First, Medicaid reform will be a sticking point. The AHCA fundamentally changes Medicaid from an open-ended entitlement program
, where the federal government is on the hook for a theoretically limitless amount of spending, to one where it spends a fixed and predictable amount of money per year. This change could be particularly problematic for states that chose to accept Obamacare's Medicaid expansion
, which extended eligibility to anyone making less than 138% of the federal poverty level (about $16,000 a year in 2017). The challenge is that these states aren't all governed by Democrats -- 11 GOP governors, including John Kasich and Chris Christie, took Obamacare's Medicaid expansion. Republican senators from these states are concerned
about how the transition will affect Medicaid coverage and will therefore be looking for a gentler transition from the current financing system to the new one proposed by the AHCA.