"It provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states," the letter -- signed by Govs. John Kasich (R-OH), Rick Snyder (R-MI), Brian Sandoval (R-NV), Asa Hutchinson (R-AR) -- said.
The four governors' states have all expanded Medicaid, which the House GOP bill would phase out through an enrollment freeze starting in 2020. The legislation, the American Health Care Act, would also in that year convert Medicaid into a per capita capped financing system, in which the feds would provide a set amount of funding each year based on the number of enrollees in each state's program.
The governors argued that the states should be given a choice between receiving a per capita cap or a block grant, or maintaining the match rate system, but with expansion enrollees receiving a traditional match rate rather than the more generous enhanced rate offered under the Affordable Care Act.
The letter went on to lay out the governors' recommendations for how to transition to these kinds of systems. It also called for an overhaul of the waiver process by which states can currently apply to the HHS to approve tweaks to their programs. The governors asked for more flexibility to impose enrollment limits, work requirements, cost sharing, a reduction of benefits and payment reforms, among other proposed changes of their programs.
Read the full letter, via Bloomberg, below: