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Ohio Gov. John Kasich (Pablo Martinez Monsivais / AP)

Republican governors met with GOP members of the Senate Finance Committee on Thursday to talk about Medicaid, one of the most politically tricky parts of Obamacare repeal.

The takeaways:

  • As far as people covered through the Medicaid expansion losing their insurance, "it ain't gonna happen," Minority Whip John Cornyn told reporters.
  • Giving states more flexibility over how the program works is key to any Republican Medicaid efforts.
  • A per capita cap is looking likely, as are much less strict benefit requirements.

The GOP's problem: Some Republican governors took the Medicaid expansion, enrolling millions of new people into the program. If the Medicaid expansion is repealed along with the rest of Obamacare, those people would either lose their coverage, or states would have to fork out much more money to keep them covered (the federal government pays for the majority of expansion).

The other issue is how, if Medicaid expansion is kept, congressional Republicans get around accusations of unfairly giving some states — expansion states — more money than those who didn't take the expansion.

Here are some ideas discussed at the meeting:

  • Texas Gov. Greg Abbott, non-expansion state: He thinks what will end up happening is states will receive federal funding through a per capita cap, regardless of whether they have expanded Medicaid or not. States would be able to choose what income level qualifies for Medicaid, in theory meaning states could still expand or choose to lower the income threshold. "A big takeaway I think is that it looks like it's going to be very fair to all states," he said. Cornyn said while per capita caps were discussed, no decisions have been made.
  • Ohio Gov. John Kasich, expansion state: Suggested moving the top earners included in the expansion onto exchanges, where they'd receive federal assistance for private coverage. Cornyn called the idea "creative." Kasich told reporters he wants the program to have "guardrails," but currently, "are there some things in that package that if we have flexibility, we wouldn't need to provide? The answer to that is yes." Wouldn't guarantee Ohions wouldn't lose coverage, but he's "down here trying to do my best to make sure that we have a good plan."
  • Utah Gov. Gary Herbert: States need to spend less on Medicaid, and can do so partially by "restricting benefits and limiting some what the benefit packages are...the same is true with restricting the number of people that get on the system."

Still unclear: If Medicaid expansion is kept, in some form or another who will pay for it? While cutting benefits will reduce the cost of the program, someone will still have to assume financial responsibility for the expansion population. States are unlikely to want to take that on.

Go deeper

Federal court blocks Biden's vaccine mandate for health workers in 10 states

President Biden delivers remarks on the Omicron COVID-19 variant following a meeting with his COVID-19 response team. Photo: Anna Moneymaker via Getty Images

A federal court in Missouri has blocked the Biden administration from enforcing a coronavirus vaccine mandate for health care workers at federally funded facilities in 10 states.

Why it matters: Monday's decision is the first victory for opponents of the rule, which requires health care workers to get vaccinated by Jan. 4, 2022. The case is one of four lawsuits challenging the Centers for Medicare & Medicaid Services' (CMS) rule and argues that the mandate will exacerbate staffing shortages.

Twitter's next act

Illustration: Annelise Capossela/Axios

Twitter co-founder and CEO Jack Dorsey is exiting the company he helped build at a time when its future has never been so uncertain.

Why it matters: The person who controls Twitter controls the de facto public square — with implications for politics, media and free speech.

2 hours ago - Health

CDC strengthens COVID booster recommendation

Rochelle Walensky. Photo: Chip Somodevilla/Getty Images

The Centers for Disease Control and Prevention (CDC) on Monday strengthened its previous recommendation for booster shots, saying that everyone 18 and older "should" receive a booster dose.

Why it matters: Last month, CDC director Rochelle Walensky accepted a key advisory committee's recommendation that adults "may" get the shot. The slight, but strengthened, change in wording comes amid the emergence of the Omicron coronavirus variant.