Filling the need for trusted information on national health issues…

Views of Governors and Insurance Commissioners on ACA Repeal and Changes to Medicaid: Responses to a Congressional Request for State Input on Health Reform

Appendix Table 1: Characteristics of Respondents to House Members’ Request
State Respondent Political Affiliation of
Governor at Time of Response
Implemented Medicaid Expansion? Marketplace Structure*
Governor Insurance Commissioner
Total: 35 29 14 Republican: 18
Democrat: 17
26 FFM: 14
SBM: 12
SBM-FP: 5
Partnership: 4
Alabama Y Republican FFM
Arizona Y Republican Y FFM
Arkansas Y Y Republican Y SBM-FP
California Y Y Democrat Y SBM
Colorado Y Y Democrat Y SBM
Connecticut Y Y Democrat Y SBM
Delaware Y Y Democrat Y Partnership
District of Columbia** Y Democrat Y SBM
Florida Y Republican FFM
Georgia Y Republican FFM
Idaho Y Republican SBM
Illinois Y Republican Y Partnership
Kentucky Y Republican Y SBM-FP
Louisiana Y Y Democrat*** Y FFM
Maryland Y Republican Y SBM
Massachusetts Y Republican Y SBM
Minnesota Y Democrat Y SBM
Montana Y Democrat Y FFM
Nevada Y Republican Y SBM-FP
New Hampshire Y Democrat**** Y Partnership
New Mexico Y Republican Y SBM-FP
New York Y Democrat Y SBM
North Dakota Y Republican Y FFM
Ohio Y Y Republican Y FFM
Oklahoma Y Republican FFM
Oregon Y Democrat Y SBM-FP
Pennsylvania Y Democrat Y FFM
Rhode Island Y Democrat Y SBM
Tennessee Y Republican FFM
Utah Y Republican FFM
Vermont Y Democrat**** Y SBM
Virginia Y Democrat FFM
Washington Y Y Democrat Y SBM
West Virginia Y Democrat Y Partnership
Wisconsin Y Republican FFM
NOTES: *This column describes whether a state has elected to use the Federally-facilitated Marketplace (FFM), establish a Marketplace in partnership with the federal government (Partnership), establish a State-based Marketplace that uses the federal platform (SBM-FP) or establish and operate its own State-based Marketplace (SBM). *The affiliation for the District of Columbia is for Mayor, not Governor. ***In Louisiana, the Insurance Commissioner is an elected position. The Insurance Commissioner who provided a response for Louisiana is Republican. ****In New Hampshire and Vermont, the Governorship switched after the response was provided, which resulted in a change in the political party of these states’ governors from Democrat to Republican.
SOURCE: Kaiser Family Foundation analysis of responses provided to request from members of the House of Representatives for state input on health reform.

 

Appendix Table 2:
Comments from Governors and Insurance Commissioners on ACA and ACA Repeal
State Implemented Medicaid Expansion? Cited Positive Effects of ACA Cited Concerns with ACA Cited Concerns/Cautions About Repeal of ACA
Total: 35 26 23 21 29
Democratic Governor: 17 16 17 3 17
California Y Y Y
Colorado Y Y Y
Connecticut Y Y Y Y
Delaware Y Y Y
District of Columbia Y Y Y
Louisiana* Y Y Y Y
Minnesota Y Y Y
Montana Y Y Y
New York Y Y Y
New Hampshire** Y Y Y
Oregon Y Y Y
Pennsylvania Y Y Y
Rhode Island Y Y Y
Virginia Y Y
Vermont** Y Y Y
Washington Y Y Y
West Virginia Y Y Y Y
Republican Governor: 18 10 6 18 12
Alabama Y Y
Arizona Y Y Y
Arkansas Y Y
Florida Y
Georgia Y
Idaho Y Y
Illinois Y Y Y
Kentucky Y Y
Maryland Y Y Y
Massachusetts Y Y Y Y
Nevada Y Y Y Y
New Mexico Y Y Y Y
North Dakota Y Y Y
Ohio Y Y Y Y
Oklahoma Y Y
Tennessee Y
Utah Y Y Y
Wisconsin Y Y
NOTES: *In Louisiana, both the Democratic governor and the independently elected Republican insurance commissioner provided responses. **In New Hampshire and Vermont, the governorship switched after the response was provided, which resulted in a change in the political party of these states’ governors from Democrat to Republican.
SOURCE: Kaiser Family Foundation analysis of responses provided to request from members of the House of Representatives for state input on health reform.

