The Fate Of 16.8 Million Medicaid Enrollees Rests On 20 GOP Senators From 14 States

Jeffrey Young and Alissa Scheller

The Senate is on the verge of debating legislation to repeal and “replace” the Affordable Care Act, and Medicaid is on the chopping block.

Whatever happens next with Obamacare repeal and the future of Medicaid will depend in large measure on whether GOP senators choose to fight for the combined 16.8 million of their constituents on Medicaid, including 4.3 million who gained Medicaid coverage because of the Affordable Care Act, according to data from state agencies compiled by HuffPost.

See the facts and figures about Medicaid in states with Republican senators in the HuffPost infographic at the bottom of this article.

The Republicans in the House narrowly passed health care legislation last month that would gut the health care program, which the federal government jointly operates and finances with the states, for low-income families, people with disabilities and elderly nursing home patients. President Donald Trump staged a celebration at the White House after the passage of a measure projected to cause 14 million Medicaid beneficiaries to lose coverage. That’s despite repeatedly promising during his campaign not to cut Medicaid.

The American Health Care Act not only would undo the Affordable Care Act’s Medicaid expansion ― a major contributor to the law’s success at driving the uninsured rate to a historic low ― but would take hundreds of billions of dollars out of the rest of Medicaid, which would force states to make major cutbacks to who they cover, what benefits they provide and how much they pay doctors and hospitals.

The vast majority of Americans support continuing the Medicaid expansions, including 93 percent of Democrats, 83 percent of independents and 71 percent of Republicans, according to a survey conducted this month by the Henry J. Kaiser Family Foundation. More than seven in 10 favor leaving current federal funding for Medicaid overall in place, the poll found.

There are 20 Republican senators representing 14 states where the stakes are especially high because they’re among the 31 states and the District of Columbia that accepted federal funding to expand Medicaid to poor adults under the Affordable Care Act. Most of those states have Republican governors, legislatures or both, and Trump won all but two of them in November.

Large segments of some of these states’ populations rely on Medicaid. More than 30 percent of those living in Sen. John Kennedy’s Louisiana, Sens. John Boozman and Tom Cotton’s Arkansas, and Senate Majority Leader Mitch McConnell and Sen. Rand Paul’s Kentucky are Medicaid beneficiaries. More than one-fifth of those living in eight of the other states with Republicans senators are enrolled in Medicaid.

GOP senators like Alaska’s Lisa Murkowski and Ohio’s Rob Portman have sounded cautious notes about winding down the Medicaid expansion and slashing Medicaid funding overall. Yet in spite of their warnings and the significant number of their constituents who would be affected by cuts, Medicaid beneficiaries in these states can’t necessarily count on their senators for help.

Most of the GOP senators from Medicaid expansion states won their most recent elections ― 10 of which were just last year ― handily in states that went big for Trump over former Secretary of State Hillary Clinton in the presidential race. Just two of these 20 senators are up for re-election next year: Jeff Flake of Arizona and Dean Heller of Nevada.

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1912

Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.
Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.

1935

President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first.
President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first.

1942

Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk.
Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk.

1945

President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere.
President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere.

1960

John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress.
John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress.

1965

President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor.
President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor.

1974

President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes.
President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes.

1976

President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside.
President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside.

1986

President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost.
President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost.

1988

Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.
Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.

1993

President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate.

1997

Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. 
Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. 

2003

President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people.
President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people.

2008

Hillary Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Barack Obama, who has a less comprehensive plan.
Hillary Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Barack Obama, who has a less comprehensive plan.

2009

President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance.
President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance.

2010

With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare."
With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare."

2012

On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care."
On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care."

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This article originally appeared on HuffPost.