A new government report explains why Republicans, after nine years of opposing Obamacare, are having such a hard time repealing it.

The answer: It’s pretty much about the money. It’s not about providing Medicaid coverage to low-income adults.  Some moderate Republicans who profess concern for the needy are actually trying to shift more of the cost of providing them Medicaid coverage from their states to the federal government.  They’re holding out for more federal cash for their states. And they just might get it – from Senate Democrats.

Obamacare made an offer to states that agreed to extend Medicaid eligibility to childless, nondisabled, low-income adults: The federal government would pay 100 percent of the medical bills for this new category of “expansion adults.” That percentage would slowly decline, but never fall below 90 percent. The District of Columbia and 31 states jumped at the offer.

The federal government pays a much lower federal matching percentage for every other category of recipients, including children, blind and disabled adults, pregnant women, and the frail elderly. That matching rate varies from 50 percent in states with relatively high per capita incomes (California, for example) to nearly 75 percent in the poorest state (Mississippi).

The Senate bill to “repeal and replace” Obamacare would leave the Medicaid expansion in place, but would ultimately eliminate the higher federal reimbursement for their care.  The federal government would bear the same share of medical assistance for nondisabled, childless adults as it does for pregnant women and people with disabilities.  It slowly phases out the current Medicaid reimbursement policy that discriminates on the basis of age, gender, pregnancy, and disability.

Some Senate Republicans are clinging to this inequitable arrangement that provides a sweet deal for their states.

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