Tag Archives: paul ryan

Trump to travel to Wisconsin Tuesday

President Donald Trump will travel to Wisconsin this week to speak at a local factory.

The White House confirms the president will pay a visit to Republican House Speaker Paul Ryan’s home state on Tuesday.

State Rep. Tod Ohnstad told The Milwaukee Journal Sentinel that Trump will visit the Kenosha headquarters of a tool manufacturer named Snap-on.

It will be the president’s first visit to the state since taking office. He canceled plans to visit the state earlier this year amid concerns about protests. Trump was last in Wisconsin in December on his “thank you” tour.

The president is also expected to travel to Atlanta on April 28 to speak at the National Rifle Association’s annual leadership forum. That’s according to the organization.

He pledged during the campaign to fight to protect the Second Amendment and was endorsed by the NRA.

Trump signs measure reversing Obama era rule protecting women’s access to basic health care

President Donald Trump on April 13  signed a resolution allowing states to restrict how federal funds for contraception and reproductive health are spent.

“This is a major pro-life victory,” said the House Speaker Paul Ryan, R-Wis.

Abortion rights advocates had an opposite reaction.

Under the Congressional Review Act, which allows lawmakers to repeal newly minted rules, both the House and Senate had passed a resolution killing Obama’s regulation that had protected federal grants for clinics in states wanting to block the funding.

States such as Texas in recent years have kept the grants from going to clinics as part of the country’s longstanding fight over abortion. Broadly, many Republicans seek to restrict abortion or make it illegal while Democrats have fought to keep abortion legal.

The resolution had narrowly passed the U.S. Congress, with Vice President Mike Pence called to the Senate on March 30 to break a tie vote in the chamber, where Republicans hold a slim majority.

The grants, known as “Title X” funds, were already barred from going directly to abortion services but under the now-null regulation family planning clinics had been assured they could receive money even in the face of state objections.

“Allowing states to withhold Title X funding from family planning clinics won’t make anyone safer or healthier — it will instead place essential services out of reach,” said Diane Horvath-Cosper, a medical doctor and fellow at Physicians for Reproductive Health.

She said for many people the clinics are the only place where they can receive affordable health services such as disease testing.

Planned Parenthood issued a statement that denounced the signing of the resolution. The statement said the bill Trump signed does not “defund” Planned Parenthood, but this “latest move could embolden states to try to block access to health care through Title X, both at Planned Parenthood health centers and independent clinics. These types of actions are already illegal, as a court in Florida found just this past summer.”

Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said, “People are sick and tired of politicians making it even harder for them to access health care and this bill is just the latest example. Planned Parenthood strongly opposes President Trump’s willingness to undermine millions of women’s access to birth control through the Title X family planning program. Four million people depend on the Title X family planning program, and by signing this bill, President Trump disregards their health and well-being.”

Consider actions in the past three months by the Trump administration and anti-women’s health members of Congress:

• Trump reinstated and expanded the global gag rule, meaning a range of health organizations combating HIV or the spread of Zika will be banned from all U.S. global health funding if they also happen to provide counseling, referrals, or services for safe and legal abortion.

• The House considered a bill to repeal the ACA that would have prohibited women from getting care at Planned Parenthood through the Medicaid program, ended maternity coverage for millions of women and imposed a ban on insurance coverage for abortion.

• Extremists in Congress attempted to revive the failed ACA repeal bill by trading away women’s health and proposing to gut the essential health benefits provision, which would roll back maternity care, raise insurance rates for women and reduce access to birth control and other reproductive health care.

• The Senate confirmed anti-women’s health nominee Judge Neil Gorsuch, to the Supreme Court.

• The Trump administration eliminated U.S. funding for UNFPA, an organization whose mission is to champion maternal and child health across the globe.

Laguens said, “Women marched in historic numbers the day after the inauguration because they feared the worst. Their worst fears are now coming true. We are facing the worst political attack on women’s health in a generation as lawmakers have spent the past three months trading away women’s health and rights at every turn. That’s why women are the core of the resistance and have have been organizing and speaking out since the day after the election. They know speaking up and speaking out can change the direction of this government.”

