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AP file photo

The House Republican Obamacare replacement bill has a new problem: It's lost the confidence of four key GOP governors. In a letter to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell, the governors — John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada, and Asa Hutchinson of Arkansas — said the bill doesn't give states enough flexibility or enough money:

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.

What they want: They included their own Medicaid proposal, which has three important differences from the House bill:

  • It would give states a choice between switching to per-capita caps or block grants, not just per-capita caps.
  • States could also keep the current structure of Medicaid, but with less money.
  • They'd get more flexibility to run their programs differently so they can manage with less federal funds.

Why it matters: Republicans are already divided on how to end Obamacare's Medicaid expansion, and the opposition from these high-profile governors isn't going to help. All four states expanded Medicaid (Michigan and Arkansas did it in revised form).

Go deeper

Updated 5 mins ago - Politics & Policy

Inauguration Day dashboard

U.S. Capitol and stage are lit at sunrise ahead of the inauguration of Joe Biden. Photo: Patrick Semansky - Pool/Getty Images

President Biden has delivered his inaugural address at the Capitol, calling for an end to the politics as total war but warning that "we have far to go" to heal the country.

What's next: Biden has arrived at the White House and he will sign executive orders and other presidential actions.

33 mins ago - Podcasts

Podcast: After the Biden inaugural

Joe Biden was sworn in today as America's 46th president in an inauguration unlike any other in modern history.

Axios Re:Cap goes deeper into the speech, the atmosphere and what it all tells us about the incoming administration, with Axios political reporters Hans Nichols and Alexi McCammond.

Biden embarks on a consequential presidency

Photo illustration: Sarah Grillo/Axios. Photo: Joe Raedle/Getty Images

Donald Trump tried everything to delegitimize the rival who vanquished him. In reality, he's set Joe Biden on course to be a far more consequential U.S. president than he might otherwise have become.

The big picture: President Biden now confronts not just a pandemic, but massive political divisions and an assault on truth — and the aftermath of the assault on the Capitol two weeks ago that threatened democracy itself.