Governors are very concerned about what a repeal of the ACA will do to their state budgets, given that the Medicaid expansion was a large part of what states used -- red and blue -- to bring them into balance.
The repeal plans congressional Republicans have floated wouldn't likely take effect until 2019 or 2020. But already, governors and state legislatures are voicing concerns that repealing the ACA may leave millions of people uninsured, as well as take away some of the mechanisms that helped their states drastically slash their uninsured rates.
It's not just Democrats who are worried. Republican governors are also very concerned,
At the top of their list of concerns is the fact that the most likely blueprint in Congress for repeal, a 2015 bill that President Barack Obama vetoed, would also repeal federal funding for Medicaid expansion, which was estimated to have helped cover 11 million adults across the country in 2015. Ten Republican governors have taken advantage of the expansion, which was so successful in some places like Kentucky that, even though Gov. Matt Bevin (R) campaigned on scrapping the ACA, he simply made some tweaks to the program once he took office.
The Congressional repeal plan from 2015 would also repeal tax increases that were part of the ACA, likely shifting the burden for paying for health care from the federal government to individual states.
The fundamental problem here is that health care policy in this country has a lot of moving parts. A few cannot be stripped away without breaking the whole machine. Medicare, Medicaid, employer insurance, and individual insurance will be irreparably harmed by ACA's repeal, and that is before we get to what happens to those in the medical profession.
For example, the ACA had provisions to assist medical students with their tuition in exchange for a commitment to general practice for a number of years. Will they repeal that, too? If so, we will have an even more serious shortage of general practitioners in the future. It also rewarded wellness programs for employers, which have been shown to make a difference in health outcomes in the long term.
Here's Montana's Republican House Speaker, worrying about all the people who will lose access to health care.
On Tuesday, Montana's Republican House speaker, Austin Knudsen, warned that repeal could make it harder for Montana, which only voted to expand Medicaid in 2015, to pay for the program. He said that the state either was going to have to try to come up with some kind of solution, or else hope that Congress comes up with a fix itself.
“You’re going to tell me that we’re going to put 100,000 people on the Medicaid rolls and then when the federal government takes the money away we're just going to jerk the rug out from under them? I don’t see that as being a realistic answer,” Knudsen told the Billings Gazette. “The state of Montana is going to have to look at trying to help keep those people covered. Whether I like the bill or not, it passed. It was signed into law. We covered a whole bunch more people.”
If I were those governors and legislators, I'd be putting as much pressure as possible on our national Republican overlords to step back from an ACA repeal and consider doing more to strengthen it.
Gather your strength, because the fight for the social safety net is about to rage, starting January 3rd when the new Congress is sworn in. Have all the phone numbers handy to pressure your representatives to do the right thing.