Republicans in North Carolina and Kansas who hope to scale back Medicaid can claim a victory in the updated GOP plan to overhaul the 2010 health care law. The package takes aim at those two states, which had the highest — albeit long-shot — hopes of expanding their Medicaid programs this year.

The provision, included in a manager’s amendment to the bill released by House leaders on Monday, would prevent states from expanding their Medicaid programs if they didn’t already do so by March 1.

In Kansas, the legislature is debating expansion, although GOP Gov. Sam Brownback has successfully blocked it in previous years. In North Carolina, newly elected Democratic Gov. Roy Cooper had hoped to expand Medicaid through executive power, despite legislative opposition, before a federal court stayed the action. Under the updated GOP bill, neither state’s effort could go forward unless some expansion took place by March 1.

The provision in the manager’s amendment was put in partially to restrict Cooper’s ability to expand Medicaid and partially because GOP governors wanted to avoid political pressure to expand their own states’ entitlement programs, according to North Carolina Republican Rep. Richard Hudson.

“I did get something for North Carolina. We got a provision that says we can’t expand Medicaid,” he said Tuesday. “There’s a number of states, even Republican governors, who have asked for that [addition], so there’s no pressure to do it.”

The provision is a kind of sweetener for some conservatives intent on overhauling Medicaid, which covered almost 69 million low-income Americans in December. The Republican Study Committee and the House Freedom Caucus have called for measures to further restrict federal Medicaid funding and the expansion option that was in the 2010 health care law.

North Carolina’s Mark Walker, chairman of the Republican Study Committee, which advocated for the provision’s inclusion in the manager’s amendment, said he wanted to help Republican governors who chose not to expand Medicaid in their states avoid increased political pressure to do so.

“That was to prevent some states or governors to be able to not be walked off the plank when it comes to expanding,” he said. “So that was just a protection for the governors that you wouldn’t open up a free-fall for Medicaid expansion.”

He declined to comment on whether the March 1 date targeted his home state or others.

“This is basically them saying, ‘There’s no more expansion, period.’ Whether it’s North Carolina, whether it’s Kansas, it’s all done. It’s saying, ‘We’re done, no more, period,’” said Dee Mahan, director of Medicaid initiatives for the consumer group Families USA, which has pushed for further expansion.

Long-shot efforts

Hopes for expansion were long shots, at best, in both Kansas and North Carolina. In North Carolina, a federal court stayed Cooper’s attempts in January and it’s unlikely Health and Human Services Secretary Tom Price would have approved the Democratic governor’s request. 

In Kansas, a state Senate committee is expected to vote as early as Thursday on a bill to expand the state’s Medicaid program. The full state Senate may pass it next week, according to media reports. Brownback, a Republican, may still veto the effort. If the legislature overrides that veto and the provision in the manager’s amendment doesn’t become law, Price may simply disallow the expansion attempt through a federal waiver. 

“Gov. Brownback has been a stalwart voice for repealing and replacing Obamacare, and he believes this bill has improved, having worked with Congress to ensure this legislation is good for Kansas,” Brownback’s communications director Melika Willoughby said in an email, when asked about the provision to block expansion.

Kansas Sen. Pat Roberts, a Republican, also supports the measure but said he doesn’t believe it takes aim at his state specifically.

“I don’t think there’s that much targeting,” he said Tuesday. “You’ve got to control spending one way or the other.”

A spokeswoman for the House Energy and Commerce Committee, which oversees the Medicaid program, did not respond to a request for comment.

In Maine, residents also hope to collect enough signatures to petition the state legislature to consider expanding the state’s Medicaid program, a measure Republican Gov. Paul R. LePage would oppose.

“States that have not expanded should not expand now, only to fall off the federal funding cliff in 2020,” LePage spokesman Peter Steele said in an email. “While this would prevent massive budget problems across the country, like those that Maine experienced in the past and Oregon is now experiencing, it would also negate the citizen initiative.”

The 2010 health care law allowed governors to receive enhanced federal funding to expand Medicaid coverage to include individuals earning up to 138 percent of the poverty level. Thirty-one states and the District of Columbia chose to expand, but several mainly Republican-led states did not.

The original House GOP bill would have allowed states to enroll individuals in the expansion for two years, but would have stopped offering the higher federal funding in 2020 for new enrollees. The enhanced federal funding would have been available indefinitely for people who had previously enrolled, but those who left the Medicaid program could not have returned as part of the population covered by higher federal payments for expansion.