governors. Walker noted that Wisconsin did not take the expansion money, but its Medicaid program still has been able to expand coverage to everyone living in poverty. It did that by transitioning less-poor people off Medicaid and into the Obamacare marketplaces, Politifact points out. And other states that did not take the expansion money still receive billions of dollars from the federal government for traditional Medicaid enrollees. In other words, expansion states may be hit harder by major changes to Medicaid funding, but all 50 states are bound to be affected profoundly.
Walker, who briefly ran for president in 2016 on a fiscally conservative platform, said Friday he’s open to changes to the program, but said governors need to be “at the forefront of helping shape the reform, as well as the replacement,” since they are the ones administering the program. That’s a priority for governors on both sides of the aisle, who are convening in Washington beginning Friday for the National Governors Association winter meeting. Health care is likely to be one of the leading subjects for governors throughout their four-day stay in D.C.
They lunched with Vice President Mike Pence Friday. And Ohio Republican Governor John Kasich, a defender of the Medicaid expansion, was scheduled to meet, one-on-one, with President Trump later Friday afternoon. On Monday morning, all the governors will meet Trump at the White House, followed by briefings on health reform with Republican and then Democratic members of Congress in the afternoon.
Walker supports congressional Republicans’ efforts to repeal Obamacare. House Speaker Paul Ryan has promised to unveil a plan to “repeal and replace” the law in the coming weeks, once Congress is back from its current recess. “I think it’s a given there’s going to be a repeal,” Walker said. “I think most of us are focused in on the replace and the reform that we’d like to see happening. It’s not enough just to replace Obamacare, which we think can be done in a way that’s as good or better…but then make sure we’re reforming.”
Medicaid was the first program he brought up at Friday's event, unprompted, in that context. Most of the Republican plans floated on Capitol Hill envision turning Medicaid into a “block grant” program, which would cap the amount of money the federal government provides to states for the coverage, but give them more flexibility on how to spend it. According to the Kaiser Family Foundation, a health care think tank, that could mean cuts in federal funding by limiting “growth to a pre‐set amount,” rather than matching state costs as they rise, as the current system does.
Walker said Friday he supports giving states more flexibility in terms of Medicaid spending, but was lukewarm about the idea of block grants. “To me, you could have something even short of that,” he said, “as long as it doesn’t set states up for failure.” That's a huge caveat.Try Newsweek: Subscription offers