Republicans will not only keep the Medicaid expansion, they will broaden it, says Lamar Alexander, Senate health panel chair

Sen. Lamar Alexander (Photo by M. Scott Mahaskey, Politico)

Republicans in Congress will not only keep the expansion of Medicaid, but will broaden it, says U.S. Sen. Lamar Alexander of Tennessee, a former governor who is a familiar figure to many Kentuckians and is close to Senate Majority Leader Mitch McConnell of Kentucky.

That's what Alexander told reporters Burgess Everett and Jennifer Haberkorn of Politico, which headlines their story by saying that he could be "the stealth Republican force behind Obamacare repeal" and replacement. But other senators may disagree and have more leverage.

The Patient Protection and Affordable Care Act allows states to expand Medicaid to people earning up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. Democrat Steve Beshear did that as governor in 2014, adding 440,000 people to the rolls; Republican Gov. Matt Bevin is trying to reduce the cost, now that the state has to pay a small part of it: 5 percent this year, which would rise to the current law's limit of 10 percent in 2020.

Alexander told Politico that Republicans need to first fix the subsidized insurance markets the ACA created, "which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States," the reporters write. "From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law."

President Donald Trump campaigned on a promise to repeal the law soon after taking office, but said recently it might be next year before that happens. "Daily Senate Republican lunches regularly erupt in disagreement over strategy," Politico reports. "It’s now mid-February without a clear path forward, after years of Republican show votes to repeal the law. . . . Conservatives inside and outside Congress have already grown frustrated with the GOP’s plodding pace."

Alexander is not as conservative as other Republicans. but he is chairman of the Senate Health, Education, Labor and Pensions Committee, which makes him a major player in the discussions. He "was one of the first lawmakers to call on Republicans not to scrap Obamacare until a replacement is ready to go," the reporters note. "That’s now the GOP’s mantra."

"If there’s a softer side to Republicans’ plans to gut the law, it’s best represented by Alexander, a lawmaker who so loves cutting a deal that he voluntarily left the top ranks of Republican leadership to better work with Democrats," Everett and Haberkorn write. "The folksy Tennessee senator is quietly prevailing upon Republican lawmakers to take a deep breath. . . . His goal, in a nutshell: to reassure millions of Americans that Republicans aren’t trying to snatch away their health insurance."

Alexander "repeatedly stressed" in the Politico interview that he is on the same page as Trump and House Speaker Paul Ryan, the reporters note. "Those relationships have given other Republicans confidence in Alexander’s role." Sen. John McCain (R-Ariz.), told them: “That’s the key guy.”

But Finance Committee Chair Orrin Hatch of Utah, whose panel has jurisdiction over taxes, insurance subsidies and Medicaid, told Politico that Alexander “doesn't have much to do with it. He takes a great interest in it, and I’m glad he does, and I want to get his best ideas.” The two disagree, for example, on taxes that fund the subsidies; Hatch wants to repeal them quickly, but "Alexander urges caution: If Republicans repeal taxes now, how can they be sure they’ll have the revenue needed to pay for their replacement plan?"