BOISE, Idaho — Idaho Gov. C.L. “Butch” Otter says he had too many concerns about the latest GOP effort to repeal President Barack Obama’s health care law to join other Republican governors in a letter backing the bill.

Earlier this week, 15 GOP governors sent a letter to Senate Majority Leader Mitch McConnell, a Kentucky Republican, writing that they “appreciate” the bill by GOP Sens. Bill Cassidy and Lindsey Graham. The proposal would replace much of Obama’s law with block grants to states, giving them leeway on spending the money. It would also cut and reshape Medicaid.

“It is a path forward but it’s a path forward with a few speedbumps in it for us,” Otter said Wednesday.

The Republican governor added that he is aware Idaho’s GOP U.S. Sens. Jim Risch and Mike Crapo plan on voting in favor of the bill and he doesn’t have a problem with them doing so.

However, Otter and other top Idaho officials say they have questions about the conditions on using the block grants and the lack of flexibility to allow Idaho to build its own plan to manage costs.

For example, officials with Idaho Department of Insurance recently submitted an analysis to Otter noting that the bill is not compatible with the latest state proposal to provide health care to poor residents who do not have medical coverage.

The insurance agency, along with the Department of Health and Welfare, has been preparing to woo the Idaho Legislature in January to sign off on petitioning the federal government to allow the state’s sickest adults— like those with stage-4 cancers — get insurance from Medicaid.

Childless adults who are below the federal poverty line currently do not qualify for Medicaid in Idaho, , nor do they qualify for subsidized plans on Idaho’s health insurance marketplace exchange — this group is also known as the Medicaid gap.

But the Senate’s health care reform bill would cap Medicaid spending based on historical-per-capita costs. This means the state’s proposal to cover the medically expensive individuals under Medicaid would result in higher-per-capita Medicaid costs and force the state to cover any costs higher than the cap.

“I have serious concerns with the Graham Cassidy Bill … It does not give states the flexibility it needs to manage costs. The state could work with adequately funded block grants as long as the state had the ability to control costs,” said Insurance Director Dean Cameron in an email.

Otter said he recently talked to Health and Human Services Secretary Tom Price on the phone about Idaho’s waiver plan and said Price assured him that the federal government would work with Idaho.

Overall, the Senate bill would let states set their own coverage health requirements, allow insurers to boost premiums on people with serious medical conditions and end Obama’s mandates that most Americans buy insurance and that companies offer coverage to workers. The measure is supported by the White House and Senate leaders, but supporters are still looking for the 50 GOP votes they would need to pass the bill over solid Democratic opposition.

Senate Republicans must pass the measure by Sept. 30 to avoid a Democratic filibuster.