So now what? Options for consumers as health law drama fades

The Republican health plan designed to replace the Obama-era health law known as the Affordable Care Act would not have taken full effect for a few years — and now it’s dead. But many people still face questions about getting insurance for next year, including on the government run exchanges.

WILL I HAVE PLANS TO CHOOSE FROM?

It depends on where you live. Choices are dwindling, but chances are at least one insurer will sell in your market. That company may offer several plans.

Generally, big cities will have more choices than rural areas where there may not be enough customers to attract insurers.

As of now, there are 16 counties in a region of Tennessee around Knoxville that have no insurers committed to sell coverage on the exchange next year. About a third of the nation’s 3,100 counties are down to just one insurer.

Insurers have been pulling back, and more are expected to leave, but health care researchers are not predicting mass defections.

“For most consumers, (2018) will look a lot like ‘17,” said Dan Mendelson, president of the consulting firm Avalere.

Customers can try to find coverage outside their exchange, but then they won’t be able to use tax credits to help pay the bills, which may be particularly painful since many markets have seen prices soar.

 

ARE THERE FIXES IN STORE?

Last month, the Health and Human Services Department, which runs exchanges in many states, proposed some adjustments to try to stabilize these marketplaces.

For example, insurers want greater scrutiny of people who sign up for coverage outside of the open enrollment period. Customers are supposed to be allowed to do so only if they have a life-changing event like the birth of a child, a marriage, or the loss of a job that provided coverage, but insurers have found that people are just waiting to sign up when they need care.

Another proposed adjustment would let insurers design cheaper plans tailored to younger people who may not need lots of health care but want to be protected in the event of a big injury or sickness. That could be very helpful, because insurers say they have struggled to attract younger and healthier customers to the marketplaces to balance out the claims they pay from those who use their coverage.

Those changes are expected to be finalized in the next month or so.

 

WHEN WILL INSURERS MAKE THEIR DECISIONS ON 2018?

Some have said they want to see the final version of the proposed federal adjustments before deciding where and what kinds of coverage they will offer.

But insurers generally have to decide by this spring whether they will participate in order to leave enough time for regulatory approvals and marketing before enrollment starts next fall.

Aetna, the nation’s third largest insurer, has set an April 1 deadline for deciding on 2018. The company has already pared its marketplace participation down to 4 states this year from 15 because of heavy financial losses.

Customers won’t know for certain who is selling on their exchanges until early next fall. While insurers have to apply to sell coverage on their exchanges generally by late spring or early summer, they can drop out later.

 

IS THE AFFORDABLE CARE ACT ‘IMPLODING’ AS PRESIDENT TRUMP HAS SAID ON TWITTER?

No. The marketplaces are not expected to dissolve next year, even though choices have dwindled.

While there’s debate over the law’s tax burdens and its impact on government budgets, the federal plan has covered more than 20 million people.

About 11 million are covered through an expansion of Medicaid, the health program designed to help poor Americans. Another 12 million buy private insurance through the law’s marketplaces, most with help from subsidies based on income.

‘Where’s Paul Ryan? town hall’ planned for April 1

Leaders in the movement for immigrant and worker rights will join constituents of House Speaker Paul Ryan on April 1 to hold a town hall-style forum.

Ryan rejected invitations to attend the forum, according to a news release from Voces de la Frontera, a leading immigrant rights group in Wisconsin.

The town hall event comes as leaders from more than a dozen immigrant and civil rights organizations and unions gather in Ryan’s district to plan for a General Strike on May Day, which is May 1.

U.S. Rep. Luís Gutiérrez, D-Chicago, will be present with a delegation from Illinois, along with Wisconsin elected officials.  Gutiérrez is a national leader in the immigrant rights movement.

At the town hall, organizers will formally announce the national General Strike for Immigrant & Refugee Rights.

“Paul Ryan has refused to meet with constituents who have repeatedly requested a town hall meeting with him since Feb. 23,” said Voces de la Frontera member Valeria Ruiz of Racine. “Since January, we have witnessed more immigrant families separated, more threats from the Trump administration against local government officials and now a federal budget that funds war and immigration agents over public education, health care and good jobs.”

