GOP governors wary of health bill
Cuts to Medicaid and premium subsidies top list of concerns
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.”