MedicaidExpansion.011316 99.jpg

From left to right, Gov. John Bel Edwards, flanked by Dept. of Health and Hospitals Secretary Dr. Rebekah E. Gee, MD (center), shakes hands in January 2016 with his health care transition team co-chairs, Gary Wiltz, CEO of Teche Action Clinic, and Ronald A. Goux, president of the Louisiana Nursing Home Association, at the State Capitol after Edwards signed his his first executive order to provide for Medicaid expansion in the state of Louisiana.

Advocate file photo by TRAVIS SPRADLING

One feature of the Affordable Care Act rewrite working its way through Congress is that it could push a good bit of decision-making down to the state level. While the Senate has kept its version of the House-passed bill under tight wrap, the final proposal is expected to give states the ability to opt out of some current federal requirements such as guaranteed coverage for things like pregnancy and substance abuse.

So lawmakers in Washington might want to listen to some input from the people who'd have to implement any new law.

Last week, Gov. John Bel Edwards signed on to a joint letter to Congress seeking big changes in the approach it's taking.

The letter was powerful not just for its harsh message about Congress's current track, but also for who the messengers are. Edwards is one of four Democratic governors to sign it, along with Colorado's John Hickenlooper, Pennsylvania's Tom Wolf and Montana's Steve Bullock. Three Republicans also signed: Ohio's John Kasich, Massachusetts' Charlie Baker and New Mexico's Brian Sandoval.

The group expressed some serious concerns over Congress's approach, both on style — Republican House and Senate leaders have made no effort to try to appeal to Democrats — and even more on substance.

The letter argues that "true and lasting reforms" are best achieved in a bipartisan fashion. And it skewers the House-passed bill, which it says fails to control costs, stabilize markets and help people dealing with chronic conditions, mental health challenges and drug addiction.

The bill "calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states," the letter says, adding that "Medicaid provisions included in this bill are particularly problematic."

The House bill, and reportedly the still-unfinished Senate version, propose big rollbacks in Medicaid spending, including the expansion that Edwards considers his administration's most significant success.

"Instead, we recommend Congress address factors we can all agree need fixing," the letter continues.

The fact that that last part still needs to be said tells you just how far off track this process has gotten.

Follow Stephanie Grace on Twitter, @stephgracela.