Bevin takes high profile in governors' debates in Washington about future of Medicaid, which covers 1.3 million Kentuckians

Matt Bevin and other governors spoke outside the White House.

As governors debated the future of Medicaid over the weekend in Washington, Kentucky Gov. Matt Bevin was an outspoken participant, according to several news reports.

Bevin is the first governor quoted in a Politico story that began, "Republican governors are split over an Obamacare replacement plan — just like their counterparts in Congress. The big problem is how to make sure a repeal of the health law doesn't penalize red states that took billions of dollars in federal funds to add low-income residents to Medicaid rolls," such as Kentucky, "or those who shunned the extra money," like Tennessee.

The story, by Rachana Pradhan and Brianna Ehley, says Republicans were having difficulty figuring out how to limit Medicaid spending equitably in the repeal and replacement of the Patient Protection and Affordable Care Act.

”This is still fairly gelatinous,” Bevin told Politico. “There's a lot of ideas, a lot of moving parts, a lot of governors with different ideological perspectives — all of that is in the cauldron right now.” He added, “A solution must be there. Repealing alone serves no purpose.”

A plan by House Republicans would eliminate the expansion of the Medicaid program in 2020 and convert Medicaid to a block-grant program, in which states would get limited payments based on their numbers of Medicaid members. A consultant's report to the National Governors Association meeting "predicted that Medicaid reforms being proposed by House Republicans would result in tens of thousands of people losing their insurance coverage in an average-size state," reports The Associated Press.

When Democratic Govs. Jay Inslee of Washington and Terry McAuliffe of Virginia called the report "disturbing," Bevin "said if Democrats were disturbed, they haven't been paying attention," AP reports. Bevin said, “The kind of conversation that's being had now — sobering, shocking, surprising as it might be to some — is the conversation that we must have because the piper has to get paid at some point. People are looking at reality, and that's good.”

Seven Republican governors have offered a plan that "urges Congress to change Medicaid from an open-ended federal entitlement to a program designed by each state within a financial limit," AP reports. They include some who expanded Medicaid, such as Ohio Gov. John Kasich, or who wanted to but were thwarted, such as Tennessee Gov. Bill Haslam.

"It's not clear whether House Republicans will accept the GOP governors' proposal," AP reports. In January, Bevin urged House Majority Leader Kevin McCarthy "to gradually reduce aid to people over the poverty line," notes Kery Murakami, Community Newspaper Holdings Inc.'s Washington correspondent.

Bill Lucia of Route Fifty reports, "Bevin stressed that there had been a good dialogue about health care between Republican and Democratic governors."

Lucia asked the governor if the proposals would hurt the Commonwealth's finances. Bevin replied, “There will be an impact, no question there will be an impact. What I’m saying and what I think other governors are saying: ‘Trust us, we’ll handle the impact’.” He added, “We need to rethink the system. It’s not purely a function of enrolling people and thinking we’ve helped them, giving them coverage if that doesn’t actually lead to anything.”

There is a divide between Republican governors; those who expanded Medicaid under "Obamacare" want to keep what they have, and those who didn't want to be treated equally. Bevin is in an unusual position, as the Republican successor to a Democratic governor who gave Kentucky the greatest reduction of any state in the percentage of people without health insurance, largely by expanding Medicaid to 440,000 people with incomes up to 138 percent of the federal poverty level.

That governor was Steve Beshear, who will give the nationally televised response to President Trump's address to Congress Tuesday night.

Now that states are paying 5 percent of the bills for people covered by Medicaid expansion, set to rise in annual steps to 10 percent in 2020, Bevin says Kentucky can't afford to have 1.3 million people on the program, and has proposed changes that his administration says would leave Medicaid with 86,000 fewer members in five years than it would have without the changes.

Bevin made his proposal during the Obama administration. The Trump administration is expected to approve it or even expand it, since its chief Medicaid administrator was the chief drafter of the main model for Bevin's proposal: an Indiana program that charges income-based premiums and requires most Medicaid recipients to work or look for work.

While several Republican governors have been happy to take billions of dollars from the federal government to improve the health of their people, Bevin has been among those who have focused on a broader fiscal issue. he told Lucia, “No one seems overly concerned about or focused upon the fact that, as a nation, we currently have $20 trillion in debt.”