She added, “Ryan should do his job and meet with his constituents. He should block funding for war and the separation of immigrant families, and serve the needs of working class families and the unemployed instead of serving his wealthy corporate benefactors.”

Analysis: The outsider dealmaker faltering in White House

Donald Trump campaigned as an outsider — celebrating his lack of political experience by selling himself as a dealmaker willing to buck Republican orthodoxy and his own party’s leadership. He alone would reshape Washington.

He’s tried governing the same way.

His actions are a blitz.

He rarely consults old Washington hands.

And he hangs the threat of retribution over anyone who challenges him.

And now he and his party have been dealt a stinging defeat on a signature campaign promise, a defeat that further weakens a president whose approval rating has hovered under 40 percent and humiliates Republicans who have pledged for seven long years to undo President Barack Obama’s health care law.

Trump’s haphazard approach to the health care bill — first demanding a House vote despite an uncertain result, then suddenly suggesting he’d support a future bipartisan solution — underscored Trump’s political identity: He is seemingly uninterested in leading a political party or unifying the federal government.

The failed vote — despite Republican control of the White House and both houses of Congress — highlighted severe cracks within the GOP that Trump’s presidency won’t easily mend.

Trump now wants to turn to tax reform, an ambitious, complicated plan at the center of his agenda, and he does so wounded by the health care collapse as well as the uncertain legal status of his travel ban and an ongoing federal investigation into possible contacts and coordination between his campaign aides and Russian officials.

The loss exposed a limit to Trump’s go-it-alone style, one forged over decades in the business world and seemingly proven effective by his improbable win.

The novice campaigner used the sheer force of his celebrity and personality to draw loyal supporters and frequently bend the Republican Party to his whims.

He defied the party leadership repeatedly, skipped a debate, refused to sign a loyalty pledge and turned the scathing power of his Twitter account on fellow Republicans even after he clinched the nomination and the party pined for unity.

Experts say Trump’s style has hurt his ability to govern effectively.

“Donald Trump’s ‘Art of the Deal’ doesn’t work in Washington. Politics is a profession and you have to know how to collect votes,” said Douglas Brinkley, a presidential historian at Rice University. “Trump is a salesperson and he oversold what he can get done.”

Brinkley said Trump’s failure stood in stark contrast to the master negotiations conducted by presidents Franklin D. Roosevelt and Lyndon Johnson, who enjoyed majorities in both houses of Congress and achieved sweeping legislative accomplishments.

Instead, Trump’s initial struggles were reminiscent of the problems Jimmy Carter faced when he declared that his fellow Democrats were “an albatross around my neck” while facing intraparty rebellion.

More than two dozen members of the House Freedom Caucus oppose the health care plan because they say it doesn’t go far enough to undo Obamacare.

Some moderate Republicans, meanwhile, were turned off by a recent Congressional Budget Office analysis predicting 24 million people would lose coverage in a decade.

Republicans seemed willing to risk Trump’s wrath, taking comfort in the political safety their deep-red home districts provide against his possible attacks.

Trump was once a Democrat. He favored abortion rights most of his adult life and espoused views on trade similar to those of liberal Democratic presidential candidate Bernie Sanders.

He often doesn’t work in specifics, allowing supporters to read in what they want and he abruptly shifts stances — like when he abandoned his vow to send Hillary Clinton to prison — yet rarely losing support of his loyal backers. That degree of unpredictability gave some credibility to his ultimatum to force a vote or keep Obamacare in place, despite his years-long crusade against it.

Trump’s commitment to the bill seemed wavering. He said “there were things in this bill that I didn’t particularly like” and, for the first time, suggested that he would support a bipartisan health care measure.

He also claimed that “I’ve never said repeal and replace Obamacare within 64 days,” a surprising statement considering he vowed to do so “on day one” nearly every night on the campaign trail.

Though Trump publicly abstained from blaming House Speaker Paul Ryan, the White House suggested some fault lay with members who opposed the measure. That act of political defiance should seem familiar to the occupant of the White House, according to one longtime Trump ally.

“The people who are defeating this are the ones most like Trump — ones willing to break from the pack,” said former House Speaker Newt Gingrich, who also questioned the wisdom of setting a hard deadline to pass the legislation.