 

Appendix Table 3:
Comments from Governors and Insurance Commissioners on Medicaid Financing and Flexibility and Waivers
State Capped Medicaid Financing State Medicaid Flexibility Increase Section 1115 Waiver Flexibility/ Streamline Processes Section 1332 Waivers
Total: 35 Concerns: 12
Support: 6
NC: 17
Increase: 14
Can already innovate: 2
Do not tie to reduced financing: 4
NC: 18
Yes: 10
NC: 25
Support: 7
No plans: 8
NC: 20
Democratic Governor: 17 Concerns: 10
Support: 0
NC: 7
Increase: 3
Can already innovate: 2
Do not tie to reduced financing: 3
NC: 11
Yes: 0
NC: 17
Support: 2
No plans: 2
NC: 13
California Concerns NC NC NC
Colorado Concerns Increase NC Support
Connecticut Concerns Can already innovate NC NC
Delaware NC NC NC No plans
District of Columbia NC NC NC NC
Louisiana* Concerns Do not tie to reduced financing NC No plans
Minnesota Concerns Can already innovate; Do not tie to reduced financing NC Support
Montana Concerns Increase; Do not tie to reduced financing NC NC
New York Concerns NC NC NC
New Hampshire** Concerns NC NC NC
Oregon Concerns NC NC NC
Pennsylvania NC NC NC NC
Rhode Island NC NC NC NC
Virginia NC NC NC NC
Vermont** NC NC NC NC
Washington Concerns NC NC NC
West Virginia NC Increase NC NC
Republican Governor: 18 Concerns: 2
Support: 6
NC: 10
Increase: 11
Can already innovate: 0
Do not tie to reduced financing: 1
NC: 7
Yes: 10
NC: 8
Support: 5
No plans: 6
NC: 7
Alabama NC Increase Yes No plans
Arizona Concerns Increase Yes No plans
Arkansas Support, w/ caveats Increase Yes No plans
Florida Support, w/ caveats Increase Yes NC
Georgia NC NC NC NC
Idaho NC NC NC No plans
Illinois NC NC NC NC
Kentucky Support Increase Yes Support
Maryland NC NC NC NC
Massachusetts Concerns Increase, Do not tie to reduced financing Yes Support
Nevada NC Increase Yes Support
New Mexico NC NC NC Support
North Dakota NC NC NC NC
Ohio Support, w/ caveats Increase NC NC
Oklahoma NC NC Yes Support
Tennessee NC Increase Yes No plans
Utah Support, w/ caveats Increase Yes No plans
Wisconsin Support Increase NC NC
NOTES: *In Louisiana, both the Democratic governor and the independently elected Republican insurance commissioner provided responses. **In New Hampshire and Vermont, the governorship switched after the response was provided, which resulted in a change in the political party of these states’ governors from Democrat to Republican.
NC indicates no comments provided on that topic or response could not be classified based on the comments provided.
“Support w/caveats” indicates cases in which the respondent cited support for capped financing but included qualifications regarding how the cap should be structured.
SOURCE: Kaiser Family Foundation analysis of responses provided to request from members of the House of Representatives for state input on health reform.

 

