By Ryan Teague Beckwith
March 17, 2017

Four sitting Republican governors have come out against the GOP health care bill.

In a joint letter sent Thursday to the leaders of the House and Senate, the governors of Ohio, Michigan, Nevada and Arkansas argued that the “current version” of the American Health Care Act in the House hurts states.

“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 the state,” the letter says.

It is signed by Ohio Gov. John Kasich, Michigan Gov. Rick Snyder, Nevada Gov. Brian Sandoval and Arkansas Gov. Asa Hutchinson. All four states accepted federal money to expand Medicaid in the Affordable Care Act.

There are currently 33 Republican governors in the U.S., 16 of which head states that expanded Medicaid. Other Republican governors have raised concerns about the health care effort, particularly on Medicaid.

The House bill would freeze the Medicaid expansion in all states by 2020, gradually shrinking the program’s enrollment over time, and cap Medicaid spending on individual enrollees.

The four governors said they support “fundamental reform” of Medicaid, outlining an alternative approach that would give states the option to embrace their own reform or stick with the current formula with less federal money.

Contact us at editors@time.com.

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