GOP gov­er­nors wary of health bill

Cuts to Med­i­caid and pre­mium sub­si­dies top list of con­cerns

Northwest Arkansas Democrat-Gazette - - NATIONAL - ALI­SON NOON AND BILL BARROW In­for­ma­tion for this ar­ti­cle was con­trib­uted by Becky Bohrer, Bob Christie and Dan Sewell of The As­so­ci­ated Press.

CARSON CITY, Nev. — As Repub­li­can sen­a­tors work to ful­fill a seven-year-old prom­ise to scrap much of Demo­crat Barack Obama’s health care law, Repub­li­can gov­er­nors are warn­ing those sen­a­tors to first, do no harm.

While a re­peal of the law would be a tri­umph for Repub­li­cans and Pres­i­dent Don­ald Trump, the gov­er­nors are more wor­ried about blow­ing a hole in state bud­gets and not main­tain­ing health care cov­er­age for con­stituents.

“We are the voice of re­al­ity,” Ne­vada GOP Gov. Brian San­doval told The As­so­ci­ated Press.

San­doval said he has been in reg­u­lar con­tact with Ne­vada Repub­li­can Sen. Dean Heller to dis­cuss the ram­i­fi­ca­tions of the evolv­ing GOP plan. Heller, who will run for re-elec­tion next year, has joined San­doval in op­pos­ing the cur­rent mea­sure.

For wary Repub­li­cans, the main con­cerns about the GOP plan are rolling back pre­mium sub­si­dies that help peo­ple buy pri­vate in­sur­ance poli­cies and phas­ing out the ex­pan­sion of Med­i­caid, the fed­eral-state in­sur­ance pro­gram for the poor, dis­abled and many nurs­ing home pa­tients. In Ne­vada, more than 220,000 res­i­dents have gained cov­er­age through Med­i­caid ex­pan­sion, 13,000 of them chil­dren.

“They set pol­icy, but we’re the ones who have to de­velop the bud­gets, de­velop the care, de­velop the plans, work di­rectly with the peo­ple,” San­doval said. He said if money is re­duced, gov­er­nors will be left to de­cide among un­pop­u­lar choices: “Raise a tax or limit cov­er­age or change el­i­gi­bil­ity re­quire­ments” for cov­er­age.

Heller is lis­ten­ing. “I can­not sup­port a piece of leg­is­la­tion that takes in­sur­ance away from tens of mil­lions of Amer­i­cans and tens of thou­sands of Ne­vadans,” he said re­cently.

Ohio’s John Ka­sich has been one of the most out­spo­ken GOP gov­er­nors in crit­i­ciz­ing Repub­li­can pro­pos­als. That has in­creased pres­sure on Ohio GOP Sen. Rob Port­man, who an­nounced his op­po­si­tion to the bill af­ter Sen­ate Ma­jor­ity Leader Mitch McCon­nell abruptly post­poned a vote.

Port­man said he has dis­cussed with Ka­sich var­i­ous fi­nanc­ing op­tions that would ease any changes to Med­i­caid while not gut­ting drug treat­ment pro­grams, specif­i­cally for opi­oid abuse. One McCon­nell pro­posal would be to pro­vide an ad­di­tional $45 bil­lion over a decade for states’ drug abuse pro­grams.

In Ari­zona, GOP Gov. Doug Ducey has called Obama’s law “a dis­as­ter,” but he has urged Repub­li­can Sens. Jeff Flake and John McCain to shield states from ex­ten­sive Med­i­caid cuts. The pro­gram cov­ers 1.9 mil­lion Ari­zo­nans, nearly 28 per­cent of all res­i­dents. The ex­pan­sion alone cov­ers 400,000.

Both sen­a­tors have yet to in­di­cate how they’d vote on a GOP bill.

Alaska Gov. Bill Walker, an in­de­pen­dent who iden­ti­fies as a con­ser­va­tive, has had reg­u­lar con­tacts with the state’s two Repub­li­can sen­a­tors — Lisa Murkowski and Dan Sul­li­van — over what the Repub­li­can health care over­haul will mean for his state. Alaska has some of the high­est health care costs and great­est med­i­cal needs in the coun­try.

Tra­di­tional Med­i­caid cov­ers about a quar­ter of Alaska’s 740,000 res­i­dents, while the ex­pan­sion ben­e­fits 34,000 more.

Murkowski has said she doesn’t have enough in­for­ma­tion to vote for the GOP plan. She has op­posed the elim­i­na­tion of fed­eral money for Planned Par­ent­hood, a pro­vi­sion of the bill.

With 52 Repub­li­can sen­a­tors, just three de­fec­tions leave McCon­nell short of a ma­jor­ity. Democrats are uni­fied in op­po­si­tion.

The Repub­li­can leader has said he plans to in­tro­duce yet an­other ver­sion of the bill af­ter Congress re­turns today. But McCon­nell also said that if he is un­able to get 50 votes for the GOP plan, he would try to shore up in­sur­ance mar­kets, a leg­isla­tive step that would in­volve Democrats.

In Ne­vada, San­doval and Heller have a public ser­vice record that has over­lapped since 1994, when San­doval won a seat in the Ne­vada Leg­is­la­ture and then-Assem­bly­man Heller was elected to the sec­re­tary of state’s of­fice. Shar­ing a mod­er­ate ap­proach in their con­ser­va­tivism, they have a re­la­tion­ship go­ing back decades.

“He trusts me to give him in­for­ma­tion,” the gover­nor said, “and he trusts me” for speak­ing up for peo­ple who have ben­e­fited from the Med­i­caid ex­pan­sion.

When scan­dal forced out Repub­li­can Sen. John En­sign in 2011, San­doval tapped then Rep. Heller to fill the Sen­ate seat.

Asked whether he would con­sider en­dors­ing one of Heller’s chal­lengers if the sen­a­tor even­tu­ally voted to roll back Med­i­caid, San­doval laughed.

“No,” he said. “Ab­so­lutely not.”

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