Appendix Table 4:
Comments from Governors and Insurance Commissioners on Changes to Private Insurance
State Increase State Regulatory Authority Sale of Insurance Across State Lines Individual Mandate Maintain Financial Assistance for Consumers Expand HSAs High Risk Pools
Total: 35 Yes: 19
NC: 16
Support: 5
Oppose: 3
NC: 27
Oppose Mandate: 3
Alternative Approach: 7
Maintain Mandate: 2
NC: 23
Support: 11
In Transition: 4
NC: 20
Yes: 4
NC: 31
Consider: 12
Concerns: 4
NC: 19
Democratic Governor: 17 Yes: 3
NC: 14
Support: 0
Oppose: 1
NC: 16
Oppose Mandate: 0
Alternative Approach: 0
Maintain Mandate: 1
NC: 16
Support: 2
In Transition: 1
NC: 14
Yes: 0
NC: 17
Consider: 2
Concerns: 2
NC: 13
California NC Oppose Maintain Support NC Concerns
Colorado NC NC NC NC NC NC
Connecticut Yes NC NC NC NC NC
Delaware NC NC NC NC NC Concerns
District of Columbia NC NC NC NC NC NC
Louisiana* Yes NC NC In transition NC Consider w/federal funds
Minnesota NC NC NC NC NC NC
Montana NC NC NC NC NC NC
New York NC NC NC NC NC NC
New Hampshire** NC NC NC NC NC NC
Oregon NC NC NC NC NC NC
Pennsylvania NC NC NC NC NC NC
Rhode Island NC NC NC NC NC NC
Virginia NC NC NC NC NC NC
Vermont** NC NC NC NC NC NC
Washington NC NC NC NC NC NC
West Virginia Yes NC NC Support NC Consider w/federal funds
Republican Governor: 18 Yes: 16
NC: 2
Support: 5
Oppose: 2
NC: 11
Oppose Mandate: 3
Alternative Approach: 7
Maintain Mandate: 1
NC: 7
Support: 9
In Transition: 3
NC: 6
Yes: 4
NC: 14
Consider: 10
Concerns: 2
NC: 6
Alabama Yes NC Alternative Support Yes Consider w/federal funds
Arizona Yes Support NC In transition NC Consider w/federal funds
Arkansas Yes Support Oppose Support NC Consider w/federal funds
Florida Yes Support Alternative Support Yes NC
Georgia Yes Support Oppose NC NC Consider w/federal funds
Idaho Yes Oppose Alternative Support NC  Consider w/federal funds
Illinois NC NC NC NC NC NC
Kentucky Yes NC Oppose Support NC Consider
Maryland Yes NC NC NC NC NC
Massachusetts Yes NC Maintain Support NC Concerns
Nevada Yes NC NC NC NC Consider w/federal funds
New Mexico Yes NC Alternative Support NC Concerns
North Dakota Yes Oppose NC In transition NC NC
Ohio Yes NC Alternative NC Yes NC
Oklahoma Yes Support Alternative Support Yes Consider w/federal funds
Tennessee Yes NC NC NC NC Consider w/federal funds
Utah Yes NC Alternative In transition NC Consider w/federal funds
Wisconsin NC NC NC Support NC NC
NOTES: *In Louisiana, both the Democratic governor and the independently elected Republican insurance commissioner provided responses. **In New Hampshire and Vermont, the governorship switched after the response was provided, which resulted in a change in the political party of these states’ governors from Democrat to Republican.
NC indicates no comments provided on that topic or response could not be classified based on the comments provided.
SOURCE: Kaiser Family Foundation analysis of responses provided to request from members of the House of Representatives for state input on health reform.

 

Appendix B: Summary of Responses from Associations

Four associations (American Academy of Actuaries, Democratic Governors Association, National Governors Association, and the Republican Governors Association) responded to Congress’ request for input. Key takeaways from the associations include:

American Academy of Actuaries. The American Academy of Actuaries urges Congress to consider the potential adverse consequences of repealing provisions of the ACA, including the individual mandate and enrollee subsidies, without also enacting a replacement approach at the same time. They express concern that a repeal of major provisions of the ACA would lead to loss of enrollment, affordability challenges, and market instability. They note that offering pre-existing condition protections requires incentives for enrollment; eliminating provisions that encourage enrollment would threaten sustainability; and increasing risks or eliminating cost-sharing reduction reimbursements could cause an increase in insurer withdrawals from the market.

Democratic Governors Association. The Democratic Governors Association opposes a repeal of the Affordable Care Act, including its Medicaid expansion, citing concerns over financial stability and health of states. They note that repealing the ACA would result in loss of coverage, shift of costs to state governments, economic uncertainty, loss of consumer protections provided under the ACA, and increases in uncompensated care. The letter also highlights the role of Medicaid and its expansion on increased coverage and combatting the opioid use epidemic.

National Governors Association. The National Governors Association highlights the need to work in a bipartisan manner to build a more efficient health care system, put patients first, and address the underlying issues of unsustainable health care spending. They urge Congress to consider incorporating Governors’ suggestions throughout the legislative process; consider reforms to private health insurance that provide meaningful state flexibilities; maintain a meaningful federal role in the Medicaid financing partnership that does not shift costs to states; protect states from unforeseen financial risks; maintain predictability in health reform legislation; and support the continuation of innovative state health care programs that rely on federal funding.

Republican Governors Association. The Republican Governors Association seeks to advance alternatives to the ACA. They also highlight concerns about the quality and sustainability of the Medicaid program. The Republican Governors Association seeks to reflect on state flexibilities gained in recent years and factors inhibiting state innovation to respond to the unique needs of Medicaid beneficiaries.

Issue Brief

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.