“If it was a negotiating tactic, it wasn’t a good one,” said Gingrich, who suggested that relations between Trump and Ryan, always strained, would get worse.

“The president feels burned. I suspect you’ll see him far more engaged on matters like tax reform, which he is passionate about. But it will be more complicated now.”

Republican leaders’ failure to get the health plan through the House, a task considered easier than in the Senate, may portend even greater difficulty in passing complicated tax reform and the rest of Trump’s ambitious agenda.

“Doing big things is hard,” said Ryan.

No vote on health care: A humiliating defeat for Trump

In a humiliating failure, President Donald Trump and GOP leaders yanked their bill to repeal “Obamacare” off the House floor when it became clear it would fail badly — after seven years of nonstop railing against the health care law.

Democrats said Americans can “breathe a sigh of relief.”

Trump said Obama’s law was imploding “and soon will explode.”

Thwarted by two factions of fellow Republicans, from the center and far right, House Speaker Paul Ryan said President Barack Obama’s health care law, the GOP’s No. 1 target in the new Trump administration, would remain in place “for the foreseeable future.”

It was a stunning defeat for the new president after he had demanded House Republicans delay no longer and vote on the legislation, pass or fail.

His gamble failed.

Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation’s health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.

He had“never said repeal and replace it in 64 days,” a dejected but still combative Trump said at the White House.

However, he had repeatedly shouted during the presidential campaign that it was going down “immediately.”

The bill was withdrawn just minutes before the House vote was to occur and lawmakers said there were no plans to revisit the issue.

Republicans will try to move ahead on other agenda items, including overhauling the tax code, though the failure on the health bill can only make whatever comes next immeasurably harder.

Trump pinned the blame on Democrats.

“With no Democrat support we couldn’t quite get there,” he told reporters in the Oval Office. “We learned about loyalty, we learned a lot about the vote-getting process.”

The Affordable Care Act was approved in 2010 with no Republican votes.

Despite reports of backbiting from administration officials toward Ryan, Trump said: “I like Speaker Ryan. … I think Paul really worked hard.”

For his part, Ryan told reporters: “We came really close … but we came up short. … This is a disappointing day for us.”

But when asked how Republicans could face voters after their failure to make good on years of promises, Ryan quietly said: “It’s a really good question. I wish I had a better answer for you.”

Last fall, Republicans used the issue to gain and keep control of the White House, Senate and House. During the previous years, they had cast dozens of votes to repeal Obama’s law in full or in part, but when they finally got the chance to pass a repeal version that actually had a chance to become law, they couldn’t deliver.

Democrats could hardly contain their satisfaction.

The outcome leaves both Ryan and Trump weakened politically.

For the president, this piles a big early congressional defeat onto the continuing inquiries into his presidential campaign’s Russia connections and his unfounded wiretapping allegations against Obama.

Ryan was not able to corral the House Freedom Caucus, the restive band of conservatives that ousted the previous speaker. Those Republicans wanted the bill to go much further, while some GOP moderates felt it went too far.

Instead of picking up support, the bill went the other direction, with several key lawmakers coming out in opposition. Rep. Rodney Frelinghuysen of New Jersey, chairman of a major committee, Appropriations, said the bill would raise costs unacceptably on his constituents.

The defections raised the possibility that the bill would not only lose on the floor, but lose big.

The GOP bill would have eliminated the Obama statute’s unpopular fines on people who do not obtain coverage and would also have removed the often-generous subsidies for those who purchase insurance.

Republican tax credits would have been based on age, not income like Obama’s, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama’s Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.

The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.

Republicans had never built a constituency for the legislation, and in the end the nearly uniform opposition from hospitals, doctors, nurses, the AARP, consumer groups and others weighed heavily with many members. On the other side, conservative groups including the Koch outfit argued the legislation did not go far enough in uprooting Obamacare.

Ryan made his announcement to lawmakers at a very brief meeting, where he was greeted by a standing ovation in recognition of the support he still enjoys from many lawmakers.

When the gathering broke up, Rep. Greg Walden of Oregon, chairman of the Energy and Commerce Committee that helped write the bill, told reporters: “”We gave it our best shot. That’s it. It’s done. D-O-N-E done. This bill is dead.”

‘We just pulled it’ Trump says after no vote on GOP health care plan

GOP House leaders pulled their health care bill from consideration on March 24 due to a shortage of votes despite desperate lobbying by the White House and its allies, dealing a big blow to President Donald Trump.

Republican leadership had planned a vote on the measure after Trump cut off negotiations with Republicans who had balked at the plan and issued an ultimatum to vote on Friday, win or lose.

Republican moderates as well as the most conservative lawmakers objected to the legislation. But the White House and House leaders were unable to come up with a plan that satisfied both moderates and conservatives.

Trump told the Washington Post: “We just pulled it.”

Amid a chaotic scramble for votes, House Speaker Paul Ryan, R-Wis., who has championed the bill, met with Trump at the White House before the measure was pulled from the House floor after hours of debate.

Trump told the Post the health care bill would not be coming up again in the near future and that he wanted to see if Democrats who uniformly objected to the Republican plan would come to him to work on health care legislation, a Washington Post reporter said on MSNBC.

For now, Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act — known as Obamacare — will remain in place despite seven years of Republican promises to dismantle it.

Repealing and replacing Obamacare was a top campaign promise by Trump in the 2016 presidential election, as well as by most Republican candidates, “from dog-catcher on up,” as White House spokesman Sean Spicer put it during a briefing on Friday.

The House failure to pass the measure called into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

Trump already has been stymied by federal courts that blocked his discriminatory executive actions barring entry into the United States of people from several Muslim-majority nations.

Now members of his own party worry the defeat on the health care legislation could cripple his presidency just two months after the billionaire real estate mogul took office.

In a blow to the bill’s prospects, House Appropriations Committee Chairman Rodney Frelinghuysen announced his opposition, expressing concern about reductions in coverage under the Medicaid insurance program for the poor and the retraction of “essential” health benefits that insurers must cover.

“We need to get this right for all Americans,” Frelinghuysen said.

Progressive groups overwhelmingly opposed the health care plan as offered by Ryan and the amendments intended to appease even more conservative members of his party.

House Speaker Paul Ryan departs following a meeting with President Trump at the White House. REUTERS/Carlos Barria

Move to dump essential benefits could strand chronically ill

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average consumer’s upfront insurance costs, such as premiums and deductibles, said experts on both sides of the debate to repeal and replace the Affordable Care Act.

But, they add, it will likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill, and putting consumers at greater financial risk if they need care.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a non-network hospital might not be covered.

What might be desirable for business would leave patients vulnerable.

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

Such a change could give carriers wide room to do that by eliminating or shrinking “essential health benefits” including hospitalization, prescription drugs, mental health treatment and lab services from plan requirements — especially if state regulators don’t step in to fill the void, analysts said.

As part of the push by House GOP leaders to gain more support for their plan, they amended the bill Thursday  to allow states to decide, starting next year, what if any benefits  insurers must provide on the individual market, rather than requiring health plans to include the law’s essential health benefits, according to House Ways and Means Chairman Kevin Brady (R-Texas).

The Affordable Care Act requires companies selling coverage to individuals and families through online marketplaces to offer 10 essential benefits, which also include maternity, wellness and preventive services — plus emergency room treatment at all hospitals. Small-group plans offered by many small employers also must carry such benefits.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Donald Trump agreed after meeting with members of the conservative Freedom Caucus to leave it out of the measure under consideration, said White House Press Secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill but were still trying to line up support.

“Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan, R-Wis. “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, said Gary Claxton, a vice president and insurance expert at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,”said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA most individual plans didn’t include maternity coverage, either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with preexisting illness, analysts said.

Before President Barack Obama’s health overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under a Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she said.

Michael Cannon, an analyst at the libertarian Cato Institute and a longtime Obamacare opponent, also believes dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he said. Republicans “are shooting themselves in the foot if they the offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller said. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This is published here under a Creative Commons license.

