Governors mull Medicaid expansion ahead of Trump meeting

By Tom LoBianco, David Wright and Tami Luhby CNN

(CNN) -- A group of governors huddled Saturday with Health and Human Services Secretary Tom Price in Washington to air their concerns on Medicaid and the effort to repeal Obamacare.

The meeting comes two days before governors are set to meet with President Donald Trump at the White House, where worries about the Obamacare replacement are expected to dominate the discussion.

Price only briefly talked about his meeting Saturday as he dashed out of the room, surrounded by staffers, calling it "a good, candid exchange." The Health and Human Services Department later said in a release that "they discussed real, positive solutions."

Governors said afterward that much of the focus was on how to treat states that expanded Medicaid under the Affordable Care Act and those that didn't fairly.

Oklahoma Gov. Mary Fallin told reporters afterward that Price was in a "listening mode" and did not say which items Trump would support or oppose.

"He's in a listening mode right now, and certainly has talked about partnership with the states, listening to different challenges we face as governors," she said.

Governors also heard presentations from consulting firms McKinsey & Co. and Avalere Health that showed millions of residents could lose coverage under the Republican plan. The analyses, first reported by Vox, showed that many people would not be able to afford coverage if the GOP gave them tax credits based on age instead of Obamacare's subsidies based on income. Even more low-income residents would lose access to Medicaid coverage under the Republicans' plan to change federal funding levels.

Governors discussed whether Medicaid would be turned into a block-grant program or a per capita program, in which states would receive fixed funding based on the number of enrollees. They also discussed possibly compensating states that did not expand Medicaid.

Kentucky Gov. Matt Bevin, who has been in regular talks with the Trump White House about how to handle any Obamacare replacement, called the discussions of policy "gelatinous."

"That's your word of the day," said Bevin, who has a proposed overhaul to Kentucky's Medicaid expansion program pending before HHS. "It is this sort of amorphous thing that has yet to gel up, and until it does, we don't know what it will look like."

Republicans have convened a group of 10 governors (and their Medicaid directors) from five states that expanded Medicaid and five that did not to talk about how they should handle Medicaid, Fallin said.

Wisconsin Gov. Scott Walker, chairman of the Republican Governors Association, started the group a few weeks ago and said that they have been talking regularly by phone. Bevin and Arkansas Gov. Asa Hutchinson are also part of the group.

Congressional Republicans have also asked Walker, Ohio Gov. John Kasich, Nevada Gov. Brian Sandoval and Tennessee Gov. Bill Haslam to come up with a deal to resolve the expansion problem.

Changing Medicaid into a per-capita funding program and eliminating expansion could reduce federal spending by $1.4 trillion over 10 years, according to Avalere's analysis. Governors are wary of overhauling Medicaid because it's the largest source of federal funding for states.

Republican governors also have grown increasingly skittish about the fate of their low-income residents who gained coverage under Medicaid expansion -- as well as the future. Some 11 million adults are now insured in the 31 states, plus the District of Columbia, that expanded Medicaid. Sixteen of those states are run by Republicans.

"I think the concern of governors alike, not just Republican governors, but governors on either side of the aisle is: Give us a base, give us a foundation upon which we could help slow the curve. But you can't cut Medicaid. There's no way about it," Walker told The Washington Post on Friday.

Republicans have been feeling pressure across the country as Democratic protesters have flooded town halls hosted by Republican lawmakers -- yelling, screaming and chanting over the legislators and at times telling deeply personal stories about their health care.

Hutchinson, who expanded Medicaid, cited the surprising town hall hosted by Sen. Tom Cotton earlier this week in northwest Arkansas.

"Any time you have 2,000 Arkansans show up at a town hall meeting, that gets people's attention, and particularly politicians. And I think you have to understand that this is reflecting voter intensity. They are very concerned," Hutchinson told CNN Saturday.

"There's nothing more precious to you then health care, whether you have an individual policy or whether it's an employer policy or whether it's Medicaid."

CNN's Manu Raju contributed to this report.

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