National Council for Mental Wellbeing

Skip to content National Council for Mental Wellbeing
Find a Provider
National Council for Mental Wellbeing logo
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Stephanie Pellitt

Policy and Advocacy Associate

Governors Divided on Health Care Reform

March 2, 2017 | ACA | Medicaid | Comments
Share on LinkedIn

At the National Governors’ Association winter meeting last weekend, discussion focused on health care reform and included closed-door meetings with HHS Secretary Tom Price and President Trump. During the weekend of bipartisan meetings, multiple tensions erupted regarding Medicaid expansion and instituting block grants or per capita caps for Medicaid. Ultimately, governors walked away from the event without a clear path forward for health care reform.


During the meeting, a divide among GOP governors who opted to expand Medicaid under the ACA and those who did not was evident. Of the 31 Medicaid expansion states, 16 have Republican governors. Many Republican governors from pro-Medicaid expansion states have been vocal about preserving coverage for the Medicaid expansion population. They include Govs. Charlie Baker of Massachusetts, Rick Snyder of Michigan, John Kasich of Ohio, Asa Hutchinson of Arkansas and Brian Sandoval of Nevada.

A Republican policy document released last week gives some insight into how Congress may alter Medicaid expansion. Under the policy document’s guidance, Congress would allow states that expanded their Medicaid programs to continue receiving the enhanced federal match payments for a limited period of time. However, at the end of this allotted time, states that choose to maintain the expanded Medicaid population would be reimbursed at the traditional payment rate for eligible beneficiaries.

The proposed plan would offer non-expansion states “additional temporary resources for safety-net providers during this period of time.” No details are yet available on what these additional resources might look like or which providers might see additional support.


A recently released Republican plan to change Medicaid financing from an open-ended state/federal matching formula into a block grant or “per capita cap” structure also spurred disagreement among governors. Democratic governors were opposed to the proposal, citing concerns that it would strip the program of needed federal funds. Reducing federal spending in Medicaid has been a long-standing conservative priority. According to House Majority Leader Kevin McCarthy (R-California), “Medicaid is on track to transform into a $1 trillion annual entitlement program we simply cannot afford.”


Medicaid is a critical source of care for many individuals living with mental health and addiction disorders. The National Council has fact sheets detailing the potential impacts of repealing Medicaid expansion and implementing block grants/per capita caps for Medicaid. Advocates are invited to share this document with legislators and staff as they work to stave off these potential life-threatening reforms to the Medicaid.