On Medicaid money, GOP has win-or-lose proposition for states

New England’s bucolic countryside looks much the same on either side of the Connecticut River separating Vermont from New Hampshire. But Medicaid beneficiaries are far better off in Vermont.

Vermont generously funds its Medicaid program. It provides better benefits, such as dental care, and pays doctors more than New Hampshire’s program does. That brings more doctors into the program, giving enrollees more access to care.

New Hampshire has twice Vermont’s population, but Vermont spends almost as much on Medicaid and covers more enrollees. Under the complicated formulas that set federal funding, Vermont’s substantial investment helps it capture nearly as much aid from the government as New Hampshire gets.

States’ policies differ about who or what to cover in Medicaid, and those decisions have led to historical variances in how much federal money they receive. House Republicans’ effort to shrink federal Medicaid spending would lock in the differences in a way that favors those already spending high amounts per enrollee.

“Republicans are finding out why changing Medicaid is so hard and why the easiest thing to do is to do nothing given the substantial variation in federal spending across states,” said John Holahan, a health policy expert with the nonpartisan Urban Institute.

Here’s why.

Medicaid, the national health program for low-income people that covers about 1 in 5 Americans, is 60 percent funded by the federal government and 40 percent by states. Total spending in 2015 was about $532 billion, according to the latest official data.

Federal funding is open-ended, which means the government guarantees states it will pay a fixed rate of their Medicaid expenses as spending rises.

Those matching rates are tied to average personal incomes and favor the lowest-income states. Mississippi has the highest Federal Matching Assistance Percentage — 76 — while 14 wealthy states, including New York and California, get the minimum 50 percent from the federal government.

But state Medicaid spending varies significantly, too, and that influences how much federal money each receives to fund its program. State policies about how generous benefits should be and how much to pay doctors and hospitals account for those differences.

GOP leaders want to give states a set amount of money each year based on the number of Medicaid enrollees they had in 2016, a formula known as per-capita caps.

A per-capita system would benefit high-spending states already receiving relatively rich allotments from the government, the Urban Institute said in a paper last September.

According to its estimates, if the system were in effect this year, Vermont would receive $6,067 per enrollee — one of the highest allotments in the country — while New Hampshire would get the least, just $3,084 per enrollee.

Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets.

“It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.

Under the GOP bill, federal Medicaid funding to states would be adjusted annually based on a state’s enrollment and medical inflation. But that would not be enough to keep up with rising Medicaid spending per enrollee, which would force states to put up more of their money or scale back the program, the nonpartisan Congressional Budget Office said March 13.

Other analyses of the GOP plan have reached the same conclusion.

Since 1999, however, the average annual growth rate in Medicaid spending per enrollee has risen more slowly than medical inflation, according to MACPAC, the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Republicans argue that overhauling federal Medicaid spending as they propose would hold down federal costs while giving states more leeway to run their programs as they see fit. “This incentive would help encourage efficiencies and accountability with taxpayer funds,” House Speaker Paul Ryan wrote last June in his white paper, A Better Way.”

Rep. Greg Walden (R-Ore.), chairman of the powerful House Energy and Commerce Committee, which has oversight of health care matters, sounded a similar note at a press conference in Washington, D.C., when the GOP plan was announced. “I think it’s really important to empower states and to put Medicaid on a budget,” he said.

But Fox argued the opposite would happen under a per-capita system — instead of gaining more control over their Medicaid programs, states would not be able to meet their needs because they’d have fewer dollars to decide how to spend, he said.

Bill Hammond, director of health policy for the nonpartisan Empire Center for Public Policy in New York, said House leaders’ decision to tie future Medicaid funding to medical inflation could help mute concerns that funding wouldn’t keep up with rising costs, but would not address the fairness issue of giving some states higher per-capita amounts than others.

“If a low-spending state decides it wants to spend more money on paying hospitals and doctors or adding more benefits, they would have a harder time doing that without breaking the federal cap,” he said.

Medicaid advocates in New Hampshire are worried because their state has few alternatives to make up for a loss in federal funding. New Hampshire lacks an income or sales tax.

“There is a tremendous amount of fear among families here as Republicans try to dismantle the ACA,” said Martha-Jean Madison, co-director of New Hampshire Family Voices.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.