Ohio Gov. John Kasich said a draft House Republican bill that would gut major pieces of the health care law, including Medicaid expansion, was “inadequate” and “not acceptable.” | Getty GOP governors split on Obamacare replacement At the National Governors Association Winter Meeting, leaders from 33 GOP-controlled states say they’re trying to find consensus.

Republican governors are split over an Obamacare replacement plan -- just like their counterparts in Congress.

The big problem is how to make sure a repeal of the health law doesn't penalize red states that took billions of dollars in federal funds to add low-income residents to Medicaid rolls -- or those who shunned the extra money.


Leaders of 33 GOP-controlled states gathered for the National Governors Association Winter Meeting said they're working to present a consensus plan to Congress. But Republican designs on capping Medicaid, the health entitlement for the poor, are making it difficult to come up with a system that doesn't create winners and losers.

”This is still fairly gelatinous,” Kentucky Gov. Matt Bevin said Saturday. “There's a lot of ideas, a lot of moving parts, a lot of governors with different ideological perspectives-- all of that is in the cauldron right now.”

“A solution must be there,” he added. “Repealing alone serves no purpose.”

The governors are split on whether to ask Congress to preserve the federal funding boost Obamacare made available to cover millions of additional low-income adults and broader structural changes.

“We’re working through many different ideas,” said Oklahoma Gov. Mary Fallin, one of about a dozen governors trying to craft a compromise. Fallin, whose state did not expand its program, said it would be “very challenging” for her to revamp the program if Oklahoma winds up with less federal money than it currently gets.

The federal government paid states' full cost of expanding Medicaid for the first three years under Obamacare and is on the hook to pick up at least 90 percent going forward. Several expansion state governors want to ensure the flow of funds continues, but those in holdout states haven't signed off as a group or agreed on conditions for tapping the higher level of federal funding.

One option in a reshaped system would be for states to receive a block grant, or lump sum, that wouldn't be adjusted to reflect economic downturns or population growth. A second would be to cap how much the federal government gives states for each Medicaid beneficiary. A third path being discussed would allow states to keep covering those who signed up under Obamacare with less federal money. The governors also are wrestling with whether to apply any spending caps to the entire Medicaid population or only those people who enrolled under the health law.

“I wouldn’t say there’s a consensus yet. But I think that’s something we’re certainly trying to work towards,” said Wyoming Gov. Matt Mead. “We certainly want a recognition that some of the larger states -- big states like California and Texas -- they have their own challenges, but they may be different. We want to make sure that we have a plan that fits for rural Wyoming.”

GOP governors who expanded Medicaid are being increasingly vocal about the prospect of millions of people losing benefits in a post-Obamacare landscape. After meeting with President Donald Trump on Friday, Ohio Gov. John Kasich said a draft House Republican bill that would gut major pieces of the health care law, including Medicaid expansion, was “inadequate” and “not acceptable.”

“I don’t care what the Republicans do on this,” said Kasich, who was slated to meet White House Chief of Staff Reince Priebus and HHS Secretary Tom Price on Saturday. “If they do something that I think is wrong, I’m going to speak out.”

Kasich and others such as Arkansas' Asa Hutchinson support cutting off Medicaid coverage levels at the federal poverty line for low-income adults but oppose rolling back the Obamacare expansion.Tightening eligibility came up as governors met on Saturday with Price, a sharp critic of Obamacare, during a closed-door session on health care.

Beyond the Obamacare expansion, Republicans in Congress want to end the open-ended nature of Medicaid. But scrapping the Obamacare expansion wouldn't change significant state-by-state variations in federal spending on different groups of enrollees.

According to the Urban Institute, federal Medicaid spending per enrollee in 2017 ranges from a low of $3,804 in New Hampshire to a high of $10,459 in the District of Columbia.

“I’m interested in seeing all of us save money,” said Michigan Gov. Rick Snyder, who wants to preserve Medicaid expansion and not impose federal spending caps on high-cost populations, such as seniors jointly eligible for Medicare and Medicaid. “How do we do it in a way where we’re still providing effective health care and